Persistence and change in disparities in HIV infection among injection drug users in New York City after large-scale syringe exchange programs.
OBJECTIVE
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.


METHODS
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).


RESULTS
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.


CONCLUSIONS
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.
Des Jarlais
Don C
DC
Beth Israel Medical Center, 160 Water St-24th Fl, New York, NY 10038, USA. dcdesjarla@aol.com
Arasteh
Kamyar
K
Hagan
Holly
H
McKnight
Courtney
C
Perlman
David C
DC
Friedman
Samuel R
SR
D000328:Adult; D001741:Black or African American; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000208:ethnology*; D054624:Health Status Disparities; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D018671:Needle-Exchange Programs; D016017:Odds Ratio; D015995:Prevalence; D016320:Substance Abuse Treatment Centers; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000208:ethnology*; D044465:White People