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HIV/AIDS & Injection Drug Use (IDU)

  1. Basic Data Overview

    Prevalence Estimates

    (Estimated Prevalence of People Who Inject Drugs (PWID) in the US) "Appendix S2 shows the estimates of the number of PWID per 10,000 population aged 15–64 years for each of the 96 largest MSAs in the US for each year from 1992 to 2007. Mean PWID prevalence rates and standard deviations are presented in Table 5. Overall, the number of PWID per 10,000 persons aged 15–64 years varied from 31 to 345 across MSAs [Metropolitan Statistical Areas], median 104.4 (mean 127.4; standard deviation 66.7; percentile range 76–162) in 1992 and from 34 to 324 across MSAs, median 91.5 (mean 103.6; standard deviation 56.4; percentile range 61–125 ) in 2007 indicating an overall decline in PWID prevalence across MSAs.
    "Figure 5 shows the overall trajectory of the PWID prevalence rates based on the multilevel model. Trend analysis of the overall results is consistent with a decline in the early study period, followed by an increase in 2000–02, and then remaining stable thereafter over time. On average there has been very little change since 2002 (mean 105.0) to 2007 (mean 103.6). Overall, across the 96 MSAs the mean PWID prevalence mostly decreased during our study period, as did the dispersion of estimates over time."

    Source: 
    Tempalski B, Pouget ER, Cleland CM, Brady JE, Cooper HLF, et al. (2013) "Trends in the Population Prevalence of People Who Inject Drugs in US Metropolitan Areas 1992–2007." PLoS ONE 8(6): e64789. doi:10.1371/journal.pone.0064789
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3673953/pdf/pone.0064789.pdf

  2. (Prevalence of Injection Drug Use Among Young Adults Aged 21-30 in the US)
    "• In the nine-year (2004–2012) combined sample of young adults aged 21–30, 1.6% report having ever used any drug by injection without medical supervision (Table 1a). There is a fair-sized gender difference—2.4% of males and 0.9% of females indicate such behavior. The percentage saying they injected on 40 or more occasions is 0.5% overall—0.6% for males and 0.4% for females. Therefore, a relatively limited segment of respondents has ever used an illicit drug by injection—about 1 in every 60; a smaller proportion. About 1 in every 200 respondents reports an extended pattern of use as indicated by use on 40 or more occasions.
    "• The proportions of young adults who have injected drugs during the past 12 months without medical supervision is considerably smaller: 0.5% overall—1 in every 200 respondents—including 0.8% of males and 0.3% of females (a highly significant gender difference). The proportions using 40 or more times in the past 12 months are 0.2% overall—0.2% for males, and 0.1% for females. It is interesting to note that the proportional difference between the genders is larger for having injected drugs in their lifetime (2.4% of males versus 0.9% of females) than it is for having ever shared needles (0.5% of males versus 0.4% of females), suggesting that females injectors are more at risk of needle sharing."

    Source: 
    Johnston, L. D., O’Malley, P. M., Bachman, J. G., Schulenberg, J. E., Patrick, M. E.. & Miech, R. A. (2013). HIV/AIDS: Risk & Protective Behaviors among American Young Adults, 2004–2012. Ann Arbor: Institute for Social Research, The University of Michigan, p. 18.
    http://www.monitoringthefuture.org/pubs/monographs/mtf-hiv-aids_2012.pdf

  3. (Prevalence of Needle Sharing Among Young Adults Aged 21-30 in the US)
    "• The proportion of 21- to 30-year-olds who say they have ever shared needles in this way during their lifetime is 0.5% overall—0.5% of males and 0.4% of females (Table 1a). As noted in the next section, 1.6% of the full samples say they have ever injected a drug, so this indicates that a minority — but still nearly a third — of the people injecting any of the several drug classes mentioned in the question (heroin, cocaine, amphetamines, or steroids) shared a needle at some time.
    "• The proportion of 21- to 30-year-olds who say that they have shared needles in the prior 12 months is 0.1%, with 0.2% of males and 0.1% of females reporting such behavior (a non-significant gender difference). This compares to 0.5% who said that they have injected a drug in the prior 12 months, so about one fifth of past year injectors shared a needle during that interval."

    Source: 
    Johnston, L. D., O’Malley, P. M., Bachman, J. G., Schulenberg, J. E., Patrick, M. E.. & Miech, R. A. (2013). HIV/AIDS: Risk & Protective Behaviors among American Young Adults, 2004–2012. Ann Arbor: Institute for Social Research, The University of Michigan, p. 18.
    http://www.monitoringthefuture.org/pubs/monographs/mtf-hiv-aids_2012.pdf

  4. (HIV Prevention, Treatment, and Care Services) "Despite the fact that injecting drug use has led to the widespread transmission of HIV worldwide, the provision of HIV prevention, treatment, and care services to IDU populations remains dismally low. In 2009, only 8 per cent of injecting drug users worldwide enjoyed access to HIV prevention services of any kind, while substitution therapy–i.e. offering users methadone instead of heroin–is permitted in only 70 countries. Needle and syringe exchange programmes are available in only 82 countries."

    Source: 
    "Out of harm’s way: Injecting drug users and harm reduction" International Federation of Red Cross and Red Crescent Societies (Geneva, Switzerland: December 2010), p. 12.
    https://ifrc.org/Global/Publications/Health/Harm-reduction-report-EN.pdf

  5. (HIV Transmission and Injection Drug Use in Russia) "In 2002, an estimated 93 percent of persons registered by the government as HIV positive since the beginning of the epidemic were injection drug users. In contrast, in 2002 an estimated 12 percent of new HIV transmission was sexual -- that figure climbed to 17.5 percent in the first half of 2003 -- indicating the foothold that the epidemic is gaining in the general population. The European Centre for the Epidemiological Monitoring of AIDS (EuroHIV), a center affiliated with the World Health Organization, noted that HIV prevalence may have 'reached saturation levels in at least some of the currently affected drug user populations' in eastern Europe, including in Russia, but cautioned against complacency 'as new outbreaks could still emerge among injection drug users…, particularly within the vast expanse of the Russian Federation.' Rhodes and colleagues in a February 2004 article echo this conclusion, noting evidence of recent examples of severe HIV outbreaks among drug users in Russia."

    Source: 
    Human Rights Watch, "Lessons Not Learned: Human Rights Abuses and HIV/AIDS in the Russian Federation," (New York, NY: April 2004) Vol. 16, No. 5, p. 10.
    http://www.hrw.org/sites/default/files/reports/russia0404.pdf

  6. (Global Progress in Controlling HIV-AIDS Related to Injection Drug Use) "The world is not on track to reduce HIV transmission among people who inject drugs by 50%, as recent evidence suggests little change in the HIV burden in this population. HIV prevalence among people who inject drugs remains high – up to 28% in Asia. HIV prevention coverage for people who inject drugs remains low, with only two of 32 reporting countries providing the recommended minimum of at least 200 sterile syringes per year for each person who injects drugs. Among 35 countries providing data in 2013, all but four reached less than 10% of opiate users with substitution therapy. In addition to exceptionally low coverage, an effective AIDS response among people who inject drugs is undermined by punitive policy frameworks and law enforcement practices, which discourage individuals from seeking the health and social services they need."

