Momplaisir Florence, Hussein Mustafa, Tobin-Fiore Danielle, Smith Laramie, Bennett David, Latkin Carl, Metzger David S
*Division of Infectious Diseases and HIV Medicine, Drexel College of Medicine, Philadelphia, PA; †Public Health Policy and Administration, Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, WI; ‡Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; §Division of Public Health, UC San Diego School of Medicine, San Diego, CA; ‖Department of Psychiatry, Drexel, College of Medicine, Philadelphia, PA; and ¶Department of Health, Behavior, and Society, School of Public Health, Johns Hopkins University, Baltimore, MD.
J Acquir Immune Defic Syndr. 2017 Dec 1;76(4):394-401. doi: 10.1097/QAI.0000000000001521.
HIV prevention interventions in the United States have failed to eliminate racial inequities. Here, we evaluate factors associated with racial inequities in HIV prevalence among people who inject drugs using HIV Prevention Trial Network 037 data.
We measured racial homophily (ie, all members share the same race), being in an HIV+ network (network with ≥1 HIV+ member), and drug and sex risk behaviors. A 2-level logistic regression with a random intercept evaluated the association between being in an HIV+ network and race adjusting for individual-level and network-level factors.
Data from 232 index participants and 464 network members were included in the analysis. Racial homophily was high among blacks (79%) and whites (70%); 27% of all-black, 14% of all-white, and 23% of racially mixed networks included HIV+ members. Sex risk was similar across networks, but needle sharing was significantly lower in all-black (23%) compared with all-white (48%) and racially mixed (46%) networks. All-black [adjusted odds ratio (AOR), 3.6; 95% confidence interval (CI), 1.4 to 9.5] and racially mixed (AOR, 2.0; 95% CI: 1.1 to 3.7) networks were more likely to include HIV+ network members; other factors associated with being in HIV+ network included homelessness (AOR, 2.0; 95% CI, 1.2 to 3.2), recent incarceration (AOR, 0.4; 95% CI, 0.2 to 0.7), and cocaine injection (AOR, 1.7; 95% CI, 1.0 to 2.7). Risk behaviors were not associated with being in an HIV+ network.
Despite having lower drug risk behavior, all-black networks disproportionately included HIV+ members. HIV prevention interventions for people who inject drugs need to go beyond individual risk and consider the composition of risk networks.
美国的艾滋病病毒（HIV）预防干预措施未能消除种族不平等现象。在此，我们利用HIV预防试验网络037的数据，评估与注射吸毒者中HIV流行率的种族不平等相关的因素。
我们测量了种族同质性（即所有成员属于同一种族）、处于HIV阳性网络（网络中至少有1名HIV阳性成员）以及毒品和性风险行为。采用具有随机截距的二级逻辑回归，评估处于HIV阳性网络与种族之间的关联，并对个体层面和网络层面的因素进行校正。
分析纳入了232名索引参与者和464名网络成员的数据。黑人（79%）和白人（70%）中的种族同质性较高；所有黑人网络的27%、所有白人网络的14%以及种族混合网络的23%包含HIV阳性成员。各网络中的性风险相似，但与所有白人网络（48%）和种族混合网络（46%）相比，所有黑人网络中的共用针头情况显著更低（23%）。所有黑人网络（校正比值比[AOR]，3.6；95%置信区间[CI]，1.4至9.5）和种族混合网络（AOR，2.0；95%CI：1.1至3.7）更有可能包含HIV阳性网络成员；与处于HIV阳性网络相关的其他因素包括无家可归（AOR，2.0；95%CI，1.2至3.2）、近期入狱（AOR，0.4；95%CI，0.2至0.7）以及注射可卡因（AOR，1.7；95%CI，1.0至2.7）。风险行为与处于HIV阳性网络无关。
尽管毒品风险行为较低，但所有黑人网络中HIV阳性成员的比例过高。针对注射吸毒者的HIV预防干预措施需要超越个体风险，考虑风险网络的构成。
