Racial/ethnic disparities in HIV infection among people who inject drugs: an international systematic review and meta‐analysis

Abstract

Aims The Ethnic Minority Meta-Analysis (EMMA) aims to assess racial/ethnic disparities in HIV infection among people who inject drugs (PWID) across various countries. This is the first report of the data. Methods Standard systematic review/meta-analysis methods were utilized, including searching for, screening, and coding published and unpublished reports, and meta-analytic statistics. We followed the PRISMA Statement and MOOSE Guidelines for reporting methods. Disparities were measured with the odds ratio for HIV prevalence among ethnic minority PWID compared to ethnic majority PWID; an odds ratio> 1.0 indicated higher prevalence among ethnic minorities. Results Racial/ethnic disparities in HIV prevalence among PWID were examined in 131 prevalence reports, with 214 racial/ethnic minority to majority comparisons, comprising 106,715 PWID. Overall, the pooled OR indicates an increased likelihood of higher HIV prevalence among racial/ethnic minority compared to racial/ethnic majority PWID (OR=2.09, 95% CI 1.92-2.28). Among 214 comparisons, 106 produced a statistically significant higher OR for minorities; in 102 comparisons the OR was not significantly different from 1.0; six comparisons produced a statistically significant higher OR for majority group members. Disparities were particularly large in the US, pooled OR = 2.22 (95% CI 2.03 - 2.44). There was substantial variation in ORs—I squared = 75.3%: IQR = 1.38 - 3.56—and an approximate Gaussian distribution of the log ORs. Conclusions Among people who inject drugs, ethnic minorities are approximately twice as likely to be HIV seropositive than ethnic majorities. The great heterogeneity and Gaussian distribution suggest multiple causal factors and a need to tailor interventions to local conditions.

Perceived discrimination among racial and ethnic minority drug users and the association with health care utilization

“…While PWUDs, in general, have higher rates of several medical conditions, racial/ethnic minority PWUDs, in particular, face a disparate burden of HIV infection, decreased physical health and are less engaged in health care (Don C. Des Jarlais et al, 2012; Hall et al, 2013; Sanchez et al, 2015). In order to increase the number of PWUDs, and particularly racial/ethnic minority PWUDs, engaged in medical care, it is important to understand the factors that may deter them from initiating or remaining in medical care.…”

Study on Defense Mechanisms to Cope With Stress Due to Stigma Among People Living With HIV/AIDS Reported in Eastern India: A Single Center Experience

“…Although there remain regional and ethnic variations in prevalence rates, the inherent growing trend remains comparable worldwide. [12][13][14] They may occur alongside other forms of discrimination, such as racism, homosexuality or misogyny, prostitution, and drug abuse, and such associations complicate situation further because these are considered socially unacceptable in many parts of the world. 15,16 The concern for the developing world seems even greater.…”

Income inequality, drug-related arrests, and the health of people who inject drugs: Reflections on seventeen years of research

“…Research on drug use and on people who use drugs often seems isolated from research on major societal trends, forces and conflicts even though these have been shown to affect many other health outcomes and behaviors (Des Jarlais et al, 2012; Drucker, 2011; Pickett & Wilkinson, 2009; Williams, 2012). This separation exists in part because much of this research focuses on individuals who use drugs (or do not do so) and on individual-level predictors of which individuals use drugs, how they use drugs, or the consequences of their drug use, and ignores macro-level structures and processes.…”