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Am J Public Health. 2015 Dec;105(12):2457-65. doi: 10.2105/AJPH.2015.302861. Epub 2015 Oct 15.

HIV Infection Among People Who Inject Drugs in the United States: Geographically Explained Variance Across Racial and Ethnic Groups.

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Sabriya L. Linton, Hannah L. F. Cooper, Mary E. Kelley, Conny C. Karnes, and Mary E. Wolfe are with The Rollins School of Public Health at Emory University, Atlanta, GA. Zev Ross is with ZevRoss SpatialAnalysis, Ithaca, NY. Don Des Jarlais is with The Baron Edmond de Rothschild Chemical Dependency Institute, Mount Sinai Beth Israel, New York, NY. Barbara Tempalski is with The Institute for Infectious Disease Research, National Development and Research Institutes, New York, NY. Salaam Semaan, Elizabeth DiNenno, Teresa Finlayson, Catlainn Sionean, Cyprian Wejnert, and Gabriela Paz-Bailey are with the Centers for Disease Control and Prevention, Atlanta.



We explored how variance in HIV infection is distributed across multiple geographical scales among people who inject drugs (PWID) in the United States, overall and within racial/ethnic groups.


People who inject drugs (n = 9077) were recruited via respondent-driven sampling from 19 metropolitan statistical areas (MSAs) for the Centers for Disease Control and Prevention's 2009 National HIV Behavioral Surveillance system. We used multilevel modeling to determine the percentage of variance in HIV infection explained by zip codes, counties, and MSAs where PWID lived, overall and for specific racial/ethnic groups.


Collectively, zip codes, counties, and MSAs explained 29% of variance in HIV infection. Within specific racial/ethnic groups, all 3 scales explained variance in HIV infection among non-Hispanic/Latino White PWID (4.3%, 0.2%, and 7.5%, respectively), MSAs explained variance among Hispanic/Latino PWID (10.1%), and counties explained variance among non-Hispanic/Latino Black PWID (6.9%).


Exposure to potential determinants of HIV infection at zip codes, counties, and MSAs may vary for different racial/ethnic groups of PWID, and may reveal opportunities to identify and ameliorate intraracial inequities in exposure to determinants of HIV infection at these geographical scales.

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