  
WHO reports HIV declining among injecting drug users in New York, Brazil
Last Updated: 2001-04-16 16:12:59 EDT (Reuters Health)
By Sanjay Kumar
NEW DELHI, India (Reuters Health) - According to preliminary results from the second phase of a World Health Organization multicentre study, HIV infection among injecting drug users (IDUs) is showing a declining trend in New York and Brazil. Results were presented in Delhi earlier this month.
The WHO study is the largest ongoing international study of HIV among drug users. The first phase of the study was conducted between 1987 and 1992 and included 13 cities, mostly in developed countries. The second phase will cover 15 cities, mostly in developing countries but also including New York.
"The New York epidemic has been a very large epidemic among drug users in one city, with nearly 60,000 cases of AIDS and over 100,000 infections since the start of the epidemic in 1975," Dr. Don Des Jarlais, of Beth Israel Medical Center and one of the WHO study directors, told Reuters Health.
"New York has had more cases of AIDS than any western European country and so far the only epidemic that would rival it would be in sub-Saharan Africa," he added.
Dr. Des Jarlais said that there has been a sharp decline in HIV prevalence among IDUs in New York, dropping from about 50% initially to about 20% currently. "The rate of new infection has gone down from about 4% to nearly 1% per year [but] 20% is an unacceptably high endemic level for HIV among intravenous drug users," Dr. Des Jarlais cautioned.
"The New York data are actually really the first indication that if you have a big epidemic, with sustained prevention work, you can eventually get it under control," Dr. Des Jarlais commented. "Even if the epidemic ran out of control for 10 years or so, you can eventually bring it back under control," he added.
Preliminary results from the WHO phase 2 study under way in Rio de Janeiro, Brazil, also indicate a dramatic decline in HIV levels. The Brazilian researchers compared data from this phase of the WHO study with former studies such as WHO-1 (1990-1993), Brazilian multicity surveys conducted between 1994 and 1996 and the Rio drug treatment centers census of 1998.
"The main finding is that there is a substantial decline in seroprevalence levels of HIV that formerly were around 27% in Rio and have now reached 8.5%," Dr. Francisco Inacio Bastos, deputy coordinator of the Fiocruz AIDS Program, in Rio de Janeiro, told Reuters Health. "Similar findings are being observed in [the] cities of Santos and Salvador also," he added.
"Brazil has nearly 100,000 injecting drug users and almost all of them inject cocaine," Dr. Bastos told Reuters Health. "IDUs comprise 20% of all new HIV cases being reported," he added.
Even hepatitis levels have declined substantially. "Hepatitis C prevalence was around 70% and is now 50% and hepatitis B prevalence has also declined from 50% to 20% to 30%," said Dr. Bastos.
"Intervention programmes seem to be making a big impact and we have some indications that this could happen," Dr. Bastos said. "Brazil has now 33 needle-exchange programmes around the country and the injectors are getting clean syringes."
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