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Racial and ethnic disparities and implications for the prevention of HIV among persons who inject drugs

Jarlais, Don C.D.a; Cooper, Hannah L.F.b; Bramson, Heidia; Deren, Sherryc; Hatzakis, Angelosd; Hagan, Hollyc

Current Opinion in HIV and AIDS: July 2012 - Volume 7 - Issue 4 - p 354–361
doi: 10.1097/COH.0b013e328353d990
INJECTING DRUG USE AND HIV: Edited by Lisa Maher and Nick Walsh

Purpose of review There are now an estimated 16 million people who inject drugs (PWID) throughout the world, 3 million of whom are estimated to be infected with HIV. In many countries, substantial proportions of PWID belong to racial/ethnic/nationality minority groups, and are at increased likelihood of being infected with HIV. This article reviews current evidence on ethnic disparities in HIV infection among PWID and assesses the issues that would need to be addressed to reduce these disparities.

Recent findings An ongoing systematic review of ethnic disparities has found that, in a pooled weighted odds ratio, ethnic minority PWID are twice as likely to be HIV seropositive than ethnic majority, PWID from the same geographic area. If implemented with sufficient quality and coverage, current HIV prevention programs probably have the capability of ending HIV transmission among both ethnic majority and minority PWID. Large-scale, evidence-based prevention programs need to be implemented in the contexts of patterns of injecting drug use that continue to evolve–with injecting practices spreading to new areas, changes in drugs injected, and some transitions from injecting to noninjecting drug use. Lack of financial resources and policies against evidence-based programming are increasingly important problems that are likely to have particularly adverse effects on ethnic minority PWID.

Summary Racial/ethnic/nationality disparities in HIV infection are quite common among PWID. Addressing these disparities will be a fundamental challenge within a human rights approach to public health.

aBeth Israel Medical Center, New York, New York

bEmory University, Atlanta, Georgia

cNew York University College of Nursing, New York, New York, USA

dAthens University Medical School, Athens, Greece

Correspondence to Don C.D. Jarlais, Baron Edmond de Rothschild, Chemical Dependency Institute, Beth Israel Medical Center, 160 Water Street – 24th Floor, New York, NY 10038, USA. Tel: +1 212 256 2549; fax: +01 212 256 2570; e-mail:

© 2012 Lippincott Williams & Wilkins, Inc.