Racial/Ethnic and Sex Disparities in HIV Infection among persons who inject drugs in New York City, 1990 to 2012

Objective: Significant racial/ethnic and sex disparities in HIV infection among persons who inject drugs (PWID) have been observed in many countries, with ethnic minority group members and females usually having higher HIV prevalence.  There are evidence-based interventions to reduce HIV transmission among PWID, but whether implementation of these programs reduces disparities has not been determined.  We examined ethnic and sex disparities in HIV infection among PWID in New York City over a 30-year period with increasing implementation of evidence-based prevention programs.

Methods:  Quantitative interviews and HIV testing were conducted among PWID entering Beth Israel Medical Center drug treatment programs between 1990 and 2012.  Data were analyzed by cumulative implementation of prevention program in four time periods: 1990-1994: methadone treatment, community outreach, and HIV testing; 1995-2000: large-scale syringe exchange programs; 2000- 2006: highly active anti-retroviral treatment; and 2007-2012: NYC Condom Social Marketing program.

Results: 7139 subjects were recruited from 1990-2012.  Cumulative addition of prevention interventions was followed by substantial declines in HIV prevalence (approximately 80% declines) among all racial/ethnic groups and among both females and males from 1990 to 2012.  Disparities in HIV prevalence did not change for African-Americans or Hispanics compared to Whites (odds ratios approximately 3.0). Female/male disparity odds ratios showed a statistically significant increase over time (p < 0.05)

Conclusions: Despite large-scale implementation of effective HIV prevention programs for PWID over a long time period, racial/ethnic and female/male disparities persist.    The potential for new interventions, such as treatment as prevention, to reduce/eliminate disparities will be critically examined.