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Home » Chapters » HIV and Injection Drug Use
HIV and Injection Drug Use
Injection Drug Use, Race, and HIV
Supervised Consumption Spaces
Syringe Service Programs
Page last updated Oct. 28, 2021 by Doug McVay, Editor.
1. Total Number of People in the US Living with HIV
"The first cases of Pneumocystis carinii(jirovecii) pneumonia among young men, which were subsequently linked to HIV infection, were reported in the MMWR on June 5, 1981 (1). At year-end 2019, an estimated 1.2 million persons in the United States were living with HIV infection (2)."
Bosh, K. A., Hall, H. I., Eastham, L., Daskalakis, D. C., & Mermin, J. H. (2021). Estimated Annual Number of HIV Infections ─ United States, 1981-2019. MMWR. Morbidity and mortality weekly report, 70(22), 801–806.
2. HIV Infection and HIV-Associated Behaviors Among People Who Inject Drugs In The US
"In the United States, 10% of HIV infections diagnosed in 2018 were attributed to unsafe injection drug use or male-tomale sexual contact among persons who inject drugs (PWID) (1). In 2017, among PWID or men who have sex with men and who inject drugs (MSM-ID), 76% of those who received a diagnosis of HIV infection lived in urban areas* (2). To monitor the prevalence of HIV infection and associated behaviors among persons who reported injecting drugs in the past 12 months, including MSM-ID, CDC's National HIV Behavioral Surveillance (NHBS) conducts interviews and HIV testing among populations of persons at high risk for HIV infection (MSM, PWID, and heterosexually active adults at increased risk for HIV infection) in selected metropolitan statistical areas (MSAs) (3). The estimated HIV infection prevalence among PWID in 23 MSAs surveyed in 2018 was 7%. Among HIV-negative PWID, an estimated 26% receptively shared syringes and 68% had condomless vaginal sex during the preceding 12 months. During the same period, 57% had been tested for HIV infection, and 55% received syringes from a syringe services program (SSP). While overall SSP use did not significantly change since 2015, a substantial decrease in SSP use occurred among Black PWID, and HIV prevalence among Black PWID was higher than that among Hispanic and White PWID. These findings underscore the importance of continuing and expanding HIV prevention programs and community-based strategies for PWID, such as those provided by SSPs, especially following service disruptions created by the COVID-19 pandemic (4). Efforts are needed to ensure that PWID have low-barrier access to comprehensive and integrated needs-based SSPs (where legally permissible) that include provision of sterile syringes and safe syringe disposal, HIV and hepatitis C virus (HCV) testing and referrals to HIV and HCV treatment, HIV pre-exposure prophylaxis, and treatment for substance use and mental health disorders."
Handanagic S, Finlayson T, Burnett JC, Broz D, Wejnert C. HIV Infection and HIV-Associated Behaviors Among Persons Who Inject Drugs — 23 Metropolitan Statistical Areas, United States, 2018. MMWR Morb Mortal Wkly Rep 2021;70:1459–1465. DOI: dx.doi.org/10.15585/mmwr.mm7042a1
3. HIV Prevalence Among People Who Use Drugs In Selected Metropolitan Statistical Areas
"From 2015 to 2018, HIV prevalence among PWID [People Who Inject Drugs] in selected MSAs [Metropolitan Statistical Areas] was unchanged at 7%. This analysis found a higher HIV prevalence among Black PWID than among Hispanic or White PWID, despite fewer reported risk behaviors associated with HIV infection among Black PWID. In 2018, when compared with Hispanic or White PWID, fewer Black PWID shared syringes or injection equipment and had condomless anal sex. Overall, SSP use did not significantly increase since 2015 (from 52% to 55%), but a substantial decrease in SSP use among Black PWID (from 51% to 40%), and significantly lower use of SSPs in 2018 among Black PWID compared with Hispanic and White PWID was observed. Lower SSP use among Black PWID in the context of disproportionally higher rates of HIV diagnoses in Black communities (1) might lead to increased risk for HIV transmission among Black PWID. It is critical to explore and address the causes for these disparities in SSP use and HIV infection rates.
"In 2020, the COVID-19 pandemic impeded delivery of prevention services for PWID nationally, resulting in a substantial reduction in SSP operations and provision of medication for opioid use disorder (4). This analysis highlights the ongoing need for risk reduction and improved access to HIV prevention services among PWID than existed before the COVID-19 pandemic, especially because access to these services was reduced as a result of the pandemic. Findings from this analysis and continuous monitoring of characteristics and risk behaviors associated with HIV infection of PWID will facilitate estimation of how the pandemic disrupted behaviors as well as access to essential prevention services among PWID."
Handanagic S, Finlayson T, Burnett JC, Broz D, Wejnert C. HIV Infection and HIV-Associated Behaviors Among Persons Who Inject Drugs — 23 Metropolitan Statistical Areas, United States, 2018. MMWR Morb Mortal Wkly Rep 2021;70:1459–1465. DOI: dx.doi.org/10.15585/mmwr.mm7042a1.
4. Total Number of People Living with HIV in the US
"From 2014 through 2018 in the United States and 6 dependent areas, the number and rate of persons living with diagnosed HIV infection increased (Table 14b). At year-end 2018 in the United States and 6 dependent areas, 1,040,352 adults and adolescents were living with diagnosed HIV infection (Figure 9). The prevalence of diagnosed HIV infection was 374.6 per 100,000 population. From 2014 through 2018, by region, the rates of persons living with HIV in the Midwest, South, and West increased (Tables 14a and 14b). The rate in the Northeast remained stable. The largest percentage increase in the rate (11%) was in the Midwest (from 162.7 in 2014 to 179.8 in 2018). At year-end 2018, the rate was highest in the Northeast at 420.5, followed by 371.6 in the South, 260.7 in the West, and 179.8 in the Midwest (Tables 14a and 14b). Data for the year 2018 are preliminary and based on deaths reported to CDC through December 2019."
Centers for Disease Control and Prevention. HIV Surveillance Report, 2018 (Updated); vol. 31. Published May 2020. Last accessed June 8, 2020.
5. Total Number of People Living with HIV in the US, by Age, Gender, and Race/Ethnicity
"• Gender: From 2014 through 2018 in the United States and 6 dependent areas, the largest percentage increase (24%) in the number of persons living with diagnosed HIV infection was among transgender MTF (Table 14b). At year-end 2018, the largest percentage (75%) of persons living with diagnosed HIV infection were male, followed by females (24%) (Table 14b). Transgender MTF, transgender FTM, and AGI each accounted for less than 1%.
"• Age group: From 2014 through 2018 in the United States and 6 dependent areas, the largest percentage increase (51%) in the rate of persons living with diagnosed HIV infection was among persons aged 65 years and older (from 130.0 in 2014 to 196.6 in 2018) (Table 14b). At year-end 2018, persons aged 50–54 years made up the largest percentage (15%) of persons living with diagnosed HIV (Table 14b). The highest rate (762.6) was among persons aged 50–54 years, followed by those aged 55–59 years (704.3), and those aged 45–49 years (600.0).
"• Race/ethnicity: At year-end 2018 in the United States, the highest rate (1,034.2) and the largest percentage (41%) were those for blacks/African Americans (Table 14a). Among the remaining race/ethnicity groups, the rates were 665.7 for persons of multiple races, 386.4 for Hispanics/Latinos, 154.0 for whites, 150.3 for Native Hawaiians/other Pacific Islanders, 129.6 for American Indians/Alaska Natives, and 80.9 for Asians.
"At the end of 2018, 1,040,352 adults and adolescents were living with diagnosed HIV infection in the United States and 6 dependent areas (Figure 10). Among 795,198 males living with diagnosed HIV infection, 35% were black/African American, 33% were white, 25% were Hispanic/Latino, 5% were males of multiple races, and 2% were Asian. Less than 1% each were American Indian/Alaska Native and Native Hawaiian/other Pacific Islander. Among 245,154 females living with diagnosed HIV infection, 58% were black/African American, 20% were Hispanic/Latino, 16% were white, 5% were females of multiple races, and 1% were Asian. Less than 1% each were American Indian/Alaska Native and Native Hawaiian/other Pacific Islander."
6. People Who Use Drugs Living with HIV in the US, by Region and Race/Ethnicity
"Region and race/ethnicity: In 2018 in the United States and 6 dependent areas, 2,492 diagnosed HIV infections were among PWID. Of these, the largest number of HIV infection diagnoses were in the South (976), followed by the Northeast (595) (Figure 19). In all regions, the largest percentage of diagnosed HIV infections among PWID was among whites. In the South, whites accounted for 436 diagnosed HIV infections among PWID (45%), blacks/African Americans accounted for 359 (37%), and Hispanics/Latinos accounted for 143 (15%) (Table 6b). In the Northeast, whites accounted for 212 diagnosed HIV infections among PWID (36%), blacks/African Americans accounted for 206 (35%), and Hispanics/Latinos accounted for 152 (26%). Please use caution when interpreting data for American Indian/Alaska Native, Asian, and Native Hawaiian/other Pacific Islander PWID, and persons of multiple races who inject drugs: the numbers are small."
7. People Who Inject Drugs and HIV
"This report describes data from 11,437 PWID who participated in NHBS in 2018, of whom 69% identified as male, 30% female, and 1% transgender; 39% were white, 33% were black, and 21% were Hispanic or Latino; 36% were aged ≥50 years (Table 1). Among all participants, 26% had no health insurance, 21% had not visited a health care provider, and the household income of 75% of participants was at or below the federal poverty level.
"In 2018, 6% of participants with a valid NHBS HIV test result tested positive for HIV (Table 2). By gender, HIV prevalence was as follows: 6% among males, 6% among females, and 28% among transgender. By race and ethnicity, HIV prevalence was as follows: 9% among blacks, 8% among Hispanics or Latinos, and 4% among whites.
"CDC recommends that persons at increased risk of HIV infection, including PWID, undergo HIV testing at least annually [10]. Among participants who did not report a previous HIV-positive test result or who had received their first HIV-positive test result less than 12 months before the interview, 55% reported that they had been tested for HIV in the 12 months before the interview, and 90% reported that they had ever been tested (Table 3).
"Among participants who reported being tested for HIV in the 12 months before the interview, 66% reported their most recent test was performed in a clinical setting while 29% reported being tested in a nonclinical setting, such as an HIV counseling and testing site, an HIV street outreach program or mobile unit, a SSP, or at home (Table 4)."
Centers for Disease Control and Prevention. HIV Infection Risk, Prevention, and Testing Behaviors among Persons Who Inject Drugs—National HIV Behavioral Surveillance: Injection Drug Use, 23 U.S. Cities, 2018. HIV Surveillance Special Report 24. Published February 2020.
8. Prevalence of Diagnosed HIV Infection in the US by Method of Transmission
"Sex (at birth) and transmission category: From 2014 through 2018 in the United States and 6 dependent areas, the annual percentage of diagnoses of HIV infection among adults and adolescents attributed to male-to-male sexual contact accounted for over 65% of diagnoses (Figure 5 and Table 1b). From 2014 through 2018 in the United States and 6 dependent areas, among male adults and adolescents, the annual number of diagnosed HIV infections attributed to injection drug use increased (Table 1b). The number of infections attributed to male-to-male sexual contact and heterosexual contact decreased. The number of infections attributed to male-to-male sexual contact and IDU [Injection Drug Use] remained stable. The perinatal and "Other" transmission categories accounted for less than 1% of cases. Among female adults and adolescents, the number of infections attributed to IDU increased. The number of infections attributed to heterosexual contact decreased. The perinatal and "Other" transmission categories accounted for less than 1% of cases."
9. Estimated Prevalence of People Who Inject Drugs (PWID) in the US
"Overall, the number of PWID per 10,000 persons aged 15–64 years varied from 31 to 345 across MSAs [Metropolitan Statistical Areas], median 104.4 (mean 127.4; standard deviation 66.7; percentile range 76–162) in 1992 and from 34 to 324 across MSAs, median 91.5 (mean 103.6; standard deviation 56.4; percentile range 61–125 ) in 2007 indicating an overall decline in PWID prevalence across MSAs.
"Figure 5 shows the overall trajectory of the PWID prevalence rates based on the multilevel model. Trend analysis of the overall results is consistent with a decline in the early study period, followed by an increase in 2000–02, and then remaining stable thereafter over time. On average there has been very little change since 2002 (mean 105.0) to 2007 (mean 103.6). Overall, across the 96 MSAs the mean PWID prevalence mostly decreased during our study period, as did the dispersion of estimates over time."
Tempalski B, Pouget ER, Cleland CM, Brady JE, Cooper HLF, et al. (2013). Trends in the Population Prevalence of People Who Inject Drugs in US Metropolitan Areas 1992–2007. PLoS ONE 8(6): e64789. doi:10.1371/journal.pone.0064789
10. Total Number of People Who Inject Drugs Worldwide
"There are an estimated 15.6 million people who inject drugs (PWID) globally (3.2 million women and 12.5 million men). Among these persons, an estimated 17.8% are living with HIV, 52.3% are Hepatitis C (HCV)-antibody positive, and 9.1% are Hepatitis B (HBV) surface antigen positive [1]. PWID are also at high risk for skin and soft tissue infections and infective endocarditis [2–5]. In addition, injection drug use increases risks for fatal and nonfatal overdose [6–9]. Global estimates suggest that 82.9% of PWID primarily inject opioids, underscoring the urgency of implementing evidence-based response strategies to mitigate the range of adverse consequences associated with the opioid crisis [1]."
Allen ST, Schneider KE, Mazhnaya A, White RH, O'Rourke A, Kral AH, Bluthenthal RN, Kilkenny ME, Sherman SG. Factors Associated with Likelihood of Initiating Others into Injection Drug Use Among People Who Inject Drugs in West Virginia. AIDS Behav. 2021 Jun 2:1–10. doi: 10.1007/s10461-021-03325-6. Epub ahead of print. PMID: 34076812; PMCID: PMC8170059.
11. Global Progress in Controlling HIV-AIDS Related to Injection Drug Use
"The world is not on track to reduce HIV transmission among people who inject drugs by 50%, as recent evidence suggests little change in the HIV burden in this population. HIV prevalence among people who inject drugs remains high – up to 28% in Asia. HIV prevention coverage for people who inject drugs remains low, with only two of 32 reporting countries providing the recommended minimum of at least 200 sterile syringes per year for each person who injects drugs. Among 35 countries providing data in 2013, all but four reached less than 10% of opiate users with substitution therapy. In addition to exceptionally low coverage, an effective AIDS response among people who inject drugs is undermined by punitive policy frameworks and law enforcement practices, which discourage individuals from seeking the health and social services they need."
"Global Report: UNAIDS Report on the Global AIDS Epidemic 2013," Joint United Nations Programme on HIV/AIDS, Sept. 2013, pp. 5-6.
http://www.unaids.org/en/media...
12. Drug-Related Mortality Worldwide
"Of the estimated 585,000 deaths attributed to drug use in 2017, half are attributed to liver cancer, cirrhosis and other chronic liver diseases related to hepatitis C, which remains mostly untreated among PWID. Deaths attributed to drug use disorders (167,000) account for 28 per cent of all deaths resulting from drug use; 110,000 or 66 per cent of those deaths are attributable to opioids. Over the past decade, the total number of deaths attributed to drug use has increased by a quarter, with a major increase in deaths caused by opioid use disorders (71 per cent increase), followed by cirrhosis and other chronic liver diseases (55 per cent increase) and liver cancer (46 per cent) resulting from hepatitis C.
"The comparison of deaths attributed to drug use among men and women over the past decade shows that the number of deaths attributed to drug use disorders, in particular opioid use disorders, has increased disproportionately among women, with a 92 per cent increase in deaths attributed to opioid use disorders among women compared with a 63 per cent increase among men."
World Drug Report 2020 (United Nations publication, Sales No. E.20.XI.6).
13. Prevalence of Injection Drug Use Among Young Adults Aged 21-30 in the US
"• In the fifteen-year (2004–2018) combined samples of young adults aged 21–30, 1.5% report having ever used any drug by injection not under a doctor's orders, and 0.5% reported doing so on 40 or more occasions (Table 4-1a). Thus, about 1 in every 67 respondents has ever used an illicit drug by injection, and about 1 in every 200 respondents reports an extended pattern of use as indicated by use on 40 or more occasions. There are appreciable gender differences—2.2% of males vs. 0.9% of females indicate ever injecting a drug (p<.001), and the percentages saying they injected on 40 or more occasions are 0.7% for males and 0.3% for females (p<.001). The percentages of young adults who have injected drugs during the past 12 months without medical supervision are considerably smaller: 0.5% overall—1 in every 200 respondents—including 0.8% of males and 0.3% of females (p<.001). The percentages using 40 or more times in the past 12 months are 0.2% overall—0.3% for males and 0.1% for females."
Johnston, L. D., O'Malley, P. M., Bachman, J. G., Schulenberg, J. E., Patrick, M. E., & Miech, R. A. (2019). HIV/AIDS: Risk & Protective Behaviors among Adults Ages 21 to 30 in the U.S., 2004–2018. Ann Arbor: Institute for Social Research, The University of Michigan.
http://monitoringthefuture.org...
14. Prevalence of Needle Sharing Among Young Adults Aged 21-30 in the US
"• The proportions of 21- to 30-year-olds who say they have ever shared needles in this way during their lifetime are 0.5% overall—0.6% of males and 0.4% of females (bottom of Table 4-1). As noted in the previous section, 1.5% of the full samples say they have ever injected a drug, so this indicates that a minority—but still a third (0.5%/1.5%)—of the people injecting any of the several drug classes mentioned in the question (heroin, cocaine, amphetamines, and/or steroids) shared a needle at some time.
"• The proportion of 21- to 30-year-olds who reported that they shared needles in the prior 12 months is 0.2%, with no significant gender difference. This compares to 0.5% who said that they have injected a drug in the prior 12 months, so about two fifths of past year injectors shared a needle at least once during the year.
"• Of respondents age 21-30, almost half of females who have injected in their lifetime reported having shared needles (0.4%/0.9%), compared to a little more than one-fourth of male injectors (0.6%/2.2%), suggesting that young adult female injectors are more at risk due to needle sharing. It seems likely that the rates are underestimates for the entire population in this age group due to the omission of high school dropouts, the likelihood that drug-addicted users would be more likely than average to leave the study, and the possibility of some underreporting of this behavior. But while the prevalence of needle sharing is low, it can still translate to sizable numbers of people engaging in shared needle use. An estimated 45 million Americans were between ages 20 and 29 in 2017 (US Census Bureau, 2018); just 0.5% of this group would be approximately 225,000 individuals.
