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Don C. Des Jarlais, PhD, Theresa Perlis, PhD, Kamyar Arasteh, PhD, Lucia V. Torian, PhD, Sara Beatrice, PhD, Judith Milliken, BA, Donna Mildvan, MD, Stanley Yancovitz, MD and Samuel R. Friedman, PhD

At the time the research was completed, Don C. Des Jarlais, Theresa Perlis, Judith Milliken, Donna Mildvan, and Stanley Yancovitz were with Beth Israel Medical Center, New York, NY; Lucia V. Torian and Sara Beatrice were with the New York City Department of Health and Mental Hygiene; and Kamyar Arasteh and Samuel R. Friedman were with the National Development and Research Institutes, New York, NY.

Correspondence: Requests for reprints should be to Don C. Des Jarlais, PhD, Beth Israel Medical Center, 1st Ave and 16th St, New York, NY 10003 (e-mail: dcdesjarla{at}aol.com).

Objectives. We sought to estimate HIV incidence among injection drug users (IDUs) in New York City from 1990 to 2002 to assess the impact of an expansion of syringe exchange services. Syringe exchange increased greatly during this period, from 250000 to 3000000 syringes exchanged annually.

Methods. Serum samples were obtained from serial cross-sectional surveys of 3651 IDUs. HIV-positive samples were tested with the Serologic Test Algorithm for Recent HIV Seroconversion (STARHS) assay to identify recent HIV infections and to estimate HIV incidence. Consistency with other incidence studies was used to assess strengths and limitations of STARHS.

Results. HIV incidence declined from 3.55/100 person-years at risk (PYAR) from 1990–1992, to 2.63/100 PYAR from 1993–1995, to 1.05/100 PYAR from 1996–1998, and to 0.77/100 PYAR from 1999–2002 (P<.001). There was a very strong negative linear relationship (r= –.99, P<.005) between the annual numbers of syringes exchanged and estimated HIV incidence. These results were highly consistent with a large number of shorter incidence studies among IDUs conducted during the time period.

Conclusions. STARHS testing of samples from large serial cross-sectional surveys can provide important data for the assessment of community-level HIV prevention.

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