This post is part of a collaborative narrative series composed of my writing and Chris Arnade's photos exploring issues of addiction, poverty, prostitution and urban anthropology in Hunts Point, Bronx. For more on the series, look here.
Background There have been no studies showing that participation in programmes which provide legal access to drug-injection equipment leads to individual-level protection against incident HIV infection. We have compared HIV incidence among injecting drug users participating in syringe-exchange programmes in New York City with that among non-participants.
Findings HIV incidence among continuing exchange-users in the Syringe Exchange Evaluation was 1·58 per 100 person years at risk (95% CI 0·54, 4·65) and among continuing exchange-users in the Vaccine Preparedness Initiative it was 1·38 per 100 person-years at risk (0·23, 4·57). Incidence among non-users of the exchange in the Vaccine Preparedness Initiative was 5·26 per 100 person-years at risk (2·41, 11·49), and in the NADR cities, 6·23 per 100 person-years at risk (4·4, 8·6). In a pooled-data, multivariate proportional-hazards analysis, not using the exchanges was associated with a hazard ratio of 3·35 (95% CI 1·29, 8·65) for incident HIV infection compared with using the exchanges.
Interpretation We observed an individual-level protective effect against HIV infection associated with participation in a syringe-exchange programme. Sterile injection equipment should be legally provided to reduce the risk of HIV infection in persons who inject illicit drugs.¹ (PDF)
Tiffany: Hunts Point, Bronx. Courtesy of Chris Arnade.
You know it's the Virus because her belly protrudes like she's pregnant, he says. He only fools around with her sometimes, and not lately because she's not taking care of herself.
You know it's the Virus because of all the pill bottles he has. That and the government-provided housing, she says.
They have the Virus because they've shared needles in the drug yard since the 80s, the other side of town spins.
Henriette: Hunts Point, Bronx. Courtesy of Chris Arnade.
X's friend has the Virus because he gets desperate enough to pick needles off the ground if he can't find new ones, X says. The next day, X forgets what he says and shoots after him.
What's sick? Everyone's sick with something: the Virus everyone has, in the way no one has it, in the way that it doesn't matter. Clean needles aren't hard to get anymore. HIV is no longer death the way that more immediate things are.
Anyway, the people that Really have it get things paid for by the government: an apartment, a life, a place for their friends to inject away from the streets' eyes. Doesn't that sound nice?
Joette: Hunts Point, Bronx. Courtesy of Chris Arnade.