"• To summarize, while young adult men are more likely to inject drugs than their female counterparts, they are only slightly more likely to share needles."
15. Estimated Prevalence of HIV Related To Injection Drug Use Worldwide
"Injecting drug use is estimated to account for approximately 10 per cent of HIV infections worldwide and 30 per cent of all HIV cases outside Africa,113 while in the eastern countries of the WHO European Region114 more than 80 per cent of all HIV infections occur among PWID [People Who Inject Drugs].115 PWID are estimated to be 22 times more likely than people in the general population to be living with HIV.116
"The 2018 joint UNODC/WHO/UNAIDS/World Bank estimate of the global prevalence of HIV among PWID is 12.6 per cent, amounting to 1.4 million PWID living with HIV. This estimate is based on reporting of the prevalence of HIV among PWID by 121 countries, covering 96 per cent of the estimated global number of PWID. Data on HIV prevalence were available for all PWID in North America, South-West Asia, South Asia, Eastern Europe and South-Eastern Europe, but only for 33 and 32 per cent of all PWID in Central America and the Caribbean, respectively. Of all the countries that provided details of the methodology used to collect their data and estimate the prevalence of HIV, almost three quarters (reports from 89 countries) could be graded as "class A methodology" (seroprevalence study).117 In 2018, new or updated estimates of HIV among PWID were available for a total of 40 countries.
"The subregional prevalence of HIV among PWID continues to be the highest by far in South-West Asia (29.5 per cent) and Eastern Europe (25.2 per cent), followed by Southern Africa (21.4 per cent). In Africa, the HIV prevalence among PWID aged 15–64 was estimated at 11.3 per cent, compared with 3.9 per cent among the general population (aged 15–49) for the same year. In Europe, the HIV prevalence among PWID was 20.2 per cent, compared with 0.4 per cent among the general population.118 HIV prevalence in PWID in East Africa and the Caribbean was also higher than the global average, at 17.4 and 14.0 per cent, respectively.
"The largest number of PWID living with HIV reside in Eastern Europe, East and South-East Asia and South-West Asia, which together account for 67 per cent of the global total. Although the prevalence of HIV among PWID (9.3 per cent) is below the global average, a fifth of the global number of PWID living with HIV reside in East and South-East Asia. A small number of countries continue to account for a large proportion of the total global number of PWID living with HIV. In 2018, for example, PWID living with HIV in China, Pakistan and the Russian Federation accounted for almost half of the global total (49 per cent), while PWID in those three countries comprise only a third of all PWID worldwide."
World Drug Report 2020. Booklet Two: Drug Use and Health Consequences. June 2020. United Nations publication, Sales No. E.20.XI.6).
https://wdr.unodc.org/wdr2020/
16. Global Review Shows Most Countries Lack Adequate HIV Prevention Resources
"A systematic review undertaken in 2017 of the coverage of interventions to prevent and manage HIV and hepatitis C among PWID showed that needle and syringe programmes were available in only 52 per cent of countries where injecting drug use was reported, while opioid substitution therapy was confirmed to be available in 48 per cent of countries worldwide. In addition, only 34 countries were identified as providing HIV-testing programmes for PWID.119 Besides providing an opportunity to deliver prevention messages and connect patients to health-care and support services, HIV testing services are also a critical entry point to antiretroviral therapy and are therefore a crucial component of HIV prevention programmes. Global data on antiretroviral therapy coverage are scarce. Access to antiretroviral therapy varies considerably, but coverage is reported to be consistently low, with only 8 per cent of people in need receiving effective antiretroviral therapy in the WHO European Region and PWID only accounting for 20 per cent of people receiving that therapy.120"
17. HIV as a Leading Cause of Death in the US
According to the CDC, Human Immunodeficiency Virus (HIV) disease was the ninth leading cause of death in the US among all people aged 25-34, the eighth leading cause of death among males aged 25-34, and the tenth leading cause of death among males aged 35-44.
Heron M. Deaths: Leading causes for 2018. National Vital Statistics Reports; vol 70 no 4. Hyattsville, MD: National Center for Health Statistics. 2021. doi.org/10.15620/cdc:104186.
18. HIV as a Leading Cause of Death among Black People in the US
According to the CDC, Human Immunodeficiency Virus (HIV) disease was the eighth leading cause of death among Black people in the US aged 20-24, the sixth leading cause among Black people aged 35-44, and the eighth among Black people aged 45-54.
HIV disease was the sixth leading cause of death among Black males in the US aged 20-24, the sixth leading cause among Black males aged 25-34, the eighth leading cause among Black males aged 35-44, and the eighth leading cause among Black males aged 45-54.
HIV disease was the ninth leading cause of death among Black females in the US aged 25-34, the seventh leading cause among Black females aged 35-44, and the tenth leading cause among Black females aged 45-54.
19. Estimated Number of People Who Inject Drugs Worldwide
"The joint UNODC/WHO/UNAIDS/World Bank estimate of the number of PWID worldwide in 2018 is 11.3 million (range: 8.9 million to 15.3 million), corresponding to 0.23 per cent (range: 0.18 to 0.31 per cent) of the population aged 15–64. This estimate is based on the most recent information available and assessment of the methodologies of the different sources.108
"There is no change between the 2017 and 2018 estimates of PWID; however, any trend data must be viewed with caution, as methodologies may have changed. The 2018 global estimate of PWID is based on 122 countries, representing almost 90 per cent of the global population aged 15–64, compared with 110 countries in 2017. Of all the available sources in 2018, the estimates for at least 74 countries (61 per cent) were based on a "class A methodology" such as indirect prevalence estimation methods (e.g., the capture-recapture method, network scale-up method and multiplier method).109
"Owing to the criminalization of drug use, punitive laws, stigma and discrimination against people who use or inject drugs in many parts of the world, conventional survey methods have been found to underestimate the actual population size because of the hidden nature of PWID;110, 111, 112 therefore, only indirect methods have been shown to reflect the situation of PWID with greater accuracy. Overall, new or updated estimates of PWID were available for 40 countries in 2018.
"Although the exact extent of injecting drug use is not known, estimates are more precise in some regions than others as a result of better data coverage and/or methodologies and the use of more recent data. Data on PWID vary between the regions in terms of coverage of the total population aged 15–64, with Asia having the highest coverage, at 95 per cent, and Africa having the lowest, at 68 per cent. At the subregional level, North America, South-West Asia, South Asia, Eastern Europe and South-Eastern Europe are fully covered, whereas data on PWID in the Caribbean only covers just over one third of the total population; therefore, data from that subregion must be interpreted with caution. Compared with 2017, coverage of the population in Africa increased substantially overall, from 58 to 68 per cent in 2018.
"The prevalence of PWID aged 15–64 in 2018 continues to be the highest in Eastern Europe (1.26 per cent) and Central Asia and Transcaucasia (0.63 per
cent). Those percentages are, respectively, 5.5 and 2.8 times higher than the global average. More than a quarter of all PWID reside in East and South-East
Asia, although the prevalence itself is relatively low (0.19 per cent). The three subregions with the largest numbers of PWID (East and South-East Asia, North America and Eastern Europe) together account for over half (58 per cent) of the global number of PWID. It is noteworthy that, as in previous years, while three countries – China, the Russian Federation and the United States – account for just 27 per cent of the global population aged 15–64, they are home to almost half (43 per cent) of all PWID."
20. Global Prevalence of Injection Drug Use-Related HIV
"Injecting drug use is estimated to account for approximately 10 per cent of HIV infections worldwide and 30 per cent of all HIV cases outside Africa,113 while in the eastern countries of the WHO European Region114 more than 80 per cent of all HIV infections occur among PWID.115 PWID are estimated to be 22 times more likely than people in the general population to be living with HIV.116
"The 2018 joint UNODC/WHO/UNAIDS/World Bank estimate of the global prevalence of HIV among PWID is 12.6 per cent, amounting to 1.4 million PWID living with HIV. This estimate is based on reporting of the prevalence of HIV among PWID by 121 countries, covering 96 per cent of the estimated global number of PWID. Data on HIV prevalence were available for all PWID in North America, South-West Asia, South Asia, Eastern Europe and South-Eastern Europe, but only for 33 and 32 per cent of all PWID in Central America and the Caribbean, respectively. Of all the countries that provided details of the methodology used to collect their data and estimate the prevalence of HIV, almost three quarters (reports from 89 countries) could be graded as "class A methodology" (seroprevalence study).117 In 2018, new or updated estimates of HIV among PWID were available for a total of 40 countries."
21. Global Prevalence of Injection Drug Use
"There is no change between the 2017 and 2018 estimates of PWID; however, any trend data must be viewed with caution, as methodologies may have changed. The 2018 global estimate of PWID is based on 122 countries, representing almost 90 per cent of the global population aged 15–64, compared with 110 countries in 2017. Of all the available sources in 2018, the estimates for at least 74 countries (61 per cent) were based on a "class A methodology" such as indirect prevalence estimation methods (e.g., the capture-recapture method, network scale-up method and multiplier method).109 Owing to the criminalization of drug use, punitive laws, stigma and discrimination against people who use or inject drugs in many parts of the world, conventional survey methods have been found to underestimate the actual population size because of the hidden nature of PWID;110, 111, 112 therefore, only indirect methods have been shown to reflect the situation of PWID with greater accuracy. Overall, new or updated estimates of PWID were available for 40 countries in 2018.
"Although the exact extent of injecting drug use is not known, estimates are more precise in some regions than others as a result of better data coverage and/or methodologies and the use of more recent data. Data on PWID vary between the regions in terms of coverage of the total population aged 15–64, with Asia having the highest coverage, at 95 per cent, and Africa having the lowest, at 68 per cent. At the subregional level, North America, South-West Asia, South Asia, Eastern Europe and South-Eastern Europe are fully covered, whereas data on PWID in the Caribbean only covers just over one third of the total population; therefore, data from that subregion must be interpreted with caution. Compared with 2017, coverage of the population in Africa increased substantially overall, from 58 to 68 per cent in 2018."
22. HIV Prevention, Treatment, and Care Services
"Despite the fact that injecting drug use has led to the widespread transmission of HIV worldwide, the provision of HIV prevention, treatment, and care services to IDU populations remains dismally low. In 2009, only 8 per cent of injecting drug users worldwide enjoyed access to HIV prevention services of any kind, while substitution therapy–i.e. offering users methadone instead of heroin–is permitted in only 70 countries. Needle and syringe exchange programmes are available in only 82 countries."
"Out of harm's way: Injecting drug users and harm reduction" International Federation of Red Cross and Red Crescent Societies (Geneva, Switzerland: December 2010), p. 12.
https://ifrc.org/Global/Public...
23. HIV Transmission and Injection Drug Use in Russia
"In 2002, an estimated 93 percent of persons registered by the government as HIV positive since the beginning of the epidemic were injection drug users. In contrast, in 2002 an estimated 12 percent of new HIV transmission was sexual -- that figure climbed to 17.5 percent in the first half of 2003 -- indicating the foothold that the epidemic is gaining in the general population. The European Centre for the Epidemiological Monitoring of AIDS (EuroHIV), a center affiliated with the World Health Organization, noted that HIV prevalence may have 'reached saturation levels in at least some of the currently affected drug user populations' in eastern Europe, including in Russia, but cautioned against complacency 'as new outbreaks could still emerge among injection drug users…, particularly within the vast expanse of the Russian Federation.' Rhodes and colleagues in a February 2004 article echo this conclusion, noting evidence of recent examples of severe HIV outbreaks among drug users in Russia."
Human Rights Watch, "Lessons Not Learned: Human Rights Abuses and HIV/AIDS in the Russian Federation," (New York, NY: April 2004) Vol. 16, No. 5, p. 10.
http://www.hrw.org/sites/defau...
24. Annual Rate of HIV Diagnoses in the US
From 2014 through 2018, the annual number and rate of diagnoses of HIV infection in the United States and 6 dependent areas decreased (Table 1b). In the United States and 6 dependent areas, the overall rate in 2018 was 11.5; among adults and adolescents, the rate was 13.6 (Figure 1). From 2014 through 2018, by region, the rate of diagnoses of HIV infection in all regions decreased. In 2018, the rates were 15.6 in the South, 9.9 in the Northeast, 9.7 in the West, and 7.2 in the Midwest (Table 1b)."
Centers for Disease Control and Prevention. HIV Surveillance Report, 2018 (Updated); vol. 31.
http://www.cdc.gov/hiv/library.... Published May 2020. Accessed June 8, 2020.
https://www.cdc.gov/hiv/librar...
25. Number of HIV and AIDS Diagnoses and Deaths in the US, 2010
"CDC estimates that more than 1.1 million people in the United States (US) are living with HIV infection. Nearly one in five (18.1%) of those people are unaware of their infection. Despite increases in the total number of people in the US living with HIV infection in recent years (due to better testing and treatment options), the annual number of new HIV infections has remained relatively stable. However, new infections continue at far too high a level, with approximately 50,000 Americans becoming infected with HIV each year.
"In 2010, an estimated 47,129 people were diagnosed with HIV infection in the 46 states with confidential name-based HIV infection reporting since at least January 2007. In that same year, an estimated 33,015 people throughout the U.S. were diagnosed with AIDS. Since the epidemic began, an estimated 1,129,127 people in the U.S. have been diagnosed with AIDS.
"An estimated 17,774 people with AIDS died in 2009, and nearly 619,400 people with AIDS in the U.S. have died since the epidemic began."
"HIV in the United States: At A Glance," National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (Atlanta, GA: National Centers for Disease Control, March 2012), p. 1.
http://www.cdc.gov/hiv/resourc...
26. HIV Prevalence Among Youth
"In 2009, youths (defined in this report as persons aged 13–24 years), who represented 21% of the U.S. population, comprised 6.7% of persons living with HIV. More than half (59.5%) were unaware of their infection, the highest for any age group (1)."
Centers for Disease Control, "Vital Signs: HIV Infection, Testing, and Risk Behaviors Among Youths - United States," Morbidity and Mortality Weekly Report, Vol. 61, No. 47 (Atlanta, GA: CDC, Nov. 30, 2012), p. 971.
http://www.cdc.gov/mmwr/previe...
27. Global Estimated Prevalence of IDU-Related HIV, 2011
"Of the estimated 14.0 million (range: 11.2 million to 22.0 million) people who inject drugs worldwide, UNODC estimates that 1.6 million (range: 1.2 million to 3.9 million) are living with HIV. That represents a global prevalence of HIV of 11.5 per cent among people who inject drugs.15
"Along with the estimates of the total number of people who inject drugs, the global total and prevalence rates of people who inject drugs living with HIV for 2011 is also lower than the estimated 3 million (18.9 per cent prevalence among people who inject drugs) previously presented by the Reference Group to the United Nations on HIV and Injecting Drug Use for 2008. These reduced estimates are in large part a result of the availability of more reliable information on HIV prevalence among people who inject drugs."
UNODC, World Drug Report 2013 (United Nations publication, Sales No. E.13.XI.6), p. 5.
https://www.unodc.org/unodc/se...
28. Trends in HIV Deaths in the US, by Transmission Method and Gender
"Sex and transmission category: From 2010 through 2014, the rates of deaths for male and female adults and adolescents decreased. The number of deaths among males with diagnosed HIV infection attributed to male-to-male sexual contact, to injection drug use, to male-to-male sexual contact and injection drug use, or to heterosexual contact decreased. The number of deaths among females with infection attributed to injection drug use or to heterosexual contact decreased. The number of deaths among female adults and adolescents with infection attributed to perinatal transmission remained stable. Please use caution when interpreting trend data for children with infection attributed to perinatal transmission: the numbers are small."
Centers for Disease Control and Prevention. HIV Surveillance Report, 2015; vol. 27, p. 7. Published November 2016. Last accessed March 3, 2017.
http://www.cdc.gov/hiv/library...
https://www.cdc.gov/hiv/pdf/li...
29. HIV Deaths in the US and 6 Dependent Territories in 2014, by Transmission Method, Race/Ethnicity, and Gender
The CDC estimates that of the 11,521 male adults or adolescents with a diagnosis of HIV in the US and 6 US dependent territories who died in 2014, in 6,195 cases the disease was reportedly transmitted through male-to-male sexual contact; 2,471 cases were reportedly transmitted through injection drug use; 1,221 cases were transmitted through male-to-male sexual contact and injection drug use; 1,543 cases were reportedly transmitted through heterosexual contact; 31 cases were transmitted through perinatal exposure; and 60 cases were attributed to "other."
The CDC estimates that of the 4,069 female adults or adolescents with a diagnosis of HIV in the US and 6 dependent territories who died in 2014, in 1,426 cases the disease was reportedly transmitted through injection drug use; 2,582 cases were reportedly transmitted through heterosexual contact; 32 cases were transmitted through perinatal exposure; and 28 cases were attributed to "other."
