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Drug users in Amsterdam: are they still at risk for HIV?

Drug users in Amsterdam: are they still at risk for HIV? Nienke van der Knaap, Bart Grady , Maarten Schim van der Loeff, Titia Heijman, Arjen Speksnijder, Ronald Geskus, Maria Prins. Cluster of Infectious Diseases, Public Health Service Amsterdam AIDS 2012, Washington.

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Drug users in Amsterdam: are they still at risk for HIV?

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  1. Drug users in Amsterdam: are they still at risk for HIV? Nienke van der Knaap, Bart Grady, Maarten Schim van der Loeff, Titia Heijman, Arjen Speksnijder, Ronald Geskus, Maria Prins Cluster of Infectious Diseases, Public Health Service Amsterdam AIDS 2012, Washington

  2. Abstract #: A-452-0147-08988 Background • Drug users (DU) are at risk for contracting blood-borne viruses • Harm-reduction programmes contributed to stabilisation or decline of HIV incidence (van den Berg 2007, Crawford 2010) • Between 1985 and 2005 we observed a decline in injecting risk behaviour among DU in Amsterdam (Lindenburg et al. 2006) • However, sexual risk behaviour remained substantial and was considered to be the main risk factor for HIV acquisition

  3. Abstract #: A-452-0147-08988 Objective • To examine whether drug users in Amsterdam are still at risk for HIV • To assess whether there is a need for interventions to reduce sexual risk behaviour.

  4. Methods (1) The Amsterdam Cohort Studies among drug users Open, ongoing cohort study since 1985 Visits every 4-6 months Detailed questionnaires on self-reported sexual risk behavior, (injecting) drug use and Sexual Transmitted Infections (STI) Blood is tested for HIV antibodies and collected for storage Abstract #: A-452-0147-08988

  5. Methods (2) Trends in HIV incidencerate per calendaryear: Person-timetechniques Modelled usingpoissonregression Among all HIV negative DU at ACS entry Trends in sexual and injecting risk behaviour Modelled usinglogisticregression Adjustedfor multiple visits per individual (GEE) STI screeningamong all participantswith a cohort visitbetween November 2010 and June 2011. Chlamydia trachomatis, Neisseriagonorrhoeae, Trepanomapallidum Abstract #: A-452-0147-08988

  6. Results Abstract #: A-452-0147-08988 Baseline characteristics  [b1]geen baseline data  [b2]among those that entered the cohort from 1991? Geen 1658

  7. Results Median follow-up time was 9.2 years (IQR 3.7-14.8) Total follow-up time was 12,921 person-years By December 2011, 464 participants had died During a given calendar year about 93% (IQR 90-95) returned for a follow-up visit the next year 97 participants seroconverted for HIV Abstract #: A-452-0147-08988

  8. HIV incidence Abstract #: A-452-0147-08988

  9. Injecting and sexual risk behaviour Abstract #: A-452-0147-08988

  10. Recent visitors Abstract #: A-452-0147-08988

  11. Determinants of unprotected sex CSW: Commercial Sex Worker

  12. Conclusions Continuing very low HIV incidence rate Injecting risk behavior and sexual risk behaviour are declining over time. Unprotected sex was still substantial in 2011, but mainly among those having a steady partner and being HIV negative STI prevalence was low DU no longer play a role in the spread of HIV in Amsterdam Abstract #: A-452-0147-08988

  13. Acknowledgements All participants from the ACS among drug users Evidence for harm reduction? A. de Vos Session room 8, 17:30 Abstract #: A-452-0147-08988

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