ArticlePloS one2019
Heroin type, injecting behavior, and HIV transmission. A simulation model of HIV incidence and prevalence.
Article in PloS one, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed.
- Explaining "U-shaped" distributions of population substance use with a simple computational approach.Journal of artificial societies and social simulation : JASSS · 2025Article
- Agent based modelling of blood borne viruses: a scoping review.BMC infectious diseases · 2024Article
- HIV risk perception, pre-exposure prophylaxis (PrEP) awareness, and PrEP initiation intention among women who use drugs.Journal of substance use and addiction treatment · 2023Article
- The introduction of fentanyl on the US-Mexico border: An ethnographic account triangulated with drug checking data from Tijuana.The International journal on drug policy · 2022Article
- Growing racial/ethnic disparities in overdose mortality before and during the COVID-19 pandemic in California.Preventive medicine · 2021Article
- Methodological approaches for the prediction of opioid use-related epidemics in the United States: a narrative review and cross-disciplinary call to action.Translational research : the journal of laboratory and clinical medicine · 2021Review
- Navigating environmental constraints to injection preparation: the use of saliva and other alternatives to sterile water among unstably housed PWID in London.Harm reduction journal · 2020Article
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Authors and funding
6 authors.
Funding
Abstract
BACKGROUND AND
aimsUsing mathematical modeling to illustrate and predict how different heroin source-forms: "black tar" (BTH) and powder heroin (PH) can affect HIV transmission in the context of contrasting injecting practices. By quantifying HIV risk by these two heroin source-types we show how each affects the incidence and prevalence of HIV over time. From 1997 to 2010 PH reaching the United States was manufactured overwhelmingly by Colombian suppliers and distributed in the eastern states of the United States. Recently Mexican cartels that supply the western U.S. states have started to produce PH too, replacing Colombian distribution to the east. This raises the possibility that BTH in the western U.S. may be replaced by PH in the future.
designWe used an agent-based model to evaluate the impact of use of different heroin formulations in high- and low-risk populations of persons who inject drugs (PWID) who use different types of syringes (high vs. low dead space) and injecting practices. We obtained model parameters from peer-reviewed publications and ethnographic research.
resultsHeating of BTH, additional syringe rinsing, and subcutaneous injection can substantially decrease the risk of HIV transmission. Simulation analysis shows that HIV transmission risk may be strongly affected by the type of heroin used. We reproduced historic differences in HIV prevalence and incidence. The protective effect of BTH is much stronger in high-risk compared with low-risk populations. Simulation of future outbreaks show that when PH replaces BTH we expect a long-term overall increase in HIV prevalence. In a population of PWID with mixed low- and high-risk clusters we find that local HIV outbreaks can occur even when the overall prevalence and incidence are low. The results are dependent on evidence-supported assumptions.
conclusionsThe results support harm-reduction measures focused on a reduction in syringe sharing and promoting protective measures of syringe rinsing and drug solution heating.
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