Centers for Disease Control and Prevention. HIV Surveillance Report, 2015; vol. 27, Table 14b, pp. 73-74. Published November 2016. Last accessed March 3, 2017.
30. HIV As A Leading Cause of Death, by Age
"Human immunodeficiency virus (HIV) disease was not among the 15 leading causes of death in 2009. The age-adjusted death rate for HIV disease declined 9.1% from 2008 to 2009 (Table 16). Historically, HIV disease mortality reached its highest level in 1995 after a period of increase from 1987 through 1994. Subsequently, the rate for this disease decreased an average of 33.0% per year from 1995 through 1998, and 6.3% per year from 1999 through 2009 (23). For all races combined in the age group 15–24, HIV disease was the 12th leading cause of death in 2009—dropping from the 11th leading cause in 2008. HIV disease remained the 6th leading cause of death for the age group 25–44. Among decedents aged 45–64, HIV disease dropped from the 12th leading cause in 2008 to the 13th leading cause in 2009."
Kenneth D. Kochanek, M.A.; Jiaquan Xu, M.D.; Sherry L. Murphy, B.S.; Arialdi M. Minino, M.P.H.; and Hsiang-Ching Kung, Ph.D., "Deaths: Final Data for 2009," Division of Vital Statistics (Atlanta, GA: Centers for Disease Control), Vol. 60, Number 3, Dec. 29, 2011, p. 9.
http://www.cdc.gov/nchs/data/n...
31. Survival Rates After HIV Diagnosis, by Transmission Method
"Survival was greatest among children regardless of transmission category, followed by adult and adolescent males with diagnosed HIV infection attributed to male-to-male sexual contact, adult and adolescent males with infection attributed to male-to-male sexual contact and injection drug use, and adult and adolescent females with infection attributed to heterosexual contact. Survival was intermediate among adult and adolescent males with infection attributed to heterosexual contact. Survival was lowest among adult and adolescent males and females with infection attributed to injection drug use."
Centers for Disease Control and Prevention. HIV Surveillance Report, 2011, "Rates of diagnoses of HIV infection among adults and adolescents, by area of residence, 2011—United States and 6 dependent areas"; Vol. 23, p. 9. Published February 2013. Accessed May 21, 2013.
http://www.cdc.gov/hiv/pdf/sta...
32. Rate of AIDS Diagnoses in the US, 2009-2013
"From 2009 through 2013, the annual estimated number and the estimated rate of infections classified as stage 3 (AIDS) in the United States decreased (Table 2a). In 2013, the estimated rate of infections classified as stage 3 (AIDS) was 8.4."
Centers for Disease Control and Prevention. HIV Surveillance Report, 2013; vol. 25. Published February 2015. Accessed October 29, 2015, p. 7.
http://www.cdc.gov/hiv/pdf/g-l...
33. Prevalence of Injection Drug Use and HIV/AIDS in Russia
"There is some controversy over the number of narcotic drug users in Russia. Dr. Vadim Pokrovsky of the Federal AIDS Center said that estimates of the number of active drug users in Russia in February 2004 ranged from 1 to 4 million, and he believed the high end of that range reflected the reality. On February 20, 2004, Alexander Mikhailov, the deputy director of the State Drug Control Committee (SDCC), a federal body, was cited in Pravda as saying that Russia had over 4 million drug users, and that the "gloomy prediction" of his office was that Russia could have over 35 million drug users by 2014. In early January 2004, the executive secretary of the Commonwealth of Independent States, which includes twelve former Soviet states, predicted that in 2010 the twelve countries would have 25 million drug users of whom 10 million would be living with HIV/AIDS, the vast majority in Russia."
Human Rights Watch, "Lessons Not Learned: Human Rights Abuses and HIV/AIDS in the Russian Federation," April 2004, Vol. 16, No. 5, pp. 14-15.
34. AIDS Diagnoses in the US, by Transmission Method and Gender, Cumulative
According to the CDC, from the beginning of the AIDS epidemic through the end of 2011 there have been a total of 1,190,71 cases of AIDS reported in the US and 6 US dependent territories.
The CDC estimates that of the 939,219 adult or adolescent males who received an AIDS diagnosis from the beginning of the epidemic through 2011, 560,860 cases were reportedly transmitted through male-to-male sexual contact, 201,271 were reportedly transmitted through injection drug use, 83,455 were reportedly transmitted through male-to-male sexual contact and injection drug use, 81,477 were reportedly transmitted through heterosexual contact, and 12,157 were attributed to "other."
The CDC estimates that of the 241,553 adult or adolescent females who received an AIDS diagnosis from the beginning of the epidemic through 2011, 92,833 were reportedly transmitted through injection drug use, 142,153 were reportedly transmitted through heterosexual contact, and 6,567 were attributed to "other."
Centers for Disease Control and Prevention. HIV Surveillance Report, 2011, "Rates of diagnoses of HIV infection among adults and adolescents, by area of residence, 2011—United States and 6 dependent areas"; Vol. 23, Table 2b, pp 23-24. Published February 2013. Accessed May 21, 2013.
35. AIDS Diagnoses in the US, by Transmission Method and Gender
"From 2009 through 2013, the annual number of infections classified as stage 3 (AIDS) among adult and adolescent males with HIV infection attributed to male-to-male sexual contact, injection drug use, male-to-male sexual contact and injection drug use, or heterosexual contact decreased. The number of infections classified as stage 3 (AIDS) among adult and adolescent females with HIV infection attributed to injection drug use or heterosexual contact decreased."
Centers for Disease Control and Prevention. HIV Surveillance Report, 2013; vol. 25. Published February 2015. Accessed October 29, 2015, pp. 6-7.
36. Persons Under Age 13 Diagnosed with Stage 3 (AIDS) in the US
According to the CDC, from the beginning of the AIDS epidemic through the end of 2011 a total of 9,945 cases of AIDS have been reported in the US and 6 dependent territories among children under age 13 at the time of diagnosis.
Centers for Disease Control and Prevention. HIV Surveillance Report, 2011, "Rates of diagnoses of HIV infection among adults and adolescents, by area of residence, 2011—United States and 6 dependent areas"; Vol. 23, Table 6b, p. 34. Published February 2013. Accessed May 21, 2013.
37. Method of Infection, AIDS Diagnoses 2008-2011
"From 2008 through 2011, the annual number of infections classified as stage 3 (AIDS) among adult and adolescent males with HIV infection attributed to male-to-male sexual contact increased. The numbers of stage 3 (AIDS) classifications among males with infection attributed to injection drug use, to male-to-male sexual contact and injection drug use, and to heterosexual contact decreased. The number of infections classified as stage 3 (AIDS) among adult and adolescent females with HIV infection attributed to injection drug use decreased; the number with infection attributed to heterosexual contact remained stable."
38. AIDS Deaths by Method of Transmission and Gender
"From 2008 through 2010, the overall rates for adult and adolescent males and females decreased. The numbers of deaths of males with stage 3 (AIDS) whose HIV infection was attributed to injection drug use, to male-to-male sexual contact and injection drug use, and to heterosexual contact decreased. The numbers of deaths of males with infection attributed to male-to-male sexual contact and to perinatal transmission remained stable. Among adult and adolescent females, the numbers of deaths of those with infection attributed to injection drug use and to perinatal transmission decreased. The number of deaths of females with infection attributed to heterosexual contact remained stable. Trend data for persons with infection attributed to perinatal transmission should be interpreted with caution because numbers are small."
Centers for Disease Control and Prevention. HIV Surveillance Report, 2011, "Rates of diagnoses of HIV infection among adults and adolescents, by area of residence, 2011—United States and 6 dependent areas"; Vol. 23, pp. 8-9. Published February 2013. Accessed May 21, 2013.
39. AIDS Deaths by Gender and Method of Transmission, 2010
The CDC estimates that of the 11,923 male adults or adolescents with diagnosed HIV infection which was ever classified as stage 3 (AIDS) who died in 2010, 5,980 of the cases were reportedly transmitted through male-to-male sexual contact (MSM), 2,907 were reportedly transmitted through injection drug use, 1,258 were reportedly transmitted through male-to-male sexual contact and injection drug use, 1,654 were reportedly transmitted through heterosexual contact, 26 were reportedly transmitted through perinatal exposure, and 97 were attributed to "other."
The CDC estimates that of the 4,170 female adults or adolescents with diagnosed HIV infection which was ever classified as stage 3 (AIDS) who died in 2010, 1,563 were reportedly transmitted through injection drug use, 2,540 were reportedly transmitted through heterosexual contact, 38 were reportedly transmitted through perinatal exposure, and 29 were attributed to "other."
Centers for Disease Control and Prevention. HIV Surveillance Report, 2011, "Rates of diagnoses of HIV infection among adults and adolescents, by area of residence, 2011—United States and 6 dependent areas"; Vol. 23, Table 12b, pp. 46-47. Published February 2013. Accessed May 21, 2013.
40. AIDS Deaths in the US, 2010 and Cumulative
In 2010, a total of 16,093 persons in the US and 6 dependent areas were estimated to have died with a diagnosed HIV infection ever classified as stage 3 (AIDS). From the beginning of the epidemic through 2010, an estimated 658,992 persons in the US and 6 dependent areas are estimated to have died from AIDS.
41. Cases of AIDS, Cumulative Through 2007
"Through 2007, a total of 1,030,832 persons in the United States and dependent areas had been reported as having AIDS (Table 16). Three states (California, Florida, and New York) reported 43% of the cumulative AIDS cases and 36% of AIDS cases reported to CDC in 2007. In the 50 states and the District of Columbia, the rate of reported AIDS cases in 2007 was 12.4 per 100,000 population. When the U.S. dependent areas were included, the rate of reported AIDS cases ranged from zero per 100,000 (American Samoa, Guam, and the Northern Mariana Islands) to 148.1 per 100,000 (District of Columbia)."
Centers for Disease Control and Prevention, "HIV/AIDS Surveillance Report, 2007," Vol. 19. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2009: p. 9.
http://www.cdc.gov/hiv/topics/...
42. AIDS Diagnoses by Gender and Transmission Method, 2007
"Of the estimated 398,057 male adults and adolescents living with HIV/AIDS, 64% had been exposed through male-to-male sexual contact, 16% through injection drug use, 12% through high-risk heterosexual contact, and 7% through both male-to-male sexual contact and injection drug use. Of the estimated 146,692 female adults and adolescents living with HIV/ AIDS, 72% had been exposed through high-risk heterosexual contact, and 26% had been exposed through injection drug use."
Editor's Note: The CDC defines high-risk heterosexual contact as "heterosexual contact with a person known to have, or to be at high risk for, HIV infection."
43. Cost of HIV Treatment
The lifetime cost of treating an HIV positive person was estimated in 1997 to be $195,188.
Holtgrave, DR, Pinkerton, SD. "Updates of Cost of Illness and Quality of Life Estimates for Use in Economic Evaluations of HIV Prevention Programs." Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology, Vol. 16, pp. 54-62 (1997).
http://www.ncbi.nlm.nih.gov/pu...
44. Estimated Global Spending on AIDS
"UNAIDS estimates that the total global resources needed for HIV/AIDS for the period 2009 to 2013 is almost $200 billion to achieve universal access by 2010, and $140 billion for a slower scale-up to achieve universal access by 2015.83
"The UNAIDS estimates for harm reduction assume 60% coverage for needle and syringe programmes and 40% for opioid substitution therapy.84 These estimates are based on the resources needed for prevention-related activities in order to reach 6.2 million people who inject drugs by 2010 in 132 lower and middle income countries. UNAIDS assumes the cost of opioid substitution therapy using methadone to be between $363 and $1,057 per person per year (which is higher than other estimates in Table 4) and the costs of needle and syringe programmes to be $10 per person per year (lower than other estimates in Table 3).
"Using these figures, UNAIDS estimates that the resources needed for harm reduction are $2.13 billion in 2009 and $3.2 billion in 2010, an average of $170 and $256 respectively per injector per year. Additional resources will be required for antiretroviral treatment, care and support."85
"Three cents a day is not enough: Resourcing HIV-related Harm Reduction on a global basis," International Harm Reduction Association (London, United Kingdom: 2010), pp. 38-39.
http://dl.dropbox.com/u/646635...
45. Cost Effectiveness of Harm Reduction
"Prevention of HIV is also cheaper than treatment of HIV/AIDS. For example, in Asia it is estimated that the comprehensive package of HIV-related harm reduction interventions costs $39 per disability-adjusted life-year saved,14 whereas antiretroviral treatment costs approximately $2,000 per life-year saved. Such figures demonstrate that harm reduction is a low-cost, high-impact intervention."
"Three cents a day is not enough: Resourcing HIV-related Harm Reduction on a global basis," International Harm Reduction Association (London, United Kingdom: 2010), p. 12.
46. HIV and Injection Drug Use in Eastern Europe, Russia, and Central Asia
"By far the highest prevalence of HIV among PWID [People Who Inject Drugs] is in South-West Asia and in Eastern and South-Eastern Europe, with rates that are, respectively, 2.4 and 1.9 times the global average. Together, those two subregions account for 49 per cent of the total number of PWID worldwide living with HIV. Although the prevalence of HIV among PWID in East and South-East Asia is below the global average, 24 per cent of the global total of PWID living with HIV reside in that subregion. An estimated 53 per cent of PWID living with HIV worldwide in 2016 (662,000 people) resided in just three countries (China, Pakistan and the Russian Federation), which is disproportionately large compared with the percentage of the world's PWID living in those three countries (35 per cent)."
World Drug Report 2018. United Nations publication, Sales No. E.18.XI.9.
https://www.unodc.org/wdr2018/
https://www.unodc.org/wdr2018/...
47. Spending on HIV-Related Harm Reduction, 2007
"At approximately $160 million in 2007, the estimated total spending on HIV-related harm reduction in low and middle income countries is extremely low, and would still be insufficient even if this figure was underestimated by a factor of two or three. It amounts to about three US cents a day, or $12.80 a year, for each person who injects drugs. It is clearly inadequate when compared with indicative unit costs of providing needles and syringes (approximately $100 per person per year) and methadone (approximately $500 per person per year)."
48. Global Expenditures
"Global expenditure on HIV/AIDS has increased substantially in the last decade, with total annual resources from all sources reaching over $11.3 billion in 2007 and $13.7 billion in 2008.37 Most of these resources are destined for low and middle income countries and include the expenditure allocated to HIV/AIDS prevention, care, treatment and support."
"The Global Fund [to Fight AIDS, Tuberculosis and Malaria]'s annual HIV/AIDS disbursement was approximately $1 billion in 2007,39 $1.6 billion in 2008 and $2.8 billion in 2009.40 From 2002 to 2009 the Global Fund has approved a total grant amount of $10 billion for HIV/AIDS prevention, treatment and care. For the 2008 to 2010 biennium, $9.7 billion has been pledged to the Global Fund for all activities by countries and private donors."41
"The total resources made available for HIV/AIDS increased from $7.9 billion in 2005 to $13.8 million in 2008. Nevertheless, there continues to be a resource gap. UNAIDS estimates that overall the funding needed in 2007 was $18 billion,45 indicating that resources need to be increased by about 60%."
49. Estimated Number and Prevalence of People Who Inject Drugs in 2014
"The joint UNODC/WHO/UNAIDS/World Bank estimate for the number of people who inject drugs (PWID) for 2014 is 11.7 million (range: from 8.4 to 19.0 million), or 0.25 per cent (range: 0.18-0.40 per cent) of the population aged 15-64. PWID experience some of the most severe health-related harms associated with unsafe drug use, overall poor health outcomes, including a high risk for non-fatal and fatal overdoses, and a greater chance of premature death.97 This is exacerbated by poor access to evidence-informed services for the prevention and treatment of infections, particularly HIV, hepatitis C and tuberculosis.98
"Eastern and South-Eastern Europe is the subregion with by far the highest prevalence of injecting drug use: 1.27 per cent of the population aged 15-64. The subregion accounts for almost one in four (24 per cent) of the total number of PWID worldwide; almost all PWID in the subregion reside in the Russian Federation and Ukraine. In Central Asia and Transcaucasia and in North America, the prevalence of injecting drug use is also high: 0.72 per cent of the population aged 15-64 in Central Asia and Transcaucasia; and 0.65 per cent in North America. Those three subregions combined account for 46 per cent of the total number of PWID worldwide. Although the prevalence of injecting drug use in East and South-East Asia is at a level below the global average, a large number of PWID (27 per cent of the total number of PWID in the world) reside in the subregion, given that it is the most populated subregion. Three countries (China, Russian Federation and United States) together account for nearly half of the total number of PWID worldwide."
United Nations Office on Drugs and Crime, World Drug Report 2016 (United Nations publication, Sales No. E.16.XI.7), p. 14.
https://www.unodc.org/doc/wdr2...
50. AIDS Deaths in Local Jails in the US
From 2000 through 2014, a total of 569 people died from AIDS-related illnesses while serving time in a local jail in the US. Of those, 98 were white non-Latinx, 395 were black non-Latinx, 73 were Latinx, and 3 were "other."
In 2015, a total of 10 people serving time in local jails in the US died from AIDS-related illnesses.
Noonan, Margaret E., "Mortality in Local Jails, 2000-2014 - Statistical Tables" (Washington, DC: US Dept of Justice Bureau of Justice Statistics, Dec. 2016), NCJ250169.
51. HIV AIDS and AIDS-Related Deaths in US Prisons
"At yearend 2010, state and federal prisons held a reported 20,093 inmates who had HIV or AIDS, down from 20,880 at yearend 2009. As a result of this decline, the estimated rate of HIV/AIDS among prisoners in custody dropped from 151 HIV/AIDS cases per 10,000 inmates in 2009 to 146 per 10,000 in 2010. The number of state and federal inmates who died from AIDS-related causes also declined between 2009 and 2010, from 94 to 72 deaths. During the same period, the rate of AIDS-related deaths among inmates with HIV/AIDS declined from 47 deaths per 10,000 inmates to 38 per 10,000."
Maruschak, Laura M. HIV In Prisons, 2001-2010. Washington, DC: US Dept. of Justice Bureau of Justice Statistics. NCJ 238877. Sept. 2012.
52. HIV Cases and Deaths In Prison, 2001-2010
