title: Income inequality, drug-related arrests, and the health of people who inject drugs: Reflections on seventeen years of research.
abstract: This paper reviews and then discusses selected findings from a seventeen year study about the population prevalence of people who inject drugs (PWID) and of HIV prevalence and mortality among PWID in 96 large US metropolitan areas. Unlike most research, this study was conducted with the metropolitan area as the level of analysis. It found that metropolitan area measures of income inequality and of structural racism predicted all of these outcomes, and that rates of arrest for heroin and/or cocaine predicted HIV prevalence and mortality but did not predict changes in PWID population prevalence. Income inequality and measures of structural racism were associated with hard drug arrests or other properties of policing. These findings, whose limitations and implications for further research are discussed, suggest that efforts to respond to HIV and to drug injection should include supra-individual efforts to reduce both income inequality and racism. At a time when major social movements in many countries are trying to reduce inequality, racism and oppression (including reforming drug laws), these macro-social issues in public health should be both addressable and a priority in both research and action.
authors.affiliation: National Development and Research Institute, Inc., 71 West 23rd Street, 4th Floor, New York, NY 10010, USA. Electronic address: friedman@ndri.org.
authors.forename: Samuel R
authors.initials: SR
authors.lastname: Friedman
authors.affiliation: National Development and Research Institute, Inc., 71 West 23rd Street, 4th Floor, New York, NY 10010, USA.
authors.forename: Barbara
authors.initials: B
authors.lastname: Tempalski
authors.affiliation: NORC at the University of Chicago, 4350 East-West Hwy, Bethesda, MD 20814 USA.
authors.forename: Joanne E
authors.initials: JE
authors.lastname: Brady
authors.affiliation: Division of Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Drive 0507, La Jolla, CA 92093-0507, USA.
authors.forename: Brooke S
authors.initials: BS
authors.lastname: West
authors.affiliation: National Development and Research Institute, Inc., 71 West 23rd Street, 4th Floor, New York, NY 10010, USA.
authors.forename: Enrique R
authors.initials: ER
authors.lastname: Pouget
authors.affiliation: National Development and Research Institute, Inc., 71 West 23rd Street, 4th Floor, New York, NY 10010, USA.
authors.forename: Leslie D
authors.initials: LD
authors.lastname: Williams
authors.affiliation: Psychiatry and Preventive Medicine, Icahn School of Medicine at Mount Sinai., 39 Broadway, Suite 530, New York, NY 10006, USA.
authors.forename: Don C
authors.initials: DC
authors.lastname: Des Jarlais
authors.affiliation: Rollins School of Public Health at Emory University, 1518 Clifton Road, NE, Atlanta, GA 30322, USA.
authors.forename: Hannah L F
authors.initials: HL
authors.lastname: Cooper
mesh_terms: D019970:Cocaine-Related Disorders / Q000453:epidemiology; D003415:Crime / Q000191:economics / Q000706:statistics & numerical data*; D015658:HIV Infections / Q000191:economics / Q000453:epidemiology*; D006304:Health Status; D006556:Heroin Dependence / Q000453:epidemiology; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D015995:Prevalence; D063505:Racism; D012959:Socioeconomic Factors; D015819:Substance Abuse, Intravenous / Q000191:economics / Q000453:epidemiology*; D019966:Substance-Related Disorders / Q000191:economics / Q000453:epidemiology*; D014505:Urban Population
keywords: Drug law reform; Drug-related arrests; HIV; Health; Income inequality; Macro-social; People who inject drugs; Racism