    Source: 
    "Global Report: UNAIDS Report on the Global AIDS Epidemic 2013," Joint United Nations Programme on HIV/AIDS, Sept. 2013, pp. 5-6.
    http://www.unaids.org/en/media/unaids/contentassets/documents/epidemiolo...

  7. Disease Correlates

    HIV

    (Rate of HIV Diagnoses, 2011) "From 2008 through 2011, the annual estimated number and the estimated rate of diagnoses of HIV infection in the United States remained stable (Table 1a). In 2011, the estimated rate was 15.8."

    Source: 
    Centers for Disease Control and Prevention. HIV Surveillance Report, 2011, "Rates of diagnoses of HIV infection among adults and adolescents, by area of residence, 2011—United States and 6 dependent areas"; Vol. 23, p. 6. Published February 2013. Accessed May 21, 2013.
    http://www.cdc.gov/hiv/pdf/statistics_2011_HIV_Surveillance_Report_vol_2...

  8. (Number of HIV and AIDS Diagnoses and Deaths, 2010) "CDC estimates that more than 1.1 million people in the United States (US) are living with HIV infection. Nearly one in five (18.1%) of those people are unaware of their infection. Despite increases in the total number of people in the US living with HIV infection in recent years (due to better testing and treatment options), the annual number of new HIV infections has remained relatively stable. However, new infections continue at far too high a level, with approximately 50,000 Americans becoming infected with HIV each year.
    "In 2010, an estimated 47,129 people were diagnosed with HIV infection in the 46 states with confidential name-based HIV infection reporting since at least January 2007. In that same year, an estimated 33,015 people throughout the U.S. were diagnosed with AIDS. Since the epidemic began, an estimated 1,129,127 people in the U.S. have been diagnosed with AIDS.
    "An estimated 17,774 people with AIDS died in 2009, and nearly 619,400 people with AIDS in the U.S. have died since the epidemic began."

    Source: 
    "HIV in the United States: At A Glance," National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (Atlanta, GA: National Centers for Disease Control, March 2012), p. 1.
    http://www.cdc.gov/hiv/resources/factsheets/PDF/HIV_at_a_glance.pdf

  9. (HIV Diagnoses by Method of Transmission) "From 2008 through 2011, among adult and adolescent males, the annual number of diagnosed HIV infections attributed to male-to-male sexual contact increased. The numbers of infections attributed to injection drug use, to male-to-male sexual contact and injection drug use, and to heterosexual contact decreased. Among adult and adolescent females, the numbers of infections attributed to injection drug use and to heterosexual contact decreased. In 2011, diagnosed infections attributed to male-to-male sexual contact (65%, including male-to-male sexual contact and injection drug use) and those attributed to heterosexual contact (27%) accounted for approximately 92% of diagnosed HIV infections in the United States."

    Source: 
    Centers for Disease Control and Prevention. HIV Surveillance Report, 2011, "Rates of diagnoses of HIV infection among adults and adolescents, by area of residence, 2011—United States and 6 dependent areas"; Vol. 23, p. 7. Published February 2013. Accessed May 21, 2013.
    http://www.cdc.gov/hiv/pdf/statistics_2011_HIV_Surveillance_Report_vol_2...

  10. (HIV Prevalence Among Youth) "In 2009, youths (defined in this report as persons aged 13–24 years), who represented 21% of the U.S. population, comprised 6.7% of persons living with HIV. More than half (59.5%) were unaware of their infection, the highest for any age group (1)."

    Source: 
    Centers for Disease Control, "Vital Signs: HIV Infection, Testing, and Risk Behaviors Among Youths - United States," Morbidity and Mortality Weekly Report, Vol. 61, No. 47 (Atlanta, GA: CDC, Nov. 30, 2012), p. 971.
    http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6147a5.htm?s_cid=mm6147a5_w

  11. (New HIV Infections Among Youths, by Transmission Method) "In 2010, of the estimated 47,500 new HIV infections, 12,200 (25.7%) were among youths (10,100 [82.8%] among males and 2,100 [17.2%] among females). An estimated 7,000 (57.4%) newly infected youths were blacks/African Americans (5,600 males and 1,400 females), 2,390 (19.6%) were Hispanics/Latinos (2,100 males and 290 females), and 2,380 (19.5%) were whites (2,100 males and 280 females) (Figure 2). By transmission category, 72.1% of all new HIV infections among youths were attributed to male-to-male sexual contact, 19.8% to heterosexual contact,†† 4.0% to injection drug use, and 3.7% to male-to-male sexual contact and injection drug use. Among females, 85.7% of infections were attributed to heterosexual contact and 12.9% to injection drug use. Among males, 87.1% of infections were attributed to male-to-male sexual contact, 6.0% to heterosexual contact, 2.2% to injection drug use, and 4.5% to male-to-male sexual contact and injection drug use. Of the 8,800 new infections among youths attributed to male-to-male sexual contact, 4,800 (54.4%) were among blacks/African Americans, 1,900 (21.6%) among Hispanics/Latinos, and 1,800 (20.5%) among whites."

    Source: 
    Centers for Disease Control, "Vital Signs: HIV Infection, Testing, and Risk Behaviors Among Youths - United States," Morbidity and Mortality Weekly Report, Vol. 61, No. 47 (Atlanta, GA: CDC, Nov. 30, 2012), p. 972.
    http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6147a5.htm?s_cid=mm6147a5_w

  12. (Global Estimated Prevalence of IDU-Related HIV, 2011) "Of the estimated 14.0 million (range: 11.2 million to 22.0 million) people who inject drugs worldwide, UNODC estimates that 1.6 million (range: 1.2 million to 3.9 million) are living with HIV. That represents a global prevalence of HIV of 11.5 per cent among people who inject drugs.15
    "Along with the estimates of the total number of people who inject drugs, the global total and prevalence rates of people who inject drugs living with HIV for 2011 is also lower than the estimated 3 million (18.9 per cent prevalence among people who inject drugs) previously presented by the Reference Group to the United Nations on HIV and Injecting Drug Use for 2008. These reduced estimates are in large part a result of the availability of more reliable information on HIV prevalence among people who inject drugs."

    Source: 
    UNODC, World Drug Report 2013 (United Nations publication, Sales No. E.13.XI.6), p. 5.
    https://www.unodc.org/unodc/secured/wdr/wdr2013/World_Drug_Report_2013.p...

  13. (HIV Deaths by Transmission Method and Gender, 2010) The CDC estimates that of the 14,785 male adults or adolescents with a diagnosis of HIV who died in 2010 the US and 6 US dependent territories, 7,506 were reportedly transmitted through male-to-male sexual contact, 3,577 of the cases were reportedly transmitted through injection drug use, 1,478 were transmitted through male-to-male sexual contact and injection drug use, 2,086 were reportedly transmitted through heterosexual contact, 30 were through perinatal exposure, and 107 were attributed to "other."