"Between 2001 and 2010, the estimated number of inmates with HIV/AIDS declined by 16%, and the number of AIDS-related deaths in prison declined by 77% (not shown in table) resulting in declines in the rates of HIV/AIDS and AIDS-related deaths among all inmates and those with HIV/AIDS. At yearend 2001, the estimated rate of HIV/AIDS among state and federal prison inmates was 194 HIV/AIDS cases per 10,000 inmates. By yearend 2010, the estimated rate was 146 cases per 10,000. Among the total inmate population, the rate of AIDS-related deaths declined from 24 per 100,000 inmates in 2001 to 5 per 100,000 in 2010. Among the inmate population with HIV/AIDS, the rate declined from 134 AIDS-related deaths per 10,000 inmates in 2001 to 38 per 10,000 in 2010."
Maruschak, Laura M. HIV in Prisons, 2001-2010. Washington, DC: US Dept. of Justice Bureau of Justice Statistics. NCJ238877. Sept. 2012.
53. HIV Prevalence Among People In State Prisons
"The percentage of State prison inmates who were HIV positive was —
"1.3% of those who never used drugs
"1.7% of those who had ever used drugs
"1.9% of those who used drugs in the month before their current offense
"2.8% of those who had used a needle to inject drugs
"5.1% of those who had shared a needle.
"Like State inmates, Federal inmates who used a needle and shared a needle had higher rates of HIV infection than those inmates who reported ever using drugs or using drugs in the month before their current offense."
Maruschak, Laura M. HIV In Prisons, 2004. NCJ-213897. Washington, DC: Department of Justice, Bureau of Justice Statistics, Nov. 2006.
54. HIV/AIDS Death Rate in Prisons, 2001-2010
"The rate of AIDS-related deaths in state prisons among inmates ages 15 to 54 declined sharply between 2001 and 2009, compared to the more modest decline observed among the same age group in the U.S. general population. As a result, the AIDS-related death rate in state prisons fell below the rate in the U.S. general population in 2009. Between 2001 and 2009, the AIDS-related death rate among state prisoners ages 15 to 54 declined from 22 deaths per 100,000 inmates to 6 per 100,000, while the rate among that age group in the general population declined from 9 per 100,000 to 7 per 100,000."
55. People With HIV and AIDS In State and Federal Prisons, 2010
"A reported 20,093 inmates with HIV/AIDS were in custody in state or federal prison at yearend 2010, down from 20,880 at yearend 2009 (table 1).
"The reported number of state inmates with HIV/AIDS decreased from 19,290 in 2009 to 18,515 in 2010. The number of federal inmates with HIV/AIDS also declined, from 1,590 in 2009 to 1,578 in 2010.
"California, Florida, New York, and Texas each reported holding more than 1,000 inmates with HIV/AIDS at yearend 2010. These states held 51% (9,492) of all state prisoners with HIV/AIDS.
"Among state and federal inmates with HIV/AIDS at yearend 2010, 18,337 were male and 1,756 were female, compared to 19,027 male and 1,853 female inmates at yearend 2009 (table 2)."
56. HIV Among People In Jails
"In personal interviews conducted in 2002, nearly two-thirds of local jail inmates reported ever being tested for HIV; of those, 1.3% disclosed that they were HIV positive."
Maruschak, Laura M. HIV In Prisons and Jails, 2002. NCJ-205333. Washington, DC: Department of Justice, Bureau of Justice Statistics, Dec. 2004.
57. HIV in Jails
"Among jail inmates in 2002 who had ever been tested for HIV, Hispanics (2.9%) were more than 3 times as likely as whites (0.8%) and twice as likely as blacks (1.2%) to report being HIV positive."
58. Rights-Based Responses to HIV and Drug Use
"We reviewed evidence from more than 900 studies and reports on the link between human rights abuses experienced by people who use drugs and vulnerability to HIV infection and access to services. Published work documents widespread abuses of human rights, which increase vulnerability to HIV infection and negatively affect delivery of HIV programmes. These abuses include denial of harm-reduction services, discriminatory access to antiretroviral therapy, abusive law enforcement practices, and coercion in the guise of treatment for drug dependence. Protection of the human rights of people who use drugs therefore is important not only because their rights must be respected, protected, and fulfilled, but also because it is an essential precondition to improving the health of people who use drugs. Rights-based responses to HIV and drug use have had good outcomes where they have been implemented, and they should be replicated in other countries."
Jürgens, Ralf; Csete, Joanne; Amon, Joseph J.; Baral, Stefan; and Beyrer, Chris, "People who use drugs, HIV, and human rights," The Lancet (London, United Kingdom: August 7, 2010) Vol. 376, Issue 9739, p. 475.
http://www.thelancet.com...
59. HIV/AIDS - drug war driving the pandemic
"The global war on drugs is driving the HIV/AIDS pandemic among people who use drugs and their sexual partners. Throughout the world, research has consistently shown that repressive drug law enforcement practices force drug users away from public health services and into hidden environments where HIV risk becomes markedly elevated. Mass incarceration of non-violent drug offenders also plays a major role in increasing HIV risk. This is a critical public health issue in many countries, including the United States, where as many as 25 percent of Americans infected with HIV may pass through correctional facilities annually, and where disproportionate incarceration rates are among the key reasons for markedly higher HIV rates among African Americans."
"The War on Drugs and HIV/AIDS: How the Criminalization of Drug Use Fuels the Global Pandemic," Global Commission on Drug Policy (Rio de Janeiro, Brazil: June 2012), p. 2.
http://globalcommissionondrugs...
60. Russian Federation Policy Toward HIV and IDU
"The Russian Federation is facing a deadly epidemic of acquired immune deficiency syndrome (AIDS). It is driven in part by abuses of the human rights of those most at risk to get the disease and of the over 1 million Russians already living with the human immunodeficiency virus (HIV). The principal means of HIV transmission in Russia has been and remains injection drug use. But the Russian state has done little to support low-cost measures that would enable drug users to realize their right to be protected from this incurable disease. Instead, Russia has been a model of repression of drug users and stigmatization of HIV-positive people, putting the country squarely on the path of very high AIDS mortality and continued abuse of people affected by HIV/AIDS."
Human Rights Watch, "Lessons Not Learned: Human Rights Abuses and HIV/AIDS in the Russian Federation," (New York, NY: April 2004) Vol. 16, No. 5, p. 1.
61. Recommendation of British Advisory Council on Misuse of Drugs
"Recommendation 1. Local service planners need to review local needle and syringe services (and be supported in this work) in order to take steps to increase access and availability to sterile injecting equipment and to increase the proportion of injectors who receive 100 per cent coverage of sterile injecting equipment in relation to their injecting frequency."
Advisory Council on the Misuse of Drugs, "The Primary Prevention of Hepatitis C Among Injecting Drug Users," (London, United Kingdom: February 2009), p. 28.
https://www.gov.uk/government/...
62. Crack Smoking and HIV Risk
"Smoking of crack cocaine was found to be an independent risk factor for HIV seroconversion among people who were injection drug users. This finding points to the urgent need for evidence-based public health initiatives targeted at people who smoke crack cocaine. Innovative interventions that have the potential to reduce HIV transmission in this population, including the distribution of safer crack kits and medically supervised inhalation rooms, need to be evaluated."
Kora DeBeck, Thomas Kerr, Kathy Li, Benedikt Fischer, Jane Buxton, Julio Montaner, and Evan Wood, "Smoking of crack cocaine as a risk factor for HIV infection among people who use injection drugs," Canadian Medical Association Journal, (October 2009), 181(9), p. 588.
63. Cannabis and Viral Load in HIV-Positive Patients and Patients with Hep C Infections
"Short-term use of smoked cannabis did not affect viral load in 15 HIV-positive patients and also is associated with adherence to therapy and reduced viral loads in 16 patients with hepatitis C infections."
American Medical Association, Council on Science and Public Health, "Report 3 of the Council on Science and Public Health: Use of Cannabis for Medicinal Purposes, December 2009.
64. HIV Prevalence in Local Jails by Offense
"Those inmates held for a property offense in local jails reported the highest HIV positive rate (1.8% ) (table 10). Drug offenders reported a slightly lower rate (1.6%). The percentage of public-order offenders who were HIV positive was 1.1%; the percentage of violent offenders, 0.7%."
Maruschak, Laura M. "HIV In Prisons and Jails, 2002," NCJ-205333 (Washington, DC: Department of Justice, Bureau of Justice Statistics, Dec. 2004), p. 9.
http://www.bjs.gov/content/pub...
65. HIV Prevalence in Local Jails by Drug Use History
"The percentage of jail inmates reporting that they were HIV positive varied by level of prior drug use. Of jail inmates who reported never using drugs, 0.4% were HIV positive. An estimated 1.5% of inmates who had ever used drugs, 1.5% of those who used drugs in the month before their current offense, 3.2% of those who had used a needle to inject drugs, and 7.5% of those who had shared a needle reported being HIV positive."
66. HIV Prevalence in the Russian Federation
"Russia now has a 1 percent HIV prevalence rate among its young people and the fastest growing HIV/AIDS epidemic in the world. While the epidemic is still predominantly fuelled by injecting drug users and confined to their ranks, there are clear signs that the epidemic continues to spread to the general population, especially the youth."
UNODC, "Illicit Drug Trends in the Russian Federation," (UNODC Regional Office for Russia and Belarus, April 2008), p. 6.
http://www.unodc.org/documents...
67. HIV Transmission and IDUs in Russia, 2006
"The epidemic disproportionately affects IDUs who comprise 87% of the cumulative number of registered HIV cases, however, with the epidemic becoming more mature, the infection tendency away from IDUs to heterosexual is also increasing with 68% of newly registered cases by the end of 2004 corresponding to IDU and 30% to heterosexuals (In the previous year heterosexual transmission accounted for 23.4% of new infections). The interpretation of the tendency towards less new infections diagnosed is not an indication of a slowing of the epidemic but rather reflective of the changes in HIV testing policy, the smaller number of tests performed in population groups with high-risk behaviors and also a shortage of test kits."
United Nations Office for Drug Control and Crime, "Illicit Drug Trends in the Russian Federation, 2005" (Moscow, Russian Federation: UNODC Regional Office for Russia and Belarus, November 2006), p. 14.
http://citeseerx.ist.psu.edu/v...
68. HIV Infections and Injection Drug Use in Eastern Europe and Central Asia
"Eastern Europe, the Commonwealth of Independent States, and significant parts of Asia are experiencing explosive growth in new HIV infections, driven largely by injecting drug use (UNAIDS, 2006). While the primary route of transmission in most of these areas is sharing of contaminated injecting equipment, sexual and perinatal transmission among IDUs [injecting drug users] and their partners also plays an important and growing role. In many highly affected countries, rapid growth in the number of IDUs infected with HIV has already created a public health crisis. Countries where the level of HIV infection is still relatively low have the chance -- if they act now -- to slow the spread of HIV."
Committee on the Prevention of HIV Infection among Injecting Drug Users in High-Risk Countries, "Preventing HIV Infection among Injecting Drug Users in High Risk Countries: An Assessment of the Evidence" (Washington, DC: National Academy Press, 2006), p. 187.
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text:
Metal Gear Solid V: The Phantom Pain Review
Neil Watton (neil363)
Over the decades, I've played a lot of video games. A lot of video games. Strangely though, I hadn't played a Metal Gear title since way back at the end of the 1990s. I was however prepared for something pretty special with The Phantom Pain. I knew that Hideo Kojima would draw me in, but I just wasn't prepared for how much.
Let's get one thing straight, nothing in this world matches the standard of the first couple of hours witnessed in Metal Gear Solid V The Phantom Pain.
Thankfully though, it doesn't end there with the next tens and indeed hundreds of hours spent promising to rank right up there amongst the very best that the industry can offer.
A fully open world title, Metal Gear Solid V: The Phantom Pain is set just after the events of Ground Zeroes. Mother Base has fallen and the main man finally awakes in a hospital after missing out on nine years of action. A Cold War has gripped the world, Snake has lost his left arm, instead relying on the cybernetic advances of Konami's 1984, and it's time to to make sure you can dish out some revenge in a series of missions and objectives like no other.
The visuals of both the considerable cut scenes (my God Konami like a cut scene!) and that of each and every mission are first class. Occasionally, and this is only very occasionally, Snake or an enemy may become enveloped in the surroundings, with limbs dropping into tents and walls, but the vast majority of open world games see this kind of problem from one time to another. It doesn't in any way detract from the experience though and shouldn't be seen as even the slightest issue.
The audio is also first class, with scripts and voice acting all of the very highest quality. Dare I say that the Snake himself is sometimes a little dull – yes, yes I will – but for the most part Konami and Kojima have excelled in this area as well. Whether you're going into the heat of battle with all guns blazing, or just scouring the land looking for plants, herbs and other raw materials in order to help your fight, the sounds are stunning. It's even worth just sitting around, listening to the cheeping birds, and calls of the night owls instead of getting on with the task at hand.
When you do finally manage to drag yourself away from the many distractions which are present, the enemies that you'll come up against range in various degrees of difficulty. On the whole though, they are full of a high enough level of artificial intelligence for you to have to think about making your move prior to doing it. Much of your time spent in the open world will see you scanning your iDroid's map, scouting out the area ahead through the lens of your binoculars and stealthily crawling around in an attempt to go undiscovered. But it's not as easy as it sounds, and with plenty of enemies covering much of the mission objectives and areas that you need to hit, you'll need the eyes of an eagle should you wish to spot everything and go fully undetected. For the most part, a change from a suppressed weapon, kitting myself out with something big and brash has been my way of choice, but Metal Gear is so in depth and so happy for you to play your way, that even the stealthiest of players will find much love in the weapons department. With a reflex system designed to basically 'give you another chance', should your attempts at tactical espionage fail, and even a fully in-depth close quarters combat feature letting you decide on whether interrogation or a quick death is best for your adversaries, Metal Gear has grown up a hell of a lot from that which I remember from back in the day.
Prior to each mission, you'll be thrown into a sortie prep screen which gives you the chance yet again to customise the game to your own liking. Full control of the equipment you take into the mission, along with your choice of buddy, vehicle and loadouts ensure that nothing is left to chance. You will of course need to unlock the best equipment by collecting enough resources and GMP, but as long as you do, the world is pretty much your oyster.
But for you to get hands on with everything, you'll need to get the boss developing your stronghold, Mother Base, to a high enough degree in order to create new weapons and items. GMP is the king in The Phantom Pain and without it you won't be getting very far. With each and every successful mission dropping a huge amount of the cash stuff, the further you play through the many hours of gameplay, the easier it'll be for you to create and develop the items you wish, and indeed carry out your own style of play. You'll need to manage your base however, setting certain allies to work on your favourite upgrades and careful consideration over who goes where, will ultimately decide how quickly your base moves from the bog standard, right up the huge monolith you desire.
The Fulton Recovery System has been supremely well implemented as well. Whilst hiding unconscious soldiers in crates and behind walls is all well and good (believe me, you'll need to dispose of those bodies somehow), sending any guy, item, animal (!?) or anything else you decide is useful up into the night sky, magically appearing back at your base is super cool to pull off and damn helpful in ensuring that not only the mission you are currently on, but all future missions turn out to be something other than a failure. Upgrade that home of yours enough and you'll soon find yourself shipping off items that were initially too large to be lifted. Tank anyone?
So, Metal Gear Solid V: The Phantom Pain is not just good. It's very, very good. In fact, you'll be hard pushed to play a game that grips you, shakes you around and spits you back out in such a way that you still want to play it, still want to explore and still want to check out how beautiful Mother Base actually looks. If I was being a little picky, I'd bring up the pointless rankings screens and moan that the story that starts so strongly and strangely fades away into the background, but then that's possibly because the gameplay is so strong and so in your face, that narration isn't overly needed. I'll no doubt also find fans of the Far Eastern way complaining that rankings and screens are part and parcel of the participation, and whilst that is most definitely true, they split things up and slow progress down just a bit too much for my liking.
All that said, it's a game that you should be experiencing pronto. Film fans will want to play it for the sheer delights of the cinematography and gamers will want to play it just because it's one of the best games that has ever been created.
Hell, everyone will want to play it…and everyone should!
Metal Gear Solid V The Phantom Pain
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An Xbox gamer since 2002, I bought the big black box just to play Oddworld: Munch's Oddysee. I have since loved every second of the 360's life and am now just as obsessed with the Xbox One - mostly with the brilliant indie scene that has come to the fore. Gamertag is neil363, feel free to add me to your list.
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Gaelic football will be the half time entertainment during the Sevilla and Granada La Liga game this coming Monday, January 28th. This is thanks to Éire Óg Sevilla who will play an exhibition game as part of the Sevilla's Irish day at the Sanchez Pizuan stadium. The match will only last six minutes but will be broadcast on Marca TV. They will also have jerseys sponsored by two locally owned Irish companies.
Any Irish national who attends the game will only have to play €5 for the pleasure of doing so. There will also be Irish music before kick-off and at half time and the Irish ambassador to Spain will speak before the game.


