Racialized risk environments in a large sample of people who inject drugs in the United States

• Type of Material: Article
• Authors: Hannah Cooper, Emory University; Sabriya Linton, Emory University; Mary Kelley, Emory University; Zev Ross, ZevRoss SpatialAnal; Mary E. Wolfe, Emory University; Yen-Tyng Chen, Emory University; Maria Zlotorzynska, Emory University; Josalin Hunter-Jones, Emory University; Samuel R. Friedman, Natl Dev & Res Inst; Don Des Jarlais, Beth Israel Deaconess Med Ctr; Salaam Semaan, Ctr Dis Control & Prevent; Barbara Tempalski, Natl Dev & Res Inst; Elizabeth DiNenno, Ctr Dis Control & Prevent; Dita Broz, Ctr Dis Control & Prevent; Cyprian Wejnert, Ctr Dis Control & Prevent; Gabriella Paz-Bailey, Emory University
• Language: English
• Date: 2016-01-01
• Publisher: Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2015 Elsevier B.V.
• Final Published Version (URL): http://dx.doi.org/10.1016/j.drugpo.2015.07.015
• Title of Journal or Parent Work: International Journal of Drug Policy
• Volume: 27
• Start Page: 43
• End Page: 55
• Grant/Funding Information: This research was supported by two NIH grants: “Place Characteristics & Disparities in HIV in IDUS: A Multilevel Analysis of NHBS” (DA035101; Cooper, PI) and the Emory Center for AIDS Research (P30 AI050409; Curran, PI).
• Keywords: Risk environments; Life Sciences & Biomedicine; National HIV Behavioral Surveillance; OLDER MEXICAN-AMERICANS; US METROPOLITAN-AREAS; RESIDENTIAL SEGREGATION; HIV-INFECTION; SYRINGE EXCHANGE PROGRAMS; HIV; Substance Abuse; NEW-YORK-CITY; Critical race theory; Science & Technology; Residence characteristics; BEHAVIORAL SURVEILLANCE SYSTEM; Injection drug use; STERILE SYRINGES; SPATIAL ACCESS; SELF-RATED HEALTH
• Research Categories: Health Sciences, Public Health; Health Sciences, Epidemiology

Abstract

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). Conclusion: 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.