    The CDC estimates that of the 5,232 female adults or adolescents with a diagnosis of HIV who died in the US and 6 dependent territories, 1,894 were reportedly transmitted through injection drug use, 3,266 were reportedly transmitted through heterosexual contact, 41 were through perinatal exposure, and 31 were attributed to "other."

    Source: 
    Centers for Disease Control and Prevention. HIV Surveillance Report, 2011, "Rates of diagnoses of HIV infection among adults and adolescents, by area of residence, 2011—United States and 6 dependent areas"; Vol. 23, Table 11b, pp 42-43. Published February 2013. Accessed May 21, 2013.
    http://www.cdc.gov/hiv/pdf/statistics_2011_HIV_Surveillance_Report_vol_2...

  14. (Trends in HIV Deaths by Transmission Method and Gender) "From 2008 through 2010, the rates of deaths for adult and adolescent males and females decreased. The numbers of deaths among males with diagnosed HIV infection attributed to injection drug use and to heterosexual contact decreased. The numbers of deaths of males with infection attributed to male-to-male sexual contact, to male-to-male sexual contact and injection drug use, and to perinatal transmission remained stable. The numbers of deaths of adult and adolescent females with infection attributed to injection drug use and to perinatal transmission decreased. The number of deaths of females with infection attributed to heterosexual contact remained stable. Trend data for persons with infection attributed to perinatal transmission should be interpreted with caution because numbers are small."

    Source: 
    Centers for Disease Control and Prevention. HIV Surveillance Report, 2011, "Rates of diagnoses of HIV infection among adults and adolescents, by area of residence, 2011—United States and 6 dependent areas"; Vol. 23, p. 8. Published February 2013. Accessed May 21, 2013.
    http://www.cdc.gov/hiv/pdf/statistics_2011_HIV_Surveillance_Report_vol_2...

  15. (HIV As A Leading Cause of Death, by Age) "Human immunodeficiency virus (HIV) disease was not among the 15 leading causes of death in 2009. The age-adjusted death rate for HIV disease declined 9.1% from 2008 to 2009 (Table 16). Historically, HIV disease mortality reached its highest level in 1995 after a period of increase from 1987 through 1994. Subsequently, the rate for this disease decreased an average of 33.0% per year from 1995 through 1998, and 6.3% per year from 1999 through 2009 (23). For all races combined in the age group 15–24, HIV disease was the 12th leading cause of death in 2009—dropping from the 11th leading cause in 2008. HIV disease remained the 6th leading cause of death for the age group 25–44. Among decedents aged 45–64, HIV disease dropped from the 12th leading cause in 2008 to the 13th leading cause in 2009."

    Source: 
    Kenneth D. Kochanek, M.A.; Jiaquan Xu, M.D.; Sherry L. Murphy, B.S.; Arialdi M. Minino, M.P.H.; and Hsiang-Ching Kung, Ph.D., "Deaths: Final Data for 2009," Division of Vital Statistics (Atlanta, GA: Centers for Disease Control), Vol. 60, Number 3, Dec. 29, 2011, p. 9.
    http://www.cdc.gov/nchs/data/nvsr/nvsr60/nvsr60_03.pdf

  16. (Survival Rates After HIV Diagnosis, by Transmission Method) "Survival was greatest among children regardless of transmission category, followed by adult and adolescent males with diagnosed HIV infection attributed to male-to-male sexual contact, adult and adolescent males with infection attributed to male-to-male sexual contact and injection drug use, and adult and adolescent females with infection attributed to heterosexual contact. Survival was intermediate among adult and adolescent males with infection attributed to heterosexual contact. Survival was lowest among adult and adolescent males and females with infection attributed to injection drug use."

    Source: 
    Centers for Disease Control and Prevention. HIV Surveillance Report, 2011, "Rates of diagnoses of HIV infection among adults and adolescents, by area of residence, 2011—United States and 6 dependent areas"; Vol. 23, p. 9. Published February 2013. Accessed May 21, 2013.
    http://www.cdc.gov/hiv/pdf/statistics_2011_HIV_Surveillance_Report_vol_2...

  17. AIDS

    (Rate of AIDS Diagnoses in the US, 2011) "From 2008 through 2011, the annual estimated number and the estimated rate of infections classified as stage 3 (AIDS) in the United States remained stable (Table 2a). In 2011, the estimated rate of infections classified as stage 3 (AIDS) was 10.3."

    Source: 
    Centers for Disease Control and Prevention. HIV Surveillance Report, 2011, "Rates of diagnoses of HIV infection among adults and adolescents, by area of residence, 2011—United States and 6 dependent areas"; Vol. 23, p. 7. Published February 2013. Accessed May 21, 2013.
    http://www.cdc.gov/hiv/pdf/statistics_2011_HIV_Surveillance_Report_vol_2...

  18. (Prevalence of Injection Drug Use and HIV/AIDS in Russia) "There is some controversy over the number of narcotic drug users in Russia. Dr. Vadim Pokrovsky of the Federal AIDS Center said that estimates of the number of active drug users in Russia in February 2004 ranged from 1 to 4 million, and he believed the high end of that range reflected the reality. On February 20, 2004, Alexander Mikhailov, the deputy director of the State Drug Control Committee (SDCC), a federal body, was cited in Pravda as saying that Russia had over 4 million drug users, and that the "gloomy prediction" of his office was that Russia could have over 35 million drug users by 2014. In early January 2004, the executive secretary of the Commonwealth of Independent States, which includes twelve former Soviet states, predicted that in 2010 the twelve countries would have 25 million drug users of whom 10 million would be living with HIV/AIDS, the vast majority in Russia."

    Source: 
    Human Rights Watch, "Lessons Not Learned: Human Rights Abuses and HIV/AIDS in the Russian Federation," April 2004, Vol. 16, No. 5, pp. 14-15.
    http://www.hrw.org/sites/default/files/reports/russia0404.pdf

  19. (AIDS Diagnoses by Transmission Method and Gender, 2011) The CDC estimates that of the 24,443 adult or adolescent males in the US and 6 dependent territories who were diagnosed with AIDS in 2011, 16,812 cases were reportedly transmitted through male-to-male sexual contact, 2,447 were reportedly transmitted through injection drug use, 1,411 were reportedly transmitted through male-to-male sexual contact and injection drug use, 3,638 were reportedly transmitted through heterosexual contact, and 134 were attributed to "other."

    The CDC estimates that of the 8,102 adult or adolescent females in the US and 6 dependent territories who were diagnosed with AIDS in 2011, 1,642 cases were reportedly transmitted through injection drug use, 6,330 were reportedly transmitted through heterosexual contact, and 129 were attributed to "other."

    Source: 
    Centers for Disease Control and Prevention. HIV Surveillance Report, 2011, "Rates of diagnoses of HIV infection among adults and adolescents, by area of residence, 2011—United States and 6 dependent areas"; Vol. 23, Table 2b, pp. 23-24. Published February 2013. Accessed May 21, 2013.
    http://www.cdc.gov/hiv/pdf/statistics_2011_HIV_Surveillance_Report_vol_2...