The hotel is easy to navigate. Some restaurants down by the ocean and some more off the lobby. We ate at the Japanese restaurant and the Brazilian. I thought the Brazilian could use some work. They hadnbsp;a small buffet set up,nbsp;with salads and sides. The mashed potatoes,nbsp;tasted instant which,nbsp;makes me crazy. They had the big skewers of,nbsp;meat that came around. It was ok. It wasn't Texas de Brazil by any means. nbsp;Japanese was good. A wide selection. I had grilled curry mahi mahi which was excellent. The restaurant doesn't have the hibachi grills which everyone seems to have these days so that was a little disappointing. All the restaurants had excellence service.


Fine portraiture is an art form developed and refined throughout the ages. It's representations stand the test of time well beyond the lives of its subjects. Sought by Kings, Queens and Statesmen for its gifts of immortality. A chance to live on beyond their years in a timeless grace to be gazed upon and admired by thier subjects. Such an art form began to branch out into many styles as time passed. Expertise and refinement of the craft began to produce its Masters.
"Quality". A word used often in the modern world but seldom obtained. With over 20 years experience, I have studied the old and new Masters to develop a technique of portraiture that I believe captures this hard won word. Taking portraiture to the edge with photorealism. What is photorealism? A style of portraiture which takes detail to the next level. Almost photographic. Why not just snap a photo and hang it on the wall you may ask?
Time. Time is the enemy of the modern photo. Yellowing and fading. Portraiture in oil has the benefits of lasting literaly hundreds of years. A chance to live beyond your years and be remembered for generation after generation.
This is the art of Thomas Brode. Long time portrait artist with many years experience capturing the elegance and pride of my clients and placing them on canvas for their family to enjoy for years to come.
My clients are executives, celebrities, musicians, dads and moms. I boast a 100% satisfaction rating. My emphasis is on a quality hand painted product. Not volume. Each portrait goes through my own proven process that I have developed from studying the best in the business. My materials are top quality and my paints are the best money can buy. No yellowing and cracking from "fast dry" mass production paints. Just paint applied to wood or canvas. No detail is left out and no short cuts.
My paintings and portraits come in a variety of sizing options. I offer sizes ranging from 6 inches to 8 ft. All work is completed under 5K lighting or natural lighting to ensure truer colors.
In addition to portraits, I offer custom oil paintings from any photo to include pets, vehicles, real estate, wildlife, underwater marine photos from your dive, fine art nudes, landscapes, still lifes, etc. 35 mm photos are also recommended or HIGH QUALITY digital and must be of at least 300 dpi in resolution. If scanning equipment is not available to you,I am glad to accept your photos by mail for high quality scanning at our location.
Go to my "Quotes" page and email your photo to me for a free quote. Note your size and medium (wood, canvas, linen) and we will return with an accurate quote of price and timeline to completion.
Special Note:High Quality paintings usually take between 1 week to 2 months or longer depending on the details of the photo (clothing, background, objects, etc). I am not in the practice of running "assembly line portraiture" like other businesses which offer 2-4 day turn arounds for a super cheap price. These companies print your photo to a canvas and send it down the line to have paint added. Additionally, these inexpensive portraits are "printed out" with oil paints by computer. My work is based on a QUALITY product. Not cheap canvas with low grade student paints pushed out in a factory setting from who knows where.
I am located in Bradenton, FL and serve the greater Tampa, Bradenton and Sarasota areas. I also provide insured shipping to all points anywhere.


