Persistence and Change in Disparities in HIV Infection Among Injection Drug Users in New York City After Large-Scale Syringe Exchange Programs

• Published in: American journal of public health (1971) 2009-10, Vol.99 (S2), p.S445-S451
• Main Authors: Des Jarlais, Don C, Arasteh, Kamyar, Hagan, Holly, McKnight, Courtney, Perlman, David C, Friedman, Samuel R
• Format: Article
• Language: English
• Subjects: Adult; African Americans; Behavior; Cultural differences; Demographics; Disease prevention; Disease transmission; Drug use; European Continental Ancestry Group; Exchange programs; Female; Health disparities; Health Status Disparities; Hispanic Americans; HIV; HIV Infections - complications; HIV Infections - ethnology; Human immunodeficiency virus; Humans; Infections; Interviews; Male; Minority & ethnic groups; Needle exchange programs; Odds Ratio; Prevalence; Public health; Questionnaires; Research and Practice; State laws; Substance Abuse Treatment Centers; Substance Abuse, Intravenous - complications; Substance Abuse, Intravenous - ethnology
• ISSN: 0090-0036; 1541-0048
• DOI: 10.2105/AJPH.2008.159327

We examined racial/ethnic disparities in HIV infection among injection drug users (IDUs) before and after implementation of large-scale syringe exchange programs in New York City. Participants were recruited from IDUs entering the Beth Israel drug detoxification program in New York City. Participants (n = 1203) recruited from 1990 through 1994, prior to large-scale syringe exchange programs (pre-exchange), were compared with 1109 participants who began injecting in 1995 or later and were interviewed in 1995 through 2008 (post-exchange). There were large differences in HIV prevalence among pre-exchange vs post-exchange participants (African Americans, 57% vs 15%; Hispanics, 53% vs 5%; Whites, 27% vs 3%). Pre- and post-exchange relative disparities of HIV prevalence were similar for African Americans vs Whites (adjusted odds ratio [AOR] = 3.46, 95% confidence interval [CI] = 2.41, 4.96 and AOR = 4.02, 95% CI = 1.67, 9.69, respectively) and Hispanics vs Whites (AOR = 1.76, 95% CI = 1.49, 2.09 and AOR = 1.49, 95% CI = 1.02, 2.17). Racial/ethnic group differences in risk behavior did not explain differences in HIV prevalence. New interventions are needed to address continuing disparities in HIV infection among IDUs, but self-reported risk behaviors by themselves may not be adequate outcome measures for evaluating interventions to reduce racial/ethnic disparities in HIV infection.