Persistence of racial/ethnic differences in HIV infection among injecting drug users in New York City, 1978-2006

Objective: Racial/ethnic differences in HIV infection among injecting drug users (with minority IDUs having higher HIV prevalence) have been observed in North America, Europe and Asia. Differences emerged in 1978-81 in New York City, with prevalence of approximately 60% among minority and 30% among ethnic majority IDUs. Implementation of syringe exchange programs in the mid-1990s led to large reductions in HIV incidence among all racial/ethnic groups of IDUs.

Methods: 1402 subjects who began injecting after 1994 were recruited from IDUs entering drug abuse treatment programs from 1995-2006. A structured questionnaire was administered and serum tested for HIV.

Results: Overall HIV prevalence was 6% and this was stable over time. Prevalence among subjects injecting for < 2 years was 5%, indicating that the great majority were probably infected with HIV before beginning to inject. There were very substantial differences in HIV prevalence by race/ethnicity and gender/sexual behavior. For Blacks, HIV prevalence as 41% among MSM-IDUs, 17% among females and 9% among non-MSM males. For Hispanics, HIV prevalence was 12% among MSM-IDUs, 11% among females, and 4% among non-MSM males. For whites, HIV prevalence was 8% among MSM-IDUs, 6% among females, and 0.7% among non-MSM males. (All comparisons p < .001 except for MSM-IDUs vs. females within Hispanics and whites.)

Conclusions: Racial/ethnic differences in HIV prevalence have persisted for three decades among IDUs in New York. Sexual risk, particularly sexual risk prior to beginning to inject, appears to be the primary reason for current differences in HIV prevalence.