Search tips
Search criteria 


Logo of pubhealthrepPublic Health Reports
Public Health Rep. 1998 June; 113(Suppl 1): 107–115.
PMCID: PMC1307733

Methadone treatment protects against HIV infection: two decades of experience in the Bronx, New York City.


OBJECTIVE: We undertook a study of the role of methadone maintenance in protecting injecting drug users (IDUs) from human immunodeficiency virus (HIV) infection from the earliest days of the HIV epidemic in New York City to the present. The historical context of the epidemic in the Bronx is discussed. METHODS: For close to two decades, we have been tracking changes in injecting drug use and HIV infection levels in a Bronx cohort study of IDUs. An initial sample of 622 IDUs was recruited from a methadone treatment program in 1985, with historical data going back to 1978. Behavioral interviews and HIV testing were performed and methadone treatment program records (urine toxicology and methadone dose history) were reviewed. We examined both prevalent and incident HIV infections. The sample included African Americans (24.3%), Latinos (50.3%), and white non-Latinos (24.4%). The average methadone dose was 64 milligrams (mg) per day with an average time in treatment of five and a half years. RESULTS: We found a very low rate of incident infection of 1.7 per 100 person-years observation since 1986. Because of this low rate of infection, we were unable to determine the association between methadone treatment factors and HIV seroincidence. We found that our prevalence data on the 622 IDUs enrolled from 1985 to 1988 yielded strong findings on the role of methadone maintenance in a period when most infections occurred in this population. HIV seroprevalence was 42.9%. Logistic regression analysis revealed associations of methadone dose > or = 80 mg (adjusted odds ratio = 3.07/yr, 95% confidence interval (CI): 1.23-7.68) and last year entered methadone treatment (adjusted odds ratio = 1.22/yr, 95% CI: 1.06-1.41) to HIV infection, independent of year of last cocaine injection, needle sharing in shooting galleries, number of IDU sex partners, low income, and African American of Latino ethnicity. CONCLUSIONS: Properly dosed, long-term methadone treatment was found to be a central protective factor in preventing HIV infection from the earliest days of the epidemic in New York City. It is crucial to have high quality drug treatment programs in place before an epidemic draws our attention to the inadequacies through excess and unnecessary morbidity and mortality.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (3.1M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Rosenbaum M. The demedicalization of methadone maintenance. J Psychoactive Drugs. 1995 Apr-Jun;27(2):145–149. [PubMed]
  • Dole VP. Methadone treatment and the acquired immunodeficiency syndrome epidemic. JAMA. 1989 Sep 22;262(12):1681–1682. [PubMed]
  • Dole VP, Nyswander ME, Kreek MJ. Narcotic blockade. Arch Intern Med. 1966 Oct;118(4):304–309. [PubMed]
  • Dole VP. Implications of methadone maintenance for theories of narcotic addiction. JAMA. 1988 Nov 25;260(20):3025–3029. [PubMed]
  • Hartel DM, Schoenbaum EE, Selwyn PA, Kline J, Davenny K, Klein RS, Friedland GH. Heroin use during methadone maintenance treatment: the importance of methadone dose and cocaine use. Am J Public Health. 1995 Jan;85(1):83–88. [PubMed]
  • D'Aunno T, Vaughn TE. Variations in methadone treatment practices. Results from a national study. JAMA. 1992 Jan 8;267(2):253–258. [PubMed]
  • McLellan AT, Arndt IO, Metzger DS, Woody GE, O'Brien CP. The effects of psychosocial services in substance abuse treatment. JAMA. 1993 Apr 21;269(15):1953–1959. [PubMed]
  • Hahn RA, Onorato IM, Jones TS, Dougherty J. Prevalence of HIV infection among intravenous drug users in the United States. JAMA. 1989 May 12;261(18):2677–2684. [PubMed]
  • Metzger DS, Woody GE, McLellan AT, O'Brien CP, Druley P, Navaline H, DePhilippis D, Stolley P, Abrutyn E. Human immunodeficiency virus seroconversion among intravenous drug users in- and out-of-treatment: an 18-month prospective follow-up. J Acquir Immune Defic Syndr. 1993 Sep;6(9):1049–1056. [PubMed]
  • Moss AR, Vranizan K, Gorter R, Bacchetti P, Watters J, Osmond D. HIV seroconversion in intravenous drug users in San Francisco, 1985-1990. AIDS. 1994 Feb;8(2):223–231. [PubMed]
  • Williams AB, McNelly EA, Williams AE, D'Aquila RT. Methadone maintenance treatment and HIV type 1 seroconversion among injecting drug users. AIDS Care. 1992;4(1):35–41. [PubMed]
  • Siddiqui NS, Brown LS, Jr, Meyer TJ, Gonzalez V. Decline in HIV-1 seroprevalence and low seroconversion rate among injecting drug users at a methadone maintenance program in New York City. J Psychoactive Drugs. 1993 Jul-Sep;25(3):245–250. [PubMed]
