Among all people currently living with HIV in the United States, about 1 in 10 acquired HIV through injection drug use.[1,2] People who inject drugs (PWID) continue to be disproportionately affected by HIV and account for an estimated 7 to 10% of new HIV infections in the United States each year.[1,2] As a consequence of the ongoing opioid epidemic, HIV outbreaks have increased among populations of PWID across the United States and highlight the significant risk of acquiring HIV in this population.[3,4,5,6] The use of HIV preexposure prophylaxis (PrEP) has been shown to be safe and effective for PWID, but it is underutilized in this population.[7,8] Furthermore, many PWID lack access to evidence-based harm reduction and HIV prevention interventions, including syringe service programs and medications for opioid use disorder (MOUD). Expansion of HIV PrEP services for PWID has the potential to markedly reduce new HIV infections among this population, but increased efforts are needed to promote uptake and sustained use of HIV PrEP among PWID. A key component of this process will require expanding the number of health care professionals who are willing to and capable of providing HIV PrEP for PWID. In this lesson, we review the epidemiology of HIV among PWID, discuss evidence and guidance supporting the use of HIV PrEP for PWID, and discuss the implementation of HIV PrEP among PWID.
Prevalence of Injection-Drug Use in the United States
An estimated 3.7 million people in the United States, or 1.5% of the adult population, injected drugs during 2018 (Figure 1).[9] Of the estimated 3.7 million PWID in the United States in 2018, more than 70% were male, 50% were 18-39 years of age, and 80% were non-Hispanic White persons.[9] In 2018, the estimated prevalence of injection drug use among non-Hispanic White adults (1.8%) was nearly double that of Hispanic adults (0.93%) and non-Hispanic Black adults (0.92%).[9]