ABSTRACT
With the increasing rates of acquired immunodeficiency syndrome (AIDS) in the United States among intravenous drug users (IVDUs), their sex partners, and their children, intensive prevention and control efforts are needed to curb the spread of the epidemic. IVDUs comprise the second largest risk group for AIDS in the United States and, in New York City, account for more than half of all AIDS-related mortality. They are the major link to spreading the human immunodeficiency virus (HIV) beyond groups with defined highrisk behaviors. The reported number of women who contracted AIDS through heterosexual transmission more than doubled since 1982 (from 12 percent to 30 percent) (Guinan and Hardy 1987; Centers for Disease Control 1988). Since 1981, more than 21,000 IVDUs (27 percent of the cumulative number of AIDS cases nationwide) have been reported with a diagnosis of AIDS. Recent data in New York City and San Francisco indicate that rates of HIV infection are increasing among IVDUs who inject cocaine exclusively (Lambert 1988a). In New York City, the proportion of IVDUs with AIDS is substantially higher, representing 38.3 percent of all New York City cumulative adult cases (New York City Department of Health 1989). A recent review of narcotic-related deaths on New York City death certificates, which were then matched to the New York City Department of Health AIDS Surveillance Registry data, indicates that AIDS has been grossly underreported (Stoneburner et al. 1988). Narcotics-related deaths increased on the average of 32 percent a year between 1981 (n=492) and 1986 (n=1996). Although many of these deaths among IVDUs did not meet the AIDS surveillance case definition, many were caused by conditions suggestive of HIV
infection, such as unspecified pneumonia, endocarditis, and tuberculosis (TB).