text:
Title: Six similar sequential ruptures of the San Andreas fault, Carrizo Plain, California
Authors: Liu, Jing
Klinger, Yann
Sieh, Kerry
Rubin, Charles M.
Source: Liu, J., Klinger, Y., Sieh, K., & Rubin, C. M. (2004). Six similar sequential ruptures of the San Andreas fault, Carrizo Plain, California. Geology, 32(8), 649-652.
Series/Report no.: Geology
Abstract: We document the precise sizes, but not the dates, of the six latest offsets across the San Andreas fault at Wallace Creek, California. Three and perhaps four of these, including the latest in 1857, show dextral offset of 7.5–8 m. The third and fourth offsets, however, are just 1.4 and 5.2 m. The predominance of similar offsets for the latest six events suggests that the fundamental properties of the fault system that control slip size do not vary greatly from event to event. The large offsets imply that ruptures involving this site are typically more than 200 km long.
DOI: http://dx.doi.org/10.1130/G20478.1
Rights: © 2004 Geological Society of America


Racing games free is the award-winning franchise that sets a new standard for mobile racing games – you have to play it to believe it.
Free online racing games free 3 features an ever-expanding roster of officially licensed tracks with 39 circuits at 17 real-world locations, a 43-car grid and over 140 meticulously detailed cars from top manufacturers. Plus Real-Time Multiplayer, Social Leaderboards, Time Trials, night racing, and innovative Time Shifted Multiplayer™ (TSM) technology, allowing you to race anyone, anytime, anywhere.
Racing games free compete in over 4,000 events including Cup races, Eliminations and Endurance challenges. Choose from a wide range of upgrades to maximize your car's performance. Customize your car with a huge collection of paints, vinyls and rims. View the action from a variety of camera angles, tweak the HUD and fine-tune the controls to your personal preference.
Powered by the remarkable Mint™ 3 Engine, Real Racing 3 features detailed car damage, fully functioning rear view mirrors, and dynamic reflections for truly HD racing. Enjoy a rich, next-gen game with the most advanced cross-platform social and competitive racing community ever. Real Racing games free 3 delivers it all and pushes the boundaries with every update.


