Behavioral risk reduction in a declining HIV epidemic: injection drug users in New York City, 1990-1997

OBJECTIVES: This study assessed trends in HIV risk behaviors among injection drug users in New York City from 1990 to 1997. METHODS: Injection drug users were recruited continuously from a large drug detoxification treatment program (N = 2588) and a research storefront located in a high-drug-use area (N = 2701). Informed consent was obtained, and a trained interviewer administered a structured interview covering sociodemographics, drug use history, HIV risk behavior, and participation in syringe exchange. RESULTS: Trends were assessed for 5 risk behaviors in the 6-month period before the interview. The 3 injection risk behaviors declined significantly over time at each site (all P < .01). When data were pooled across sites, all 5 risk behaviors declined significantly over time (all P < .01). Participation in syringe exchange programs and in HIV counseling and testing increased greatly from 1990 to 1997. CONCLUSIONS: The continuing risk reduction among injection drug users indicates a "declining phase" in the large HIV epidemic in New York City. HIV prevention programs appear to be making an important contribution to the declining phase.