The prevalence of HIV/AIDS among injectors varies widely from region to region in the United States. The highest rates of IDU and HIV are found along the east coast and west coast, in the southwest, Florida, Puerto Rico, and in major metropolitan areas. Overall, of the 48,269 new cases of HIV reported in 1998, more than 50 percent were IDU-associated (Centers for Disease Control and Prevention, 1999). The prevalence of HIV infection is also related to the social context of needle sharing. In areas where injectors go to ''shooting galleries''—where anyone using a previously used needle may not know who else used the needle— there are generally high rates of HIV infection. Conversely, in areas where the IDU social network is well known and only a limited number share works with one another, the infection rate is lower (Leukefeld et al., 1991).

While IDUs with HIV infection are predominantly males of color (Hispanics and African-Americans) in their late twenties and early thirties, variations and exceptions are noted and reflect dynamics in individual metropolitan areas. In 1989, the highest prevalence of IDUs in drug treatment centers who tested positive for HIV were in the Middle Atlantic states (New York, New Jersey, and Pennsylvania), where the overall rate for HIV-positive intravenous drug using men and women in treatment was 44 percent (Centers for Disease Control, 1990b).

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