  • Serpelloni G, Carrieri MP, Rezza G, Morganti S, Gomma M, Binkin N. Methadone treatment as a determinant of HIV risk reduction among injecting drug users: a nested case-control study. AIDS Care. 1994;6(2):215–220. [PubMed]
  • Chaisson RE, Bacchetti P, Osmond D, Brodie B, Sande MA, Moss AR. Cocaine use and HIV infection in intravenous drug users in San Francisco. JAMA. 1989 Jan 27;261(4):561–565. [PubMed]
  • Schoenbaum EE, Hartel DM, Gourevitch MN. Needle exchange use among a cohort of injecting drug users. AIDS. 1996 Dec;10(14):1729–1734. [PubMed]
  • Blower S, Hartel D. HIV, drugs, and ecology. Science. 1989 Dec 8;246(4935):1236–1236. [PubMed]
  • Schoenbaum EE, Hartel D, Selwyn PA, Klein RS, Davenny K, Rogers M, Feiner C, Friedland G. Risk factors for human immunodeficiency virus infection in intravenous drug users. N Engl J Med. 1989 Sep 28;321(13):874–879. [PubMed]
  • Condelli WS, Fairbank JA, Dennis ML, Rachal JV. Cocaine use by clients in methadone programs: significance, scope, and behavioral interventions. J Subst Abuse Treat. 1991;8(4):203–212. [PubMed]
  • Saxon AJ, Calsyn DA, Jackson TR. Longitudinal changes in injection behaviors in a cohort of injection drug users. Addiction. 1994 Feb;89(2):191–202. [PubMed]
  • Meandzija B, O'Connor PG, Fitzgerald B, Rounsaville BJ, Kosten TR. HIV infection and cocaine use in methadone maintained and untreated intravenous drug users. Drug Alcohol Depend. 1994 Oct;36(2):109–113. [PubMed]
  • Anthony JC, Vlahov D, Nelson KE, Cohn S, Astemborski J, Solomon L. New evidence on intravenous cocaine use and the risk of infection with human immunodeficiency virus type 1. Am J Epidemiol. 1991 Nov 15;134(10):1175–1189. [PubMed]
  • Des Jarlais DC, Friedman SR, Novick DM, Sotheran JL, Thomas P, Yancovitz SR, Mildvan D, Weber J, Kreek MJ, Maslansky R. HIV-1 infection among intravenous drug users in Manhattan, New York City, from 1977 through 1987. JAMA. 1989 Feb 17;261(7):1008–1012. [PubMed]
  • Blower SM, Hartel D, Dowlatabadi H, Anderson RM, May RM. Drugs, sex and HIV: a mathematical model for New York City. Philos Trans R Soc Lond B Biol Sci. 1991 Feb 28;331(1260):171–187. [PubMed]
  • Marmor M, Des Jarlais DC, Cohen H, Friedman SR, Beatrice ST, Dubin N, el-Sadr W, Mildvan D, Yancovitz S, Mathur U, et al. Risk factors for infection with human immunodeficiency virus among intravenous drug abusers in New York City. AIDS. 1987 May;1(1):39–44. [PubMed]
  • Des Jarlais DC, Friedman SR, Sotheran JL, Wenston J, Marmor M, Yancovitz SR, Frank B, Beatrice S, Mildvan D. Continuity and change within an HIV epidemic. Injecting drug users in New York City, 1984 through 1992. JAMA. 1994 Jan 12;271(2):121–127. [PubMed]
  • Lurie P, Drucker E. An opportunity lost: HIV infections associated with lack of a national needle-exchange programme in the USA. Lancet. 1997 Mar 1;349(9052):604–608. [PubMed]
  • Fordyce EJ, Blum S, Balanon A, Stoneburner RL. A method for estimating HIV transmission rates among female sex partners of male intravenous drug users. Am J Epidemiol. 1991 Mar 15;133(6):590–598. [PubMed]
  • Wallace R. Urban desertification, public health and public order: 'planned shrinkage', violent death, substance abuse and AIDS in the Bronx. Soc Sci Med. 1990;31(7):801–813. [PubMed]
  • Wallace R. A synergism of plagues: "planned shrinkage," contagious housing destruction, and AIDS in the Bronx. Environ Res. 1988 Oct;47(1):1–33. [PubMed]
  • Alcabes P, Friedland G. Injection drug use and human immunodeficiency virus infection. Clin Infect Dis. 1995 Jun;20(6):1467–1479. [PubMed]
  • Drucker E, Vermund SH. Estimating population prevalence of human immunodeficiency virus infection in urban areas with high rates of intravenous drug use: a model of the Bronx in 1988. Am J Epidemiol. 1989 Jul;130(1):133–142. [PubMed]
  • Hagman G. Methadone maintenance counseling. Definition, principles, components. J Subst Abuse Treat. 1994 Sep-Oct;11(5):405–413. [PubMed]
  • Caplehorn JR, Hartel DM, Irwig L. Measuring and comparing the attitudes and beliefs of staff working in New York methadone maintenance clinics. Subst Use Misuse. 1997 Mar;32(4):399–413. [PubMed]
  • Des Jarlais DC, Paone D, Friedman SR, Peyser N, Newman RG. Regulating controversial programs for unpopular people: methadone maintenance and syringe exchange programs. Am J Public Health. 1995 Nov;85(11):1577–1584. [PubMed]
  • Diaz T, Chu SY, Byers RH, Jr, Hersh BS, Conti L, Rietmeijer CA, Mokotoff E, Fann SA, Boyd D, Iglesias L, et al. The types of drugs used by HIV-infected injection drug users in a multistate surveillance project: implications for intervention. Am J Public Health. 1994 Dec;84(12):1971–1975. [PubMed]

Articles from Public Health Reports are provided here courtesy of SAGE Publications