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

for the National HIV Behavioral Surveillance Study Group

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)43-55
Number of pages13
JournalInternational Journal of Drug Policy
Volume27
DOIs
StatePublished - Jan 1 2016

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Pharmaceutical Preparations
HIV
Hispanic Americans
Syringes
Ethnic Groups
Censuses
Crime
Poverty
Centers for Disease Control and Prevention (U.S.)
HIV Infections
Substance-Related Disorders

Keywords

  • Critical race theory
  • HIV
  • Injection drug use
  • National HIV Behavioral Surveillance
  • Residence characteristics
  • Risk environments

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Health Policy

Cite this

Racialized risk environments in a large sample of people who inject drugs in the United States. / for the National HIV Behavioral Surveillance Study Group.

In: International Journal of Drug Policy, Vol. 27, 01.01.2016, p. 43-55.

Research output: Contribution to journalArticle

for the National HIV Behavioral Surveillance Study Group. / Racialized risk environments in a large sample of people who inject drugs in the United States. In: International Journal of Drug Policy. 2016 ; Vol. 27. pp. 43-55.
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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.",
keywords = "Critical race theory, HIV, Injection drug use, National HIV Behavioral Surveillance, Residence characteristics, Risk environments",
author = "{for the National HIV Behavioral Surveillance Study Group} and Cooper, {Hannah L F} and Sabriya Linton and Kelley, {Mary E.} and Zev Ross and Wolfe, {Mary E.} and Chen, {Yen Tyng} and Maria Zlotorzynska and Josalin Hunter-Jones and Friedman, {Samuel R.} and {Des Jarlais}, Don and Salaam Semaan and Barbara Tempalski and Elizabeth DiNenno and Dita Broz and Cyprian Wejnert and Gabriela Paz-Bailey and Jennifer Taussig and Shacara Johnson and Jeff Todd and Colin Flynn and Danielle German and Debbie Isenberg and Maura Driscoll and Elizabeth Hurwitz and Nikhil Prachand and Nanette Benbow and Sharon Melville and Richard Yeager and Jim Dyer and Alicia Novoa and Mark Thrun and Alia Al-Tayyib and Emily Higgins and Eve Mokotoff and Vivian Griffin and Aaron Sayegh and Jan Risser and Hafeez Rehman and Trista Bingham and Sey, {Ekow Kwa} and Lisa Metsch and David Forrest and Dano Beck and Gabriel Cardenas and Chris Nemeth and Lou Smith and Watson, {Carol Ann} and Robinson, {William T.} and Gruber, {De Ann} and Holly Hagan",
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AU - Kelley, Mary E.

AU - Ross, Zev

AU - Wolfe, Mary E.

AU - Chen, Yen Tyng

AU - Zlotorzynska, Maria

AU - Hunter-Jones, Josalin

AU - Friedman, Samuel R.

AU - Des Jarlais, Don

AU - Semaan, Salaam

AU - Tempalski, Barbara

AU - DiNenno, Elizabeth

AU - Broz, Dita

AU - Wejnert, Cyprian

AU - Paz-Bailey, Gabriela

AU - Taussig, Jennifer

AU - Johnson, Shacara

AU - Todd, Jeff

AU - Flynn, Colin

AU - German, Danielle

AU - Isenberg, Debbie

AU - Driscoll, Maura

AU - Hurwitz, Elizabeth

AU - Prachand, Nikhil

AU - Benbow, Nanette

AU - Melville, Sharon

AU - Yeager, Richard

AU - Dyer, Jim

AU - Novoa, Alicia

AU - Thrun, Mark

AU - Al-Tayyib, Alia

AU - Higgins, Emily

AU - Mokotoff, Eve

AU - Griffin, Vivian

AU - Sayegh, Aaron

AU - Risser, Jan

AU - Rehman, Hafeez

AU - Bingham, Trista

AU - Sey, Ekow Kwa

AU - Metsch, Lisa

AU - Forrest, David

AU - Beck, Dano

AU - Cardenas, Gabriel

AU - Nemeth, Chris

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AU - Hagan, Holly

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N2 - 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.

AB - 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.

KW - Critical race theory

KW - HIV

KW - Injection drug use

KW - National HIV Behavioral Surveillance

KW - Residence characteristics

KW - Risk environments

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