Racialized risk environments in a large sample of people who inject drugs in the United States.
BACKGROUND
Substantial racial/ethnic disparities exist in HIV infection among people who inject drugs (PWID) in many countries. To strengthen efforts to understand the causes of disparities in HIV-related outcomes and eliminate them, we expand the "Risk Environment Model" to encompass the construct "racialized risk environments," and investigate whether PWID risk environments in the United States are racialized. Specifically, we investigate whether black and Latino PWID are more likely than white PWID to live in places that create vulnerability to adverse HIV-related outcomes.


METHODS
As part of the Centers for Disease Control and Prevention's National HIV Behavioral Surveillance, 9170 PWID were sampled from 19 metropolitan statistical areas (MSAs) in 2009. Self-reported data were used to ascertain PWID race/ethnicity. Using Census data and other administrative sources, we characterized features of PWID risk environments at four geographic scales (i.e., ZIP codes, counties, MSAs, and states). Means for each feature of the risk environment were computed for each racial/ethnic group of PWID, and were compared across racial/ethnic groups.


RESULTS
Almost universally across measures, black PWID were more likely than white PWID to live in environments associated with vulnerability to adverse HIV-related outcomes. Compared to white PWID, black PWID lived in ZIP codes with higher poverty rates and worse spatial access to substance abuse treatment and in counties with higher violent crime rates. Black PWID were less likely to live in states with laws facilitating sterile syringe access (e.g., laws permitting over-the-counter syringe sales). Latino/white differences in risk environments emerged at the MSA level (e.g., Latino PWID lived in MSAs with higher drug-related arrest rates).


CONCLUSIONS
PWID risk environments in the US are racialized. Future research should explore the implications of this racialization for racial/ethnic disparities in HIV-related outcomes, using appropriate methods.
Rollins School of Public Health at Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA. Electronic address: hcoope3@emory.edu.
Hannah L F
HL
Cooper
Rollins School of Public Health at Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA.
Sabriya
S
Linton
Rollins School of Public Health at Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA.
Mary E
ME
Kelley
ZevRoss SpatialAnalysis, 120 N Aurora St, Suite 3A, Ithaca, NY 14850, USA.
Zev
Z
Ross
Rollins School of Public Health at Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA.
Mary E
ME
Wolfe
Rollins School of Public Health at Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA.
Yen-Tyng
YT
Chen
Rollins School of Public Health at Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA.
Maria
M
Zlotorzynska
Rollins School of Public Health at Emory University, 1518 Clifton Road NE, Atlanta, GA 30322, USA.
Josalin
J
Hunter-Jones
Institute for Infectious Disease Research, National Development and Research Institutes, 71 West 23rd Street, 4th Fl, New York, NY 10010, USA.
Samuel R
SR
Friedman
The Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center, 160 Water Street, 24th floor, New York, NY 10038, USA.
Don
D
Des Jarlais
Centers for Disease Control and Prevention, Corporate Square Building 8, Atlanta, GA 30333, USA.
Salaam
S
Semaan
Institute for Infectious Disease Research, National Development and Research Institutes, 71 West 23rd Street, 4th Fl, New York, NY 10010, USA.
Barbara
B
Tempalski
Centers for Disease Control and Prevention, Corporate Square Building 8, Atlanta, GA 30333, USA.
Elizabeth
E
DiNenno
Centers for Disease Control and Prevention, Corporate Square Building 8, Atlanta, GA 30333, USA.
Dita
D
Broz
Centers for Disease Control and Prevention, Corporate Square Building 8, Atlanta, GA 30333, USA.
Cyprian
C
Wejnert
Centers for Disease Control and Prevention, Corporate Square Building 8, Atlanta, GA 30333, USA.
Gabriela
G
Paz-Bailey
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D003625:Data Collection; D004777:Environment; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000208:ethnology; D054624:Health Status Disparities; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D012306:Risk; D015819:Substance Abuse, Intravenous / Q000453:epidemiology* / Q000208:ethnology; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data
Critical race theory; HIV; Injection drug use; National HIV Behavioral Surveillance; Residence characteristics; Risk environments