Injection Drug Use (IDU) Related Human Immunodeficiency Virus Infection in Rural Vermont: A Comparison with Non-IDU Related Infections

Abstract

SUMMARY The epidemic of HIV infection is spreading into rural areas of the United States. Injection drug use (IDU) is contributing to this spread in a manner similar to that of larger urban areas. The purpose of this paper is to assess the extent that IDU contributes to the HIV epidemic in Vermont and to compare this group of patients to others infected by HIV by non-IDU means. Twenty-three percent of 119 HIV-positive patients attending rural clinics in Vermont identified IDU as the most likely route of their HIV infection. Another 25% were infected by heterosexual contact with someone at risk for HIV. The majority of patients reported that they became infected with HIV outside of Vermont. Over 40% of IDU patients were first diagnosed with HIV after moving to Vermont. Proportionately more women and minorities were HIV infected by IDU when compared to men and white non-Hispanic patients. The great majority of IDUs were unemployed and depended on welfare or disability for financial support. All IDUs had either Medicaid or Medicare. Most IDU patients had advanced HIV infection upon presentation, with 56% having AIDS and 74% having CD4 counts less than 500 cells/mm. IDU is having a large impact on the HIV epidemic in Vermont both medically and economically and is contributing to the growing epidemic in rural America.