title: Will "Combined Prevention" Eliminate Racial/Ethnic Disparities in HIV Infection among Persons Who Inject Drugs in New York City?
abstract: It has not been determined whether implementation of combined prevention programming for persons who inject drugs reduce racial/ethnic disparities in HIV infection. We examine racial/ethnic disparities in New York City among persons who inject drugs after implementation of the New York City Condom Social Marketing Program in 2007. Quantitative interviews and HIV testing were conducted among persons who inject drugs entering Mount Sinai Beth Israel drug treatment (2007-2014). 703 persons who inject drugs who began injecting after implementation of large-scale syringe exchange were included in the analyses. Factors independently associated with being HIV seropositive were identified and a published model was used to estimate HIV infections due to sexual transmission. Overall HIV prevalence was 4%; Whites 1%, African-Americans 17%, and Hispanics 4%. Adjusted odds ratios were 21.0 (95% CI 5.7, 77.5) for African-Americans to Whites and 4.5 (95% CI 1.3, 16.3) for Hispanics to Whites. There was an overall significant trend towards reduced HIV prevalence over time (adjusted odd ratio = 0.7 per year, 95% confidence interval (0.6-0.8). An estimated 75% or more of the HIV infections were due to sexual transmission. Racial/ethnic disparities among persons who inject drugs were not significantly different from previous disparities. Reducing these persistent disparities may require new interventions (treatment as prevention, pre-exposure prophylaxis) for all racial/ethnic groups.
authors.affiliation: The Baron Edmond de Rothschild Chemical Dependency Institute, Mount Sinai Beth Israel, New York, New York, United States of America.
authors.forename: Don
authors.initials: D
authors.lastname: Des Jarlais
authors.affiliation: The Baron Edmond de Rothschild Chemical Dependency Institute, Mount Sinai Beth Israel, New York, New York, United States of America.
authors.forename: Kamyar
authors.initials: K
authors.lastname: Arasteh
authors.affiliation: The Baron Edmond de Rothschild Chemical Dependency Institute, Mount Sinai Beth Israel, New York, New York, United States of America.
authors.forename: Courtney
authors.initials: C
authors.lastname: McKnight
authors.affiliation: The Baron Edmond de Rothschild Chemical Dependency Institute, Mount Sinai Beth Israel, New York, New York, United States of America.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Feelemyer
authors.affiliation: College of Nursing, New York University, New York, New York, United States of America.
authors.forename: Holly
authors.initials: H
authors.lastname: Hagan
authors.affiliation: Rollins School of Public Health at Emory University, Atlanta, Georgia, United States of America.
authors.forename: Hannah
authors.initials: H
authors.lastname: Cooper
authors.affiliation: Department of Psychiatry, Columbia University, New York, New York, United States of America.
authors.forename: Aimee
authors.initials: A
authors.lastname: Campbell
authors.affiliation: Department of Psychiatry, Columbia University, New York, New York, United States of America.
authors.forename: Susan
authors.initials: S
authors.lastname: Tross
authors.affiliation: The Baron Edmond de Rothschild Chemical Dependency Institute, Mount Sinai Beth Israel, New York, New York, United States of America.
authors.forename: David
authors.initials: D
authors.lastname: Perlman
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D017280:Condoms / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000208:ethnology* / Q000517:prevention & control* / Q000635:transmission; D006266:Health Education / Q000379:methods; D054624:Health Status Disparities; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D018671:Needle-Exchange Programs / Q000458:organization & administration; D009519:New York City / Q000208:ethnology; D015819:Substance Abuse, Intravenous / Q000208:ethnology* / Q000517:prevention & control*; D044465:White People / Q000706:statistics & numerical data