Racial and ethnic changes in heroin injection in the United States: Implications for the HIV/AIDS epidemic

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Abstract

Background

Racial/ethnic differences in drug injection prevalence contribute to disparities in HIV infection rates in the US between Whites, Blacks and Hispanics. We examine trends in the demographic characteristics of heroin injection drug users (IDUs) that may impact future HIV rates.

Methods

Descriptive analyses were conducted of (1) the national Treatment Episode Data Set for 1992–2004 and of the 2002–2004 baseline data from (2) CIDUS-III, a 5-city study that recruited 3285 young IDUs, and (3) NIHU-HIT, a Chicago study of 647 young noninjecting heroin users.

Results

Between 1992 and 2004, heroin was the injected drug most often reported at admission to drug treatment. During this period, the proportion of admissions reporting injection declined 44% among Blacks but only 14% for Whites. The peak age for heroin IDUs in treatment increased 10 years for Blacks while declining over 10 years for Whites. CIDUS-III enrolled about 8 times more White (64%) than Black (8%) young IDUs despite recruiting two-thirds of the sample in cities where Blacks constituted 27–64% of the population. Blacks comprised 53% of noninjecting heroin users in the Chicago NIHU-HIT, but only 2% of Chicago's CIDUS-III sample of heroin IDUs. Among current noninjecting heroin users, Whites were more likely than Blacks to have ever injected (Xd.f.=12=17.1, p < 0.001). Qualitative data supported greater resistance to injection among young Blacks than Whites.

Conclusions

Among heroin users, young Blacks are resisting injection while young Whites exhibit the opposite tendency. New research should investigate reasons for this trend and its impact on the HIV epidemic and future service needs.

Section snippets

Background

Racial/ethnic disparities in HIV infection in the United States are greatest in cases attributed to drug injection. In 2005, non-Hispanic (NH) Blacks and Hispanics, respectively, constituted 55 and 23% of such cases but only 12 and 15% of the US population (CDC, 2006a, CDC, 2006b, US Census Bureau, 2005). A recent study of 94 US metropolitan areas found that the elevated AIDS case rates for NH-Blacks compared to NH-Whites were correlated with higher drug injection rates among NH-Blacks (Cooper

Data sources

To describe patterns in the mode of heroin administration among different demographic groups between 1992 and 2004, we analyzed 3 data sources. The public Treatment Episode Data Set (TEDS) reports data from 50 states and Puerto Rico regarding the approximately 1.9 million annual admissions to public and private substance abuse treatment programs that receive state funds (SAMHSA, 2006). TEDS does not include data from facilities operated by the Federal Bureau of Prisons, the Department of

TEDS data: 1992–2004

Race/ethnicity, gender, and referral sources at admission to publicly funded drug treatment programs were largely stable between 1992 and 2004, but the proportion of admissions age 40 years and older increased from 21.6 to 34.6%. The largest changes in primary substance of abuse were for marijuana/hashish (from 6.1 to 15.9%) and methamphetamine (from 1.0 to 7.0%). The prevalence of drug injection among all admissions remained nearly constant from 1992 to 2004 (range 13.1–14.0%). However, the

Discussion

This study examined national substance abuse treatment data (TEDS) and two research studies, one of young injection drug users (CIDUS-III) and one of young noninjecting heroin users (NIHU-HIT). A striking finding in our analysis is the substantial decline in young NH-Black heroin injectors entering treatment and enrolling in research studies. As an example of the latter, NH-Blacks were only 12% of Baltimore's CIDUS-III sample despite constituting 64% of the city's population (US Census Bureau,

Role of funding source

While conducting this research, D. Broz was supported by a Predoctoral Prevention Research Training Program Fellowship sponsored by the National Institute on Drug Abuse (NIDA), and before that by NIDA grant R01 DA12068, Noninjected Heroin Use, HIV and Injection Transitions Study (NIHU-HIT). L.J. Ouellet was also supported by NIDA (grant R01 DA12068, NIHU-HIT Study) and by the Centers for Disease Control and Prevention (CDC) (grant, U64/CCU517656, Collaborative Injection Drug User Studies III

Conflict of interest

D. Broz and L.J. Ouellet have no conflicts of interest, including specific financial interest, relationship, and affiliation relevant to the subject matter discussed in the manuscript, that could inappropriately influence, or be perceived to influence, their work.

Acknowledgments

We thank the CIDUS-III Study Group, which includes the following people: Steffanie Strathdee, Elizabeth Golub, Marie Bailey-Kloch, Karen Yen-Hobelman (Baltimore); Lawrence Ouellet, Susan Bailey, Joyce Fitzgerald (Chicago); Sharon Hudson, Peter Kerndt, Karla Wagner (Los Angeles); Mary Latka, David Vlahov, Farzana Kapadia (New York); Holly Hagan, Hanne Thiede, Nadine Snyder, Jennifer V. Campbell (Seattle); Richard Garfein, David Purcell, Ian Williams, Paige Ingram, Andrea Swartzendruber (CDC).

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