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Racial/Ethnic Disparities in HIV among People who Inject Drugs: Variation and Potential Causal Structures

September 5, 2012

Don Des Jarlais, PhD
Director of Research, Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center

About the Presentation: Background: Higher rates of HIV infection among racial/ethnic (R/E) minority people who inject drugs (PWID) have been reported across the world. Developing interventions to reduce these disparities requires a better understanding of how they arise and persist.

Methods: Standard methods for systematic reviews and meta-analyses were used, including searching for, screening, and coding published and unpublished reports, and meta-analytic statistical techniques.

Results: R/E disparities in HIV prevalence among PWID were examined in 72 prevalence reports, with 144 R/E minority to majority comparisons. The pooled odds ratio (OR) for the comparison of R/E minority versus majority PWID showed a two-fold higher likelihood of HIV infection in R/E minority PWID (OR=2.06, 95% CI 1.86-2.28). Among the 144 R/E comparisons, 75 produced a statistically significant higher OR for minority group members; in 66 comparisons the OR was not significantly different from 1.0. Only three comparisons produced a statistically significant higher OR for majority group members. Disparities were particularly large in the US, pooled OR = 2.36 (95% CI 2.10 – 2.64) and China, pooled OR = 2.49 (95% CI 1.71 – 3.64). There was substantial variation in the ORs (I squared = 78.8%; IQR = 1.25 – 3.28), with the log ORs approximating a Gaussian (or “normal”) distribution. There were statistically significant disparities even at low prevalence levels, with a pooled OR = 1.53 (95% CI 1.18 – 1.98) for reports with overall PWID HIV prevalence between 1-12%.

Conclusions: Among PWID, R/E minorities are approximately twice as likely to be HIV seropositive than R/E majority group members. That significant disparities exist at low HIV prevalence suggests that the disparities arise early in HIV epidemics. The observed Gaussian distribution and the great heterogeneity found in the ORs suggest multiple causal factors and a need for multi-faceted rather than single focused interventions.

About the Presenter: Don Des Jarlais, PhD is Director of Research for the Baron Edmond de Rothschild Chemical Dependency Institute at Beth Israel Medical Center, a Senior Research Fellow with the National Development and Research Institutes, Inc. and a Guest Investigator at Rockefeller University in New York. He began his research on AIDS in 1982.

As a leader in the fields of AIDS and injecting drug use, Dr. Des Jarlais has published extensively on these topics including papers in the New England Journal of Medicine, the Journal of the American Medical Association, Science and Nature. He has been particularly active in international research, having collaborated on studies in twenty-five different countries. He serves as a consultant to various institutions, including the Centers for Disease Control and Prevention, the National Institute on Drug Abuse, the National Academy of Sciences and the World Health Organization. He is a former commissioner for the US National Commission on AIDS, and is currently a Core Group Member of the UNAIDS Reference Group on HIV and Injecting Drug Use. In 2010 Dr. Des Jarlais was elected to the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) Scientific Advisory Board (SAB).