Background: “Combined” prevention programming is now considered to be the standard of care for reducing injection risk behavior. We examined long term sexual risk behaviors among persons who inject drugs (PWID) in New York City following implementation of “combined” prevention programming, including a condom social marketing program established in 2007.
Methods: Quantitative interviews and HIV testing were conducted among PWID entering Beth Israel Medical Center drug treatment programs in New York City between 1990 and 2012. Data were analyzed by four time periods corresponding to the cumulative implementation of HIV prevention interventions including distribution of over 30 million NYC Condoms annually in New York City.
Results: A total of 7132 subjects were included; little change in sexual behavior occurred among HIV seronegative subjects, while HIV seropositive subjects reported significant decreases in being sexually active and increases in consistent condom use. HIV transmission risk declined from 14% in 1990-1995 to 2% in 2007-2012 for primary sexual partners and from 6% to 1% for casual partners. Results from the NYC Condom distribution program showed that 65% of drug users were aware of the NYC Condom, and among those who had heard of the NYC Condom, 48% had used it.
Conclusions: Cumulative implementation of combined prevention programming for PWID, including mass distribution of NYC Condoms, was associated with a substantial decline in the potential for sexual transmission of HIV from PWID between 1990 and 2012. The reduction in the potential sexual transmission of HIV from PWID occurred through the reduction in HIV seroprevalence among PWID and through reduced sexual risk behavior among the HIV seropositive PWID. These data suggest combined prevention may be considered as a standard of care for HIV positive PWID but also point to the need for interventions to reduce sexual risk among HIV negative PWID.