HIV/AIDS & Injection Drug Use (IDU)

Basic Data

(AIDS Diagnoses in the US, 2010) "From 2007 through 2009, the estimated number of persons living with an AIDS diagnosis (AIDS prevalence) increased steadily (Table 16a). At the end of 2009, an estimated 476,732 persons in the United States were living with an AIDS diagnosis."

(AIDS Diagnoses by Transmission Method and Gender, 2010) The CDC estimates that of the 25,186 adult or adolescent males in the US and 6 dependent territories who were diagnosed with AIDS in 2010, 16,935 cases were reportedly transmitted through male-to-male sexual contact, 2,906 were reportedly transmitted through injection drug use, 1,474 were reportedly transmitted through male-to-male sexual contact and injection drug use, 3,738 were reportedly transmitted through heterosexual contact, and 133 were attributed to "other."

The CDC estimates that of the 8,422 adult or adolescent females in the US and 6 dependent territories who were diagnosed with AIDS in 2010, 1,790 cases were reportedly transmitted through injection drug use, 6,506 were reportedly transmitted through heterosexual contact, and 127 were attributed to "other."

(AIDS Deaths by Gender and Method of Transmission, 2009) The CDC estimates that of the 13,179 male adult or adolescent AIDS victims who died in 2009, 6,863 of the cases were reportedly transmitted through male-to-male sexual contact (MSM), 3,030 were reportedly transmitted through injection drug use, 1,498 were reportedly transmitted through male-to-male sexual contact and injection drug use, 1,679 were reportedly transmitted through heterosexual contact, and 109 were attributed to "other."

The CDC estimates that of the 4,550 female adult or adolescent AIDS victims who died in 2009, 1,729 were reportedly transmitted through injection drug use, 2,755 were reportedly transmitted through heterosexual contact, and 66 were attributed to "other."

(Method of Infection, AIDS Diagnoses 2007-2010) "From 2007 through 2010, among adult and adolescent males, the annual number of AIDS diagnoses with infection attributed to male-to-male sexual contact increased. The numbers of AIDS diagnoses with infection attributed to injection drug use or to male-to-male sexual contact and injection drug use decreased. The number of AIDS diagnoses with infection attributed to heterosexual contact remained stable. Among adult and adolescent females, the numbers of AIDS diagnoses with infection attributed to injection drug use or to heterosexual contact decreased."

(AIDS Deaths 2009 and Cumulative) A total of 18,234 persons in the US and dependent areas were estimated to have died from AIDS in 2009. From the beginning of the epidemic through 2009, an estimated 641,976 persons in the US and dependent areas are estimated to have died from AIDS.

(Rate of HIV Diagnoses, 2010) "From 2007 through 2010, the estimated number and the estimated rate of annual diagnoses of HIV infection in the 46 states with confidential name-based HIV infection reporting remained stable (Table 1a). In 2010, the estimated rate of diagnoses of HIV infection in the 46 states was 16.1 per 100,000 population."

(HIV Diagnoses by Method of Transmission) "From 2007 through 2010, 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, those attributed to male-to-male sexual contact and injection drug use, and those attributed to heterosexual contact decreased. Among adult and adolescent females, the number of infections attributed to injection drug use and the number of infections attributed to heterosexual contact decreased. In 2010, diagnosed infections attributed to male-to-male sexual contact (61%) and the infections attributed to heterosexual contact (27%) accounted for approximately 88% of diagnosed HIV infections in the 46 states."

(HIV Deaths by Transmission Method and Gender) The CDC estimates that of the 15,882 male adults or adolescents with a diagnosis of HIV who died in 2009 in 46 states and 5 US dependent territories with confidential name-based HIV infection reporting, 8,298 were reportedly transmitted through male-to-male sexual contact, 3,604 of the cases were reportedly transmitted through injection drug use, 1,729 were transmitted through male-to-male sexual contact and injection drug use, 2,149 were reportedly transmitted through heterosexual contact, and 104 were attributed to "other."

The CDC estimates that of the 5,612 female adults or adolescents with a diagnosis of HIV who died in 46 states and 5 US dependent territories with confidential name-based HIV infection reporting, 2,027 were reportedly transmitted through injection drug use, 3,546 were reportedly transmitted through heterosexual contact, and 39 were attributed to "other."

(AIDS Deaths by Method of Transmission and Gender) "From 2007 through 2009, among adult and adolescent males, the overall rate of deaths remained stable. The numbers of deaths of males with an AIDS diagnosis with infection attributed to male-to-male sexual contact or to male-to-male sexual contact and injection drug use increased. The numbers of deaths of males with infection attributed to injection drug use or to heterosexual contact remained stable. Among adult and adolescent females, the overall rate of deaths remained stable. The number of deaths of females with infection attributed to injection drug use decreased; the number of deaths of females with infection attributed to heterosexual contact remained stable."