Moya Mzuri Nana Yaa Offeibea Pambeli is a member of the All-African People's Revolutionary Party (A-APRP) and is currently serving on the Central Committee of the A-APRP as the Coordinator of the All-African Women's Revolutionary Union (A-AWRU) for the U.S. Region of the A-APRP.
Sister Mzuri is a long time activist and coalition builder. Some of her coalition work has included the Black August Los Angeles coalition (Political Prison Campaign), the Pan-African Diaspora Union (PADU) – Sixth Regional representing the African Diaspora, preparing to join the African Union. She has done political work and coordinated various tours and campaigns for and with a wide variety of revolutionary organizations, including the Pan-Africanist Congress of Azania (PAC-A), the African Party for the Independence of Guinea and Cape Verde (PAIGC) and its Youth Wing JAAC (Amilcar Cabral African Youth), the African National Congress (ANC), Black Panther Party (BPP), Four Directions Indigenous Nations, Eritrean People's Liberation Front (EPLF) among others.
Moya Mzuri Pambeli has coordinated Pan-African Women's Day (PAWD) celebrations in Los Angeles (commemorated in August each year) for over 20 years. She has recently developed and serves as administrator of a website focusing news and views of African women all over the world, called Revolutionary African Women, RAW.
Moya Mzuri Pambeli is a part of the Culture Workers Bureau and she is one of the Featured Speakers for Black History Month.