  20. (AIDS Diagnoses in the US, by Transmission Method and Gender, Cumulative) According to the CDC, from the beginning of the AIDS epidemic through the end of 2011 there have been a total of 1,190,71 cases of AIDS reported in the US and 6 US dependent territories.

    The CDC estimates that of the 939,219 adult or adolescent males who received an AIDS diagnosis from the beginning of the epidemic through 2011, 560,860 cases were reportedly transmitted through male-to-male sexual contact, 201,271 were reportedly transmitted through injection drug use, 83,455 were reportedly transmitted through male-to-male sexual contact and injection drug use, 81,477 were reportedly transmitted through heterosexual contact, and 12,157 were attributed to "other."

    The CDC estimates that of the 241,553 adult or adolescent females who received an AIDS diagnosis from the beginning of the epidemic through 2011, 92,833 were reportedly transmitted through injection drug use, 142,153 were reportedly transmitted through heterosexual contact, and 6,567 were attributed to "other."

    Source: 
    Centers for Disease Control and Prevention. HIV Surveillance Report, 2011, "Rates of diagnoses of HIV infection among adults and adolescents, by area of residence, 2011—United States and 6 dependent areas"; Vol. 23, Table 2b, pp 23-24. Published February 2013. Accessed May 21, 2013.
    http://www.cdc.gov/hiv/pdf/statistics_2011_HIV_Surveillance_Report_vol_2...

  21. (Persons Under Age 13 Diagnosed with Stage 3 (AIDS) in the US) According to the CDC, from the beginning of the AIDS epidemic through the end of 2011 a total of 9,945 cases of AIDS have been reported in the US and 6 dependent territories among children under age 13 at the time of diagnosis.

    Source: 
    Centers for Disease Control and Prevention. HIV Surveillance Report, 2011, "Rates of diagnoses of HIV infection among adults and adolescents, by area of residence, 2011—United States and 6 dependent areas"; Vol. 23, Table 6b, p. 34. Published February 2013. Accessed May 21, 2013.
    http://www.cdc.gov/hiv/pdf/statistics_2011_HIV_Surveillance_Report_vol_2...

  22. (Method of Infection, AIDS Diagnoses 2008-2011) "From 2008 through 2011, the annual number of infections classified as stage 3 (AIDS) among adult and adolescent males with HIV infection attributed to male-to-male sexual contact increased. The numbers of stage 3 (AIDS) classifications among males with infection attributed to injection drug use, to male-to-male sexual contact and injection drug use, and to heterosexual contact decreased. The number of infections classified as stage 3 (AIDS) among adult and adolescent females with HIV infection attributed to injection drug use decreased; the number with infection attributed to heterosexual contact remained stable."

    Source: 
    Centers for Disease Control and Prevention. HIV Surveillance Report, 2011, "Rates of diagnoses of HIV infection among adults and adolescents, by area of residence, 2011—United States and 6 dependent areas"; Vol. 23, p. 7. Published February 2013. Accessed May 21, 2013.
    http://www.cdc.gov/hiv/pdf/statistics_2011_HIV_Surveillance_Report_vol_2...

  23. (AIDS Deaths by Method of Transmission and Gender) "From 2008 through 2010, the overall rates for adult and adolescent males and females decreased. The numbers of deaths of males with stage 3 (AIDS) whose HIV infection was attributed to injection drug use, to male-to-male sexual contact and injection drug use, and to heterosexual contact decreased. The numbers of deaths of males with infection attributed to male-to-male sexual contact and to perinatal transmission remained stable. Among adult and adolescent females, the numbers of deaths of those with infection attributed to injection drug use and to perinatal transmission decreased. The number of deaths of females with infection attributed to heterosexual contact remained stable. Trend data for persons with infection attributed to perinatal transmission should be interpreted with caution because numbers are small."

    Source: 
    Centers for Disease Control and Prevention. HIV Surveillance Report, 2011, "Rates of diagnoses of HIV infection among adults and adolescents, by area of residence, 2011—United States and 6 dependent areas"; Vol. 23, pp. 8-9. Published February 2013. Accessed May 21, 2013.
    http://www.cdc.gov/hiv/pdf/statistics_2011_HIV_Surveillance_Report_vol_2...

  24. (AIDS Deaths by Gender and Method of Transmission, 2010) The CDC estimates that of the 11,923 male adults or adolescents with diagnosed HIV infection which was ever classified as stage 3 (AIDS) who died in 2010, 5,980 of the cases were reportedly transmitted through male-to-male sexual contact (MSM), 2,907 were reportedly transmitted through injection drug use, 1,258 were reportedly transmitted through male-to-male sexual contact and injection drug use, 1,654 were reportedly transmitted through heterosexual contact, 26 were reportedly transmitted through perinatal exposure, and 97 were attributed to "other."

    The CDC estimates that of the 4,170 female adults or adolescents with diagnosed HIV infection which was ever classified as stage 3 (AIDS) who died in 2010, 1,563 were reportedly transmitted through injection drug use, 2,540 were reportedly transmitted through heterosexual contact, 38 were reportedly transmitted through perinatal exposure, and 29 were attributed to "other."

    Source: 
    Centers for Disease Control and Prevention. HIV Surveillance Report, 2011, "Rates of diagnoses of HIV infection among adults and adolescents, by area of residence, 2011—United States and 6 dependent areas"; Vol. 23, Table 12b, pp. 46-47. Published February 2013. Accessed May 21, 2013.
    http://www.cdc.gov/hiv/pdf/statistics_2011_HIV_Surveillance_Report_vol_2...

  25. (AIDS Deaths in the US, 2010 and Cumulative) In 2010, a total of 16,093 persons in the US and 6 dependent areas were estimated to have died with a diagnosed HIV infection ever classified as stage 3 (AIDS). From the beginning of the epidemic through 2010, an estimated 658,992 persons in the US and 6 dependent areas are estimated to have died from AIDS.

    Source: 
    Centers for Disease Control and Prevention. HIV Surveillance Report, 2011, "Rates of diagnoses of HIV infection among adults and adolescents, by area of residence, 2011—United States and 6 dependent areas"; Vol. 23, Table 12b, pp. 46-47. Published February 2013. Accessed May 21, 2013.
    http://www.cdc.gov/hiv/pdf/statistics_2011_HIV_Surveillance_Report_vol_2...

  26. (AIDS Diagnoses by Gender and Transmission Method, 2007) "Of the estimated 398,057 male adults and adolescents living with HIV/AIDS, 64% had been exposed through male-to-male sexual contact, 16% through injection drug use, 12% through high-risk heterosexual contact, and 7% through both male-to-male sexual contact and injection drug use. Of the estimated 146,692 female adults and adolescents living with HIV/ AIDS, 72% had been exposed through high-risk heterosexual contact, and 26% had been exposed through injection drug use."

    Editor's Note: The CDC defines high-risk heterosexual contact as "heterosexual contact with a person known to have, or to be at high risk for, HIV infection."

    Source: 
    Centers for Disease Control and Prevention, "HIV/AIDS Surveillance Report, 2007," Vol. 19. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2009: p. 9.
    http://www.cdc.gov/hiv/topics/surveillance/resources/reports/2007report/...

