Overview of HIV Among Injection Drug Users in New York City: Critical Next Steps to Eliminate Racial/Ethnic Disparities

Abstract

At the start of the HIV epidemic, 50% of new infections were among injection drug users (IDUs) in New York City. While HIV has declined among IDUs since the mid-1990s, parenteral transmission continues to overburden Blacks/Hispanic IDUs. Individual risk behaviors do not explain the distribution of HIV/AIDS among IDUs. Social and/or structural factors are likely fueling racial disparities creating a high-risk socioenvironmental context. While increased access to structural interventions (i.e., syringe exchange and pharmacy syringe access) is needed, it may not be sufficient to eliminate HIV/AIDS disparities among IDUs. Research on incorporating structural factors into intervention strategies is needed.

Keywords:

• risk behaviors
• racial disparities
• structural factors
• structural interventions
• disease burden

THE AUTHORS

Silvia Amesty, MD, is a family physician at the New York Presbyterian Hospital, on faculty at Columbia University, College of Physicians and Surgeons, Mailman School of Public Health, and a research fellow with the Center of Urban Epidemiologic Studies at the New York Academy of Medicine. She was educated at the University of Pennsylvania (BA, MSEd), Temple University (MD), and Columbia University (MPH). She is a board certified Family Medicine physician, and received residency training at Beth Israel Medical Center/The Institute for Urban Family Health in New York City. She has worked in the Washington Heights and Harlem communities for several years as a clinician, and has been a primary care HIV provider, after completing her fellowship training in academic family medicine.

Alexis V. Rivera, MPH, is a Research Coordinator with the Center for Urban Epidemiologic Studies at the New York Academy of Medicine. She obtained her master's degree in the Department of Epidemiology at the Mailman School of Public Health at Columbia University. Her research interests include HIV prevention interventions, racial disparities, Latino health, and urban health.

Crystal M. Fuller, PhD, MPH, is an Associate Professor of Clinical Epidemiology at Columbia University, Mailman School of Public Health and an infectious disease epidemiologist with Center for Urban Epidemiologic Studies at the New York Academy of Medicine. She completed her MPH from the Tulane University School of Public Health and her PhD from Johns Hopkins University, School of Public Health in the Infectious Disease Epidemiology Program. Her research focuses on the effect of high-risk behavior (particularly social networks) and other social determinants (individual and contextual) on initiation of injection drug use, subsequent risk behavior, and early transmission of blood-borne pathogens among drug users in New York City.