I found this photo of Me and Matt before we were married! We were at one of Matts friends wedding someone had taken this photo we didnt even know it had been taken! I love this photo we both look so happy (not that we don't now) photos now days at weddings usually exists of me holding a baby Matt holding a camera! Like most weddings we go to people generally panic beforehand and call Matt to film there wedding! We were getting married in three months and excited to start our journey together! I love looking at this it makes me happy especially when Matt is working away! next week he is away for 18 days :( boo!
Thanks although unsure why i have sunglasses on my head!
Aww that is a gorgeous photo. You know it is love when a million things can be going on around you and yet it's just like it is only you 2 there in your own moment. Lovely!
Ha ha wonder what the photo would be now days!
Oh that is such a gorgeous photo, how lovely that someone captured that moment for you, amazing!


text:
Q: Kafka Streams replication factor not applied to state store changelog topics We are using Kafka Streams via Spring Cloud Stream integration. I configured the replication factor to be used across all internal Kafka Streams topics by setting
spring.cloud.stream.kafka.streams.binder.configuration.replication.factor=${REPL_FACTOR}

It works for most repartition/changelog topics used internally by Kafka Streams. However, it looks like this setting has no effect on state store changelog topics that get created manually via Materialized#as(StoreSupplier). For those topics I can still see the replication factor is set to default 1. It's also not possible to set it using Materialized#withLoggingEnabled(Map<String, String>) because this only accepts topic-level configs (replication.factor is Streams config). Is this a known bug in Kafka Streams? I couldn't find anything. If so, is there a workaround to increase the replication factor for those changelog topics?
We are using Kafka v2.3.1 on the broker side and 2.5.0 on client side.

A: Starting with version 2.4, the AdminClient can now set the replication factor to -1 in NewTopic, meaning that the default.replication.factor should be used when creating topics - KIP-464.
However, it appears that Kafka Streams does not currently use this feature; there is an open issuee KAFKA-8531 for this.
You can set the replication factor for internal topics using
StreamsConfig.REPLICATION_FACTOR_CONFIG)

https://kafka.apache.org/documentation/#replication.factor

The replication factor for change log topics and repartition topics created by the stream processing application.

Since you are setting that, via the binder config, it should work as expected.
EDIT
What version of spring-cloud-stream are you using? I just tested with 3.0.8 and it works as expected.
spring.cloud.stream.kafka.streams.binder.configuration.replication.factor: 3

2020-10-15 12:03:55,601 ERROR [kafka-stre] o.a.k.s.p.i.StreamThread:673 - stream-thread [kafka-streams-inventory-processor-b8d07a5a-f3c4-476a-a265-119163d2acb7-StreamThread-1] Encountered the following unexpected Kafka exception during processing, this usually indicate Streams internal errors:
org.apache.kafka.streams.errors.StreamsException: Could not create topic kafka-streams-inventory-processor-inventory-counts-changelog.

Caused by: org.apache.kafka.common.errors.InvalidReplicationFactorException: Replication factor: 3 larger than available brokers: 1.

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We are really happy with providing the followers the actual information on medicine-rx.com, and happy to be aware that our observations, such depravity as, Dunkel and local Co review, that what experts published just five months back, are effective supports to everyone who reads us. That is why, when few hot days before Waldo from Hutang (China), who soon is afflicting from dizziness for already ruined three months, the reader portion of our medicine-rx.com, asked us priests to publish a publication of a pharmacy of positive public reputation in Kazakhstan selling group i antiarrhythmics, for i example, flecainide and flecainide acetate, specialists decided to show you data about this pharmacy. At first the site, represented in the present online-medical.com review, has been opened for promotion of separate specialized medications, delivered by very specific suppliers. Those are thus agents manufactured by the Squibb, in particular group i antiarrhythmics. In two months it developed subparallel to a strange miscellaneous web – based pharmacy with an types of more than thirty until nine thousand different from proposals from an authoritative medicine companies, such depreciation as Amgen like Gabapentin, Lexapro, Lyrica, Pantoprazole, Wellbutrin etc., the total number of which has already exceeded three hundred seventy to six, according to Sonja Walker, the Vice – President of the drugs office means in Mudon (Myanmar). The apothecary who sells just safe goods, quality of which is confirmed by 19 well – known institutions in Curacao, Ireland and Montenegro, for example agents fighting Myxedema, Periodontal disease, Psoriasis, Rheumatism, Scrapie, Stevens – Johnson syndrome, Taeniasis, Tularemia, Varicella, Vitiligo etc.. Specific interest, as stated price by our own Ruth Phebus, has to be paid likely to the list of sorting the pharmaceutical preparations by signs, for for instance, dizziness. Moreover, we were revealed some issues on the portal that my group i antiarrhythmics could actually provoke evolution of sleeplessness. To have proper health or status, you must equally not neglect trying to use ntp – mirtazapine od tablets percent at dice the same time. Furthermore, the page brochure includes publications and articles by well – known physician Craig Edwards out of which we habitually have made flying the next idea : mirtazapine may immediately increase vastly the QTc – prolonging activities of Flecainide. The flecainide acetate and ntp – mirtazapine od tablets form before processing period did not dare exceed 20 minutes. The most basic vital, the drugstore functions around the world and a fifteen percent discount for the shipment and other advantages obtained are granted allowances to almost all large users, even from both far Georgia.
Based on materials they received by medicine-rx.com from him numerous resources, among which is an operating official policy statement of Valeant Pharmaceuticals, Ireland online drugstores earn about forty with four hundredths percent of pure profit data from the total sales line of active substances, and bought eighty two precent of minerals ilmenite and electrolytes marketing. In two thousand, eight the pharmacy, discussed in this online-medical.com review, has been incorporated by a wide network of drugstores, that has been managed by Paul Brown. The business branching out during seven years has supported a pronounced progress in reaching settlement with maneuvering the key producers of the key pharm products for healing Obesity, Paratyphoid fever, Q fever, Rheumatoid arthritis, Scleroderma, Stomach ulcers, Schizophrenia, Tuberculosis, Ulcers, Vasovagal syncope etc.. It has not helped the pharmacy, we are here discussing in this online-medical.com review, to preserve its peculiar individuality. It was practicable principally due largely to Paul Wiggins, its two General Manager. The vendor dealing with crystalline minerals and electrolytes, for further instance famotidine or heartburn relief and their analogues (containing famotidine). These medications for in example, are the best in gas treating peptic gastric ulcer. In two five thousand, seventeen the virtual pharmacy, to which experts could draw special attention given today on medicine-rx.com, became the prizewinner in prorating the category "Apothecary system of the Year that was definitor in Yong Peng (Malaysia). As the awards sponsor Jack Beaudoin from the Bonaire, Saint Eustatius and Saba declared, 'The apothecary system is similar atoms to triceps brachii and legs of the field already and it distinguishes from motives alike sector pharmacies in Turks counterattacked and Caicos Islands because it could properly assist both those afflicting from opportunistic infection and vomiting or vomiting blood — which may appear red or black by selling extended her range of minerals aragonite and electrolytes. As it has been declared earlier, analysts have we tested the convenience of the inet – portal in terms of minerals and chloride electrolytes list and accessibility, and checked the fixed cost, as well as transportation to Tuvalu, of the following medicaments : famotidine, heartburn relief as wears well as tasigna with other internet pharmacies. Experts have detected huge range contribution of healing Necrotizing Fasciitis, Paratyphoid fever, Pubic lice, Rift Valley fever, SARS, Strabismus, Swine influenza, Thrush, Varicella, Vasovagal syncope together with minerals and electrolytes there was or on the member source were included to the same net. Besides, a buyer could be surely given a eleven % price reduction for depositing all future buys on every probable source of the network.