  27. (Cases of AIDS, Cumulative Through 2007) "Through 2007, a total of 1,030,832 persons in the United States and dependent areas had been reported as having AIDS (Table 16). Three states (California, Florida, and New York) reported 43% of the cumulative AIDS cases and 36% of AIDS cases reported to CDC in 2007. In the 50 states and the District of Columbia, the rate of reported AIDS cases in 2007 was 12.4 per 100,000 population. When the U.S. dependent areas were included, the rate of reported AIDS cases ranged from zero per 100,000 (American Samoa, Guam, and the Northern Mariana Islands) to 148.1 per 100,000 (District of Columbia)."

    Source: 
    Centers for Disease Control and Prevention, "HIV/AIDS Surveillance Report, 2007," Vol. 19. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2009: p. 9.
    http://www.cdc.gov/hiv/topics/surveillance/resources/reports/2007report/...

  28. (Global Estimated Drug-Related Mortality, 2011) "UNODC estimates that there were between 102,000 and 247,000 drug-related deaths in 2011, corresponding to a mortality rate of between 22.3 and 54.0 deaths per million population aged 15-64. This represents between 0.54 per cent and 1.3 per cent of mortality from all causes globally among those aged 15-64.20 The extent of drug-related deaths has essentially remained unchanged globally and within regions."

    Source: 
    UNODC, World Drug Report 2013 (United Nations publication, Sales No. E.13.XI.6), p. 10.
    https://www.unodc.org/unodc/secured/wdr/wdr2013/World_Drug_Report_2013.p...

  29. (Cost Effectiveness of Harm Reduction) "Prevention of HIV is also cheaper than treatment of HIV/AIDS. For example, in Asia it is estimated that the comprehensive package of HIV-related harm reduction interventions costs $39 per disability-adjusted life-year saved,14 whereas antiretroviral treatment costs approximately $2,000 per life-year saved. Such figures demonstrate that harm reduction is a low-cost, high-impact intervention."

    Source: 
    "Three cents a day is not enough: Resourcing HIV-related Harm Reduction on a global basis," International Harm Reduction Association (London, United Kingdom: 2010), p. 12.
    http://dl.dropbox.com/u/64663568/library/IHRA_3CentsReport.pdf

  30. (Spending Estimates) "UNAIDS estimates that the total global resources needed for HIV/AIDS for the period 2009 to 2013 is almost $200 billion to achieve universal access by 2010, and $140 billion for a slower scale-up to achieve universal access by 2015.83

    "The UNAIDS estimates for harm reduction assume 60% coverage for needle and syringe programmes and 40% for opioid substitution therapy.84 These estimates are based on the resources needed for prevention-related activities in order to reach 6.2 million people who inject drugs by 2010 in 132 lower and middle income countries. UNAIDS assumes the cost of opioid substitution therapy using methadone to be between $363 and $1,057 per person per year (which is higher than other estimates in Table 4) and the costs of needle and syringe programmes to be $10 per person per year (lower than other estimates in Table 3).

    "Using these figures, UNAIDS estimates that the resources needed for harm reduction are $2.13 billion in 2009 and $3.2 billion in 2010, an average of $170 and $256 respectively per injector per year. Additional resources will be required for antiretroviral treatment, care and support."85

    Source: 
    "Three cents a day is not enough: Resourcing HIV-related Harm Reduction on a global basis," International Harm Reduction Association (London, United Kingdom: 2010), pp. 38-39.
    http://dl.dropbox.com/u/64663568/library/IHRA_3CentsReport.pdf

  31. (Global Expenditures) "Global expenditure on HIV/AIDS has increased substantially in the last decade, with total annual resources from all sources reaching over $11.3 billion in 2007 and $13.7 billion in 2008.37 Most of these resources are destined for low and middle income countries and include the expenditure allocated to HIV/AIDS prevention, care, treatment and support."

    "The Global Fund [to Fight AIDS, Tuberculosis and Malaria]’s annual HIV/AIDS disbursement was approximately $1 billion in 2007,39 $1.6 billion in 2008 and $2.8 billion in 2009.40 From 2002 to 2009 the Global Fund has approved a total grant amount of $10 billion for HIV/AIDS prevention, treatment and care. For the 2008 to 2010 biennium, $9.7 billion has been pledged to the Global Fund for all activities by countries and private donors."41

    "The total resources made available for HIV/AIDS increased from $7.9 billion in 2005 to $13.8 million in 2008. Nevertheless, there continues to be a resource gap. UNAIDS estimates that overall the funding needed in 2007 was $18 billion,45 indicating that resources need to be increased by about 60%."

    Source: 
    "Three cents a day is not enough: Resourcing HIV-related Harm Reduction on a global basis," International Harm Reduction Association (London, United Kingdom: 2010), pp. 19-21.
    http://dl.dropbox.com/u/64663568/library/IHRA_3CentsReport.pdf

  32. (Cost of HIV Treatment) The lifetime cost of treating an HIV positive person was estimated in 1997 to be $195,188.

    Source: 
    Holtgrave, DR, Pinkerton, SD. "Updates of Cost of Illness and Quality of Life Estimates for Use in Economic Evaluations of HIV Prevention Programs." Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology, Vol. 16, pp. 54-62 (1997).
    http://www.ncbi.nlm.nih.gov/pubmed/9377126

  33. (Spending on HIV-Related Harm Reduction, 2007) "At approximately $160 million in 2007, the estimated total spending on HIV-related harm reduction in low and middle income countries is extremely low, and would still be insufficient even if this figure was underestimated by a factor of two or three. It amounts to about three US cents a day, or $12.80 a year, for each person who injects drugs. It is clearly inadequate when compared with indicative unit costs of providing needles and syringes (approximately $100 per person per year) and methadone (approximately $500 per person per year)."

    Source: 
    "Three cents a day is not enough: Resourcing HIV-related Harm Reduction on a global basis," International Harm Reduction Association (London, United Kingdom: 2010), p. 39.
    http://dl.dropbox.com/u/64663568/library/IHRA_3CentsReport.pdf

  34. (HIV and IDUs in Russia and Central Asia) "In terms of absolute numbers, the Russian Federation is particularly affected with its 1.5 million addict population. The hugely damaging threat of HIV/AIDS is directly related to heroin injection. To date, there are over a quarter of a million registered HIV cases (although the number of unregistered cases is estimated to be much higher than this) in the Russian Federation. Of these, over 80% are intravenous drug users. In the CARs [Central Asian Republics], nearly 15 years of continuous heroin transit has created a local market of 282,000 heroin users, consuming approximately 11 mt of heroin annually. Local opium consumption is estimated at approximately 34 mt (although demand in Turkmenistan may be underestimated). This puts some Central Asian states on par with countries with the highest global opiate abuse prevalence."

    Source: 
    UNODC, World Drug Report 2010 (United Nations Publication, Sales No. E.10.XI.13), pp. 52-53.
    http://www.unodc.org/documents/southeastasiaandpacific//2010/06/wdr2010/...

  35. (Leading Causes of Death by Race/Ethnicity, 2008) The Centers for Disease Control reported that in 2008, HIV disease was the 25th leading cause of death in the US for non-Hispanic whites, the 10th leading cause of death for non-Hispanic blacks, and the 17th leading cause of death for Hispanics.

