Nearly One Fifth of New York City Adults Are Putting Themselves at Risk for HIV Infection

Nearly one fifth (18%) of New York City adults are putting themselves at risk of HIV by having sex with multiple partners or using needles to inject drugs, the Health Department reported today, yet the vast majority (92%) do not think they are at risk. The survey also found that of people with multiple sex partners, most (60%) put themselves at risk by not always using condoms. Compared to national data, sexual risk-taking appears to be more common among New York City adults, but injection drug use appears to be roughly the same.

These new findings come from the city's Health and Nutrition Examination Survey, a 2004 study which used blood tests and computer-based interviews to study behavior and HIV infection in New York City. Full text of the study, published this month online in the journal AIDS, is available to reporters on request. It can be downloaded in abstract or full text at www.aidsonline.com.

The findings highlight common misperceptions about HIV risk and underscore the importance of education and routine HIV testing. "Far too many people are in danger of contracting HIV through risky behavior," said Dr. Thomas R. Frieden, Health Commissioner for New York City. "Reducing the number of sex partners you have and protecting yourself and your partners by consistently using condoms will help you stay safe. We should all know our HIV status, regardless of whether we think we're at risk -- and health care providers should offer this test to their patients."

The new study, whose lead author was Trang Nguyen, is the first in a U.S. city to use a citywide survey of blood samples to estimate HIV prevalence. The findings suggest that approximately 1.4% of New York City adults are infected with HIV -- about the same proportion that past studies have obtained by pooling case reports from hospitals, clinics and doctors' offices. That rate is nearly four times the national rate (0.37%), likely a reflection of a larger population of ethnic minorities and men who have sex with men in New York City -- both groups with higher infection rates.

Disparities in HIV Risk and Infection

In keeping with past surveys, the new study found an especially large HIV burden among men who have sex with other men. Their infection rate was 14%, approximately 38 times the citywide average.

Black and Hispanic New Yorkers have long been disproportionately affected by the HIV epidemic. Indeed, this survey showed that rates of HIV are nearly six times higher among black New Yorkers than white New Yorkers (3.3% versus 0.6%), a trend that has been documented through other surveillance methods since the early 1980s. The HIV rate among Hispanic New Yorkers (1.3%) was more than twice that of whites.

While HIV infection due to injection drug use has declined in New York City since the 1990s, the new study suggests the disease is still common among needle users -- 21% of whom were positive for HIV. "If you are using drugs, get help to stop," added Dr. Frieden. "But protect yourself until you stop by not sharing equipment."

To reduce risky sexual behavior, the Health Department is planning an educational campaign targeting men who have sex with men. The agency also distributes more than 3 million branded NYC Condoms each month.

To reduce transmission among drug users, the Health Department sponsors needle-exchange programs in several boroughs, helps health care providers get their patients off drugs, and contracts with service organizations to provide treatment for addiction. Needle-exchange locations are available at www.nyc.gov/html/doh/downloads/pdf/basas/sep_0707.pdf.

Some Activities Are Riskier Than Others for Contracting HIV

• Sharing needles is very likely to transmit HIV.

• Receptive anal intercourse is the riskiest sexual act -- 5 times riskier than receptive vaginal intercourse and 50 times riskier than receptive oral sex.

• Insertive anal or vaginal intercourse is 10 times riskier than insertive oral sex.

• Oral sex carries some risk for both partners, but is less risky than other penetrative sexual activities.

• Condoms greatly reduce the spread of HIV for both partners in anal, vaginal, and oral sex.

Protect Yourself From Syphilis and Other Sexually Transmitted Infections

If you are sexually active,you can reduce your risk of sexually transmitted diseases (STDs), including HIV, by having sex with only one person you are sure is not infected. If you are having sex outside of such a relationship, reduce your risk:

• Limit the number of people you have sex with. Having more partners increases your risk.

• Always use a latex condom whenever you have sex -- vaginal, anal, or oral. Free NYC Condoms are available throughout New York City. Call 311 to find out where to get them.

• Avoid alcohol and drugs when you have sex. Drinking or getting high makes it much harder to remember to use condoms to protect yourself and others.

• Know your sex partners. Before having sex with someone, ask questions about the person's sexual history. Get yourself and your partner tested for HIV and other STDs.

About the Data

The New York City Health and Nutrition Examination Survey (HANES), modeled after the Centers for Disease Control and Prevention's National Health and Nutrition Examination Survey (NHANES), examined several health conditions in New York City, including diabetes, blood pressure, cholesterol, mercury levels, and depression. The survey was conducted in 2004 in a representative sample of New York City adults 20 years of age or older. Of the 1,999 people enrolled in the survey, 1,626 were included in the risk evaluation and later testing for HIV.