(Cumulative AIDS Diagnoses by Transmission Method and Gender, 2010) According to the CDC, from the beginning of the AIDS epidemic through the end of 2010 there have been a total of 1,140,203 cases of AIDS reported in the US and 6 US dependent territories.

The CDC estimates that of the 901,110 adult or adolescent males who received an AIDS diagnosis from the beginning of the epidemic through 2010, 490,588 cases were reportedly transmitted through male-to-male sexual contact, 174,022 were reportedly transmitted through injection drug use, 75,036 were reportedly transmitted through male-to-male sexual contact and injection drug use, 61,937 were reportedly transmitted through heterosexual contact, and 99,527 were attributed to "other."

The CDC estimates that of the 229,245 adult or adolescent females who received an AIDS diagnosis from the beginning of the epidemic through 2010, 74,917 were reportedly transmitted through injection drug use, 105,085 were reportedly transmitted through heterosexual contact, and 49,243 were attributed to "other."

(Trends in HIV Deaths by Transmission Method and Gender) "From 2007 through 2009, among adult and adolescent males, the rate of deaths remained stable. Among males with diagnosed HIV infection attributed to male-to-male sexual contact, those with infection attributed to male-to-male sexual contact and injection drug use, and those with infection attributed to heterosexual contact, deaths increased. Deaths of males with diagnosed HIV infection attributed to injection drug use remained stable. Among adult and adolescent females, the rate of deaths remained stable. The number of deaths of females with infection attributed to heterosexual contact increased; the number of those with infection attributed to injection drug use remained stable."

(Number of Diagnoses and Deaths, 2010) "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."

(Persons diagnosed under age 13) According to the CDC, from the beginning of the AIDS epidemic through the end of 2009 a total of 9,898 cases of AIDS have been reported in the US and dependent territories among children under age 13 at the time of diagnosis.

(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⁾."

(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."

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

(Leading Causes 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."

(HIV and IDU Estimate - Worldwide, 2008) "Moreover, it was estimated that in 2008 there were 16 million injecting drug users worldwide and that 3 million (18.9 per cent) of them were living with HIV, though no new figures are available after 2008."

(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."

(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."

(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

(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."}

(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)."

(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)."

(Mortality and IDU, Worldwide 2010) "It is also estimated that there were between 99,000 and 253,000 deaths globally in 2010 as a result of illicit drug use, with drug-related deaths accounting for between 0.5 and 1.3 per cent of all-cause mortality among those aged 15-64.1 Moreover, it was estimated that in 2008 there were 16 million injecting drug users worldwide and that 3 million (18.9 per cent) of them were living with HIV, though no new figures are available after 2008. Global prevalence of hepatitis C infection among injecting drug users in 2010 was 46.7 per cent, meaning that some 7.4 million injecting drug users worldwide are infected with hepatitis C. And some 2.3 million injecting drug users are infected with hepatitis B. Evidence is also emerging that non-injecting drug use is also associated with an increased risk of HIV infection, principally due to unprotected sex."

(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%."

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

(HIV Transmission and IDUs) "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."

(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.

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."

(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."

(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."

(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"

(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."

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."

(Cannabis and 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."

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."

(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."

(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."

(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."

(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."

(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)."

(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."

(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."

(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%."

(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."

(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."

(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."

(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."

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."

(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, 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."

(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."

(Prevalence of IDUs and HIV/AIDS) "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."

(HIV Transmission and IDUs) "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."

(HIV Prevalence in Prisons) "Being in prison or other state detention is an important risk factor for HIV in Russia. A very high percentage of drug users in the FSU [former Soviet Union] find themselves in state custody at some time in their lives. Injection drug use is reportedly widespread in Russian prisons, and HIV prevention services such as provision of sterile syringes, disinfectant materials for syringes and condoms are virtually absent. Official statistics indicate that from 1996 to 2003, HIV prevalence in Russian prisons rose more than thirty-fold from less than one per 1,000 inmates to 42.1 per 1,000 inmates. According to a 2002 report, about 34,000 HIV-positive persons—over 15 percent of the persons officially counted as HIV-positive in the country—were in state custody, of which the large majority found out about their HIV status in prison. The Kresty pretrial detention facility in Saint Petersburg was reported in 2002 to have about 1,000 HIV-positive persons among its 7,800 inmates. Some 300,000 prisoners are released each year from penal institutions in Russia, representing an important public health challenge."

(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."