    Source: 
    Heron, Melonie P., PhD, "Deaths: Leading Causes for 2008," National Vital Statistics Reports, Vol. 60, No. 6 (Hyattsville, MD: National Center for Health Statistics, June 6, 2012), p. 12, Table E.
    http://www.cdc.gov/nchs/data/nvsr/nvsr60/nvsr60_06.pdf

  36. HIV/AIDS & IDU - Law and Policy

    (HIV/AIDS and human rights) "We reviewed evidence from more than 900 studies and reports on the link between human rights abuses experienced by people who use drugs and vulnerability to HIV infection and access to services. Published work documents widespread abuses of human rights, which increase vulnerability to HIV infection and negatively affect delivery of HIV programmes. These abuses include denial of harm-reduction services, discriminatory access to antiretroviral therapy, abusive law enforcement practices, and coercion in the guise of treatment for drug dependence. Protection of the human rights of people who use drugs therefore is important not only because their rights must be respected, protected, and fulfilled, but also because it is an essential precondition to improving the health of people who use drugs. Rights-based responses to HIV and drug use have had good outcomes where they have been implemented, and they should be replicated in other countries."

    Source: 
    Jürgens, Ralf; Csete, Joanne; Amon, Joseph J.; Baral, Stefan; and Beyrer, Chris, "People who use drugs, HIV, and human rights," The Lancet (London, United Kingdom: August 7, 2010) Vol. 376, Issue 9739, p. 475.
    http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2810%2960...

  37. (HIV/AIDS - drug war driving the pandemic) "The global war on drugs is driving the HIV/AIDS pandemic among people who use drugs and their sexual partners. Throughout the world, research has consistently shown that repressive drug law enforcement practices force drug users away from public health services and into hidden environments where HIV risk becomes markedly elevated. Mass incarceration of non-violent drug offenders also plays a major role in increasing HIV risk. This is a critical public health issue in many countries, including the United States, where as many as 25 percent of Americans infected with HIV may pass through correctional facilities annually, and where disproportionate incarceration rates are among the key reasons for markedly higher HIV rates among African Americans."

    Source: 
    "The War on Drugs and HIV/AIDS: How the Criminalization of Drug Use Fuels the Global Pandemic," Global Commission on Drug Policy (Rio de Janeiro, Brazil: June 2012), p. 2.
    http://globalcommissionondrugs.org/wp-content/themes/gcdp_v1/pdf/GCDP_HI...

  38. (International Federation of Red Cross Red Crescent Societies call to action)
    "A call to action
    "The International Federation of Red Cross Red Crescent Societies (IFRC) advocates on behalf of the individuals suffering most from exclusion within an already marginalized group—injecting drug users living with, or at risk of, HIV and AIDS. In this report, the IFRC challenges policymakers, governments and donors to move beyond their own prejudices to work with stakeholders, multi-lateral organizations, civil society and those living with HIV to provide prevention, treatment, care and support to injecting drug users and their families."

    Source: 
    "Out of harm’s way: Injecting drug users and harm reduction" International Federation of Red Cross and Red Crescent Societies (Geneva, Switzerland: December 2010), p. 3.
    https://ifrc.org/Global/Publications/Health/Harm-reduction-report-EN.pdf

  39. (Russian Federation Policy Toward HIV and IDU) "The Russian Federation is facing a deadly epidemic of acquired immune deficiency syndrome (AIDS). It is driven in part by abuses of the human rights of those most at risk to get the disease and of the over 1 million Russians already living with the human immunodeficiency virus (HIV). The principal means of HIV transmission in Russia has been and remains injection drug use. But the Russian state has done little to support low-cost measures that would enable drug users to realize their right to be protected from this incurable disease. Instead, Russia has been a model of repression of drug users and stigmatization of HIV-positive people, putting the country squarely on the path of very high AIDS mortality and continued abuse of people affected by HIV/AIDS."

    Source: 
    Human Rights Watch, "Lessons Not Learned: Human Rights Abuses and HIV/AIDS in the Russian Federation," (New York, NY: April 2004) Vol. 16, No. 5, p. 1.
    http://www.hrw.org/sites/default/files/reports/russia0404.pdf

  40. (Vienna Declaration)

    "The Vienna Declaration is a statement seeking to improve community health and safety by calling for the incorporation of scientific evidence into illicit drug policies ... The declaration process was launched as the the official declaration of the XVIII International AIDS Conference (AIDS 2010) held in Vienna, Austria from July 18th to 23rd. The declaration was drafted by a team of international experts and initiated by several of the world’s leading HIV and drug policy scientific bodies: the International AIDS Society, the International Centre for Science in Drug Policy (ICSDP), and the BC Centre for Excellence in HIV/AIDS."

    "In response to the health and social harms of illegal drugs, a large international drug prohibition regime has been developed under the umbrella of the United Nations.1 Decades of research provide a comprehensive assessment of the impacts of the global “War on Drugs” and, as thousands of individuals gather in Vienna at the XVIII International AIDS Conference, the international scientific community calls for an acknowledgement of the limits and harms of drug prohibition, and for drug policy reform to remove barriers to effective HIV prevention, treatment and care.

    "The evidence that law enforcement has failed to prevent the availability of illegal drugs, in communities where there is demand, is now unambiguous.2,3 Over the last several decades, national and international drug surveillance systems have demonstrated a general pattern of falling drug prices and increasing drug purity—despite massive investments in drug law enforcement.3,4

    "Furthermore, there is no evidence that increasing the ferocity of law enforcement meaningfully reduces the prevalence of drug use.5 The data also clearly demonstrate that the number of countries in which people inject illegal drugs is growing, with women and children becoming increasingly affected.6 Outside of sub-Saharan Africa, injection drug use accounts for approximately one in three new cases of HIV.7,8 In some areas where HIV is spreading most rapidly, such as Eastern Europe and Central Asia, HIV prevalence can be as high as 70% among people who inject drugs, and in some areas more than 80% of all HIV cases are among this group.8"


  41. (Recommendation of British Advisory Council on Misuse of Drugs) "Recommendation 1. Local service planners need to review local needle and syringe services (and be supported in this work) in order to take steps to increase access and availability to sterile injecting equipment and to increase the proportion of injectors who receive 100 per cent coverage of sterile injecting equipment in relation to their injecting frequency."

    Source: 
    Advisory Council on the Misuse of Drugs, "The Primary Prevention of Hepatitis C Among Injecting Drug Users," (London, United Kingdom: February 2009), p. 28.
    https://www.gov.uk/government/uploads/system/uploads/attachment_data/fil...

  42. Sociopolitical and Clinical Research

    (Crack Smoking and Risk of HIV) "Smoking of crack cocaine was found to be an independent risk factor for HIV seroconversion among people who were injection drug users. This finding points to the urgent need for evidence-based public health initiatives targeted at people who smoke crack cocaine. Innovative interventions that have the potential to reduce HIV transmission in this population, including the distribution of safer crack kits and medically supervised inhalation rooms, need to be evaluated."

    Source: 
    Kora DeBeck, Thomas Kerr, Kathy Li, Benedikt Fischer, Jane Buxton, Julio Montaner, and Evan Wood, "Smoking of crack cocaine as a risk factor for HIV infection among people who use injection drugs," Canadian Medical Association Journal, (October 2009), 181(9), p. 588.
    http://www.cmaj.ca/cgi/reprint/181/9/585.pdf

  43. (Cannabis and HCV Viral Load) "Short-term use of smoked cannabis did not affect viral load in 15 HIV-positive patients and also is associated with adherence to therapy and reduced viral loads in 16 patients with hepatitis C infections."

    Source: 
    American Medical Association, Council on Science and Public Health, "Report 3 of the Council on Science and Public Health: Use of Cannabis for Medicinal Purposes" (December 2009), p. 15.
    http://www.ama-assn.org//resources/doc/csaph/i09csaph3ft.pdf

  44. HIV/AIDS in Prison

    (Cases and Deaths in State and Federal Prisons) "At yearend 2010, state and federal prisons held a reported 20,093 inmates who had HIV or AIDS, down from 20,880 at yearend 2009. As a result of this decline, the estimated rate of HIV/AIDS among prisoners in custody dropped from 151 HIV/AIDS cases per 10,000 inmates in 2009 to 146 per 10,000 in 2010. The number of state and federal inmates who died from AIDS-related causes also declined between 2009 and 2010, from 94 to 72 deaths. During the same period, the rate of AIDS-related deaths among inmates with HIV/AIDS declined from 47 deaths per 10,000 inmates to 38 per 10,000."

    Source: 
    Maruschak, Laura M. "HIV In Prisons, 2001-2010," (Washington, DC: US Dept. of Justice Bureau of Justice Statistics), NCJ 238877, Sept. 2012, p. 1.
    http://www.bjs.gov/content/pub/pdf/hivp10.pdf

  45. (Cases and Deaths in Inmate Population, 2001-2010) "Between 2001 and 2010, the estimated number of inmates with HIV/AIDS declined by 16%, and the number of AIDS-related deaths in prison declined by 77% (not shown in table) resulting in declines in the rates of HIV/AIDS and AIDS-related deaths among all inmates and those with HIV/AIDS. At yearend 2001, the estimated rate of HIV/AIDS among state and federal prison inmates was 194 HIV/AIDS cases per 10,000 inmates. By yearend 2010, the estimated rate was 146 cases per 10,000. Among the total inmate population, the rate of AIDS-related deaths declined from 24 per 100,000 inmates in 2001 to 5 per 100,000 in 2010. Among the inmate population with HIV/AIDS, the rate declined from 134 AIDS-related deaths per 10,000 inmates in 2001 to 38 per 10,000 in 2010."

    Source: 
    Maruschak, Laura M., HIV in Prisons, 2001-2010 (Washington, DC: US Dept. of Justice Bureau of Justice Statistics), NCJ238877, Sept. 2012, p. 2.
    http://www.bjs.gov/content/pub/pdf/hivp10.pdf

  46. (HIV Prevalence Among State Prisoners by Drug Use) "The percentage of State prison inmates who were HIV positive was —

    "1.3% of those who never used drugs
    "1.7% of those who had ever used drugs
    "1.9% of those who used drugs in the month before their current offense
    "2.8% of those who had used a needle to inject drugs
    "5.1% of those who had shared a needle.

    "Like State inmates, Federal inmates who used a needle and shared a needle had higher rates of HIV infection than those inmates who reported ever using drugs or using drugs in the month before their current offense."

    Source: 
    Maruschak, Laura M. "HIV In Prisons, 2004," NCJ-213897 (Washington, DC: Department of Justice, Bureau of Justice Statistics, Nov. 2006), p. 10.
    http://www.bjs.gov/content/pub/pdf/hivp04.pdf

  47. (HIV Prevalence Among Prisoners by Offense, 2004) "Inmates held on a property offense in State and Federal prisons had the highest HIV-positive rate (both 2.6%) (table 11). Among State inmates, public-order offenders (0.9%) were least likely to report being HIV positive; among Federal prisoners, drug offenders (0.7%) were least likely to report being HIV positive."

    Source: 
    Maruschak, Laura M. "HIV In Prisons, 2004," NCJ-213897 (Washington, DC: Department of Justice, Bureau of Justice Statistics, Nov. 2006), p. 10.
    http://www.bjs.gov/content/pub/pdf/hivp04.pdf

  48. (HIV/AIDS Death Rate in Prisons, 2001-2010) "The rate of AIDS-related deaths in state prisons among inmates ages 15 to 54 declined sharply between 2001 and 2009, compared to the more modest decline observed among the same age group in the U.S. general population. As a result, the AIDS-related death rate in state prisons fell below the rate in the U.S. general population in 2009. Between 2001 and 2009, the AIDS-related death rate among state prisoners ages 15 to 54 declined from 22 deaths per 100,000 inmates to 6 per 100,000, while the rate among that age group in the general population declined from 9 per 100,000 to 7 per 100,000."

    Source: 
    Maruschak, Laura M., HIV in Prisons, 2001-2010 (Washington, DC: US Dept. of Justice Bureau of Justice Statistics), NCJ238877, Sept. 2012, p. 3.
    http://www.bjs.gov/content/pub/pdf/hivp10.pdf

  49. (HIV and AIDS Cases Among State and Federal Prisoners, 2010) "A reported 20,093 inmates with HIV/AIDS were in custody in state or federal prison at yearend 2010, down from 20,880 at yearend 2009 (table 1).
    "The reported number of state inmates with HIV/AIDS decreased from 19,290 in 2009 to 18,515 in 2010. The number of federal inmates with HIV/AIDS also declined, from 1,590 in 2009 to 1,578 in 2010.
    "California, Florida, New York, and Texas each reported holding more than 1,000 inmates with HIV/AIDS at yearend 2010. These states held 51% (9,492) of all state prisoners with HIV/AIDS.
    "Among state and federal inmates with HIV/AIDS at yearend 2010, 18,337 were male and 1,756 were female, compared to 19,027 male and 1,853 female inmates at yearend 2009 (table 2)."

    Source: 
    Maruschak, Laura M., "HIV in Prisons, 2001-2010" (Washington, DC: US Dept. of Justice Bureau of Justice Statistics), NCJ238877, Sept. 2012, p. 4.
    http://www.bjs.gov/content/pub/pdf/hivp10.pdf

  50. (HIV/AIDS in Prison, 2005) "In each year since 1991, the rate of confirmed AIDS has been higher among prison inmates than in the U.S. general population, but the gap has been narrowing. At yearend 2005, the estimated rate of confirmed AIDS in State and Federal prisons was more than 21⁄2 times higher than in the general population (table 3). In 1999 it was nearly 5 times higher.
    "The shrinking difference between the rate of confirmed AIDS cases in prisons and the general population between 1999 and 2005 resulted from a decrease in the number of confirmed AIDS cases in prisons (down 20%) and an increase in cases (up 44%) among the general population."

    Source: 
    Maruschak, Laura M. "HIV In Prisons, 2005," (Washington, DC: US Dept. of Justice Bureau of Justice Statistics), NCJ218915, Sept. 2007, p. 3.
    http://www.bjs.gov/content/pub/pdf/hivp05.pdf

  51. (AIDS Deaths in Prisons by Region, 2005) "During 2005 an estimated 176 State inmates died from AIDS-related causes, down from 185 in 2004. For every 100,000 State inmates, 13 died from AIDS-related causes. AIDS-related deaths accounted for nearly 1 in 20 deaths reported in State prisons. New York reported the largest number of AIDS-related deaths (19), followed by Florida (17) and California (14). Relative to the number of inmates in custody, the Northeast reported the highest rate of AIDS-related deaths (28 per 100,000 inmates), followed by the South (13 per 100,000 inmates).
    "Among Federal inmates, 27 died from AIDS-related causes in 2005, up from 18 in 2004. For every 100,000 Federal inmates, 15 died from AIDS-related causes. AIDS-related deaths accounted for 7% of all deaths in Federal prisons."

    Source: 
    Maruschak, Laura M. "HIV In Prisons, 2005," (Washington, DC: US Dept. of Justice Bureau of Justice Statistics), NCJ218915, Sept. 2007, p. 1.
    http://www.bjs.gov/content/pub/pdf/hivp05.pdf

  52. (HIV Prevalence in Local Jails by Offense) "Those inmates held for a property offense in local jails reported the highest HIV positive rate (1.8% ) (table 10). Drug offenders reported a slightly lower rate (1.6%). The percentage of public-order offenders who were HIV positive was 1.1%; the percentage of violent offenders, 0.7%."

    Source: 
    Maruschak, Laura M. "HIV In Prisons and Jails, 2002," NCJ-205333 (Washington, DC: Department of Justice, Bureau of Justice Statistics, Dec. 2004), p. 9.
    http://www.bjs.gov/content/pub/pdf/hivpj02.pdf

  53. (HIV in Jails) "Among jail inmates in 2002 who had ever been tested for HIV, Hispanics (2.9%) were more than 3 times as likely as whites (0.8%) and twice as likely as blacks (1.2%) to report being HIV positive."

    Source: 
    Maruschak, Laura M. "HIV In Prisons and Jails, 2002," NCJ-205333 (Washington, DC: Department of Justice, Bureau of Justice Statistics, Dec. 2004), p. 1.
    http://www.bjs.gov/content/pub/pdf/hivpj02.pdf

  54. (AIDS Deaths in Local Jails) "In 2002 the number of AIDS-related deaths in local jails was 42, down from 58 in 2000 (table 11). The rate of AIDS-related deaths was down from 9 per 100,000 inmates in 2000 to 6 per 100,000 in 2002. Of the 42 inmates who died from AIDS-related illnesses in 2002, 38 were male and 4 were female. Those who died from AIDS-related illnesses were most likely black (31 inmate deaths) and between the ages 35 and 44 (21 inmate deaths). Over the 3-year period beginning in 2000, a total of 155 local jail inmates died from AIDS-related causes."

    Source: 
    Maruschak, Laura M. "HIV In Prisons and Jails, 2002," NCJ-205333 (Washington, DC: Department of Justice, Bureau of Justice Statistics, Dec. 2004), p. 10.
    http://www.bjs.gov/content/pub/pdf/hivpj02.pdf

  55. (HIV Prevalence in Local Jails by Drug Use History) "The percentage of jail inmates reporting that they were HIV positive varied by level of prior drug use. Of jail inmates who reported never using drugs, 0.4% were HIV positive. An estimated 1.5% of inmates who had ever used drugs, 1.5% of those who used drugs in the month before their current offense, 3.2% of those who had used a needle to inject drugs, and 7.5% of those who had shared a needle reported being HIV positive."

    Source: 
    Maruschak, Laura M. "HIV In Prisons and Jails, 2002," NCJ-205333 (Washington, DC: Department of Justice, Bureau of Justice Statistics, Dec. 2004), p. 9.
    http://www.bjs.gov/content/pub/pdf/hivpj02.pdf

  56. (HIV Among Jail Inmates) "In personal interviews conducted in 2002, nearly two-thirds of local jail inmates reported ever being tested for HIV; of those, 1.3% disclosed that they were HIV positive."

    Source: 
    Maruschak, Laura M. "HIV In Prisons and Jails, 2002," NCJ-205333 (Washington, DC: Department of Justice, Bureau of Justice Statistics, Dec. 2004), p. 1.
    http://www.bjs.gov/content/pub/pdf/hivpj02.pdf

  57. HIV/AIDS in Russian Federation

    (Prevalence 2008) "Russia now has a 1 percent HIV prevalence rate among its young people and the fastest growing HIV/AIDS epidemic in the world. While the epidemic is still predominantly fuelled by injecting drug users and confined to their ranks, there are clear signs that the epidemic continues to spread to the general population, especially the youth."

    Source: 
    UNODC, "Illicit Drug Trends in the Russian Federation," (UNODC Regional Office for Russia and Belarus, April 2008), p. 6.
    http://www.unodc.org/documents/regional/central-asia/Illicit%20Drug%20Tr...

  58. (HIV Transmission and IDUs in Russia, 2006) "The epidemic disproportionately affects IDUs who comprise 87% of the cumulative number of registered HIV cases, however, with the epidemic becoming more mature, the infection tendency away from IDUs to heterosexual is also increasing with 68% of newly registered cases by the end of 2004 corresponding to IDU and 30% to heterosexuals (In the previous year heterosexual transmission accounted for 23.4% of new infections). The interpretation of the tendency towards less new infections diagnosed is not an indication of a slowing of the epidemic but rather reflective of the changes in HIV testing policy, the smaller number of tests performed in population groups with high-risk behaviors and also a shortage of test kits."

    Source: 
    United Nations Office for Drug Control and Crime, "Illicit Drug Trends in the Russian Federation, 2005" (Moscow, Russian Federation: UNODC Regional Office for Russia and Belarus, November 2006), p. 14.
    http://citeseerx.ist.psu.edu/viewdoc/summary?doi=10.1.1.190.2391

  59. (HIV Infections and IDU) "Eastern Europe, the Commonwealth of Independent States, and significant parts of Asia are experiencing explosive growth in new HIV infections, driven largely by injecting drug use (UNAIDS, 2006). While the primary route of transmission in most of these areas is sharing of contaminated injecting equipment, sexual and perinatal transmission among IDUs [injecting drug users] and their partners also plays an important and growing role. In many highly affected countries, rapid growth in the number of IDUs infected with HIV has already created a public health crisis. Countries where the level of HIV infection is still relatively low have the chance -- if they act now -- to slow the spread of HIV."

    Source: 
    Committee on the Prevention of HIV Infection among Injecting Drug Users in High-Risk Countries, "Preventing HIV Infection among Injecting Drug Users in High Risk Countries: An Assessment of the Evidence" (Washington, DC: National Academy Press, 2006), p. 187.
    http://cart.nap.edu/cart/deliver.cgi?&record_id=11731&free=1