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J Ethn Subst Abuse. 2017 Jul-Sep;16(3):344-362. doi: 10.1080/15332640.2016.1196629. Epub 2016 Jul 12.

Sociodemographic and access-related correlates of health-care utilization among African American injection drug users: The BESURE study.

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a Brigham and Women's Hospital , Boston , Massachusetts.
b Johns Hopkins University , Baltimore , Maryland.
c Maryland Department of Health and Mental Hygiene , Baltimore , Maryland.
d Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland.


Persons who inject drugs (PWID) may have less access to, and utilization of, health-care services, and African American PWID may be less likely than other racial groups to utilize health care in the United States. The present study evaluated the prevalence of health-care utilization (HCU) among a cohort of African American PWID in Baltimore. Data were from the 2012 Baltimore National HIV Behavioral Surveillance study. Participants were adult PWID and recruited using respondent-driven sampling (RDS). They completed a comprehensive sociobehavioral survey and voluntary HIV test with trained study interviewers. Analyses included descriptive and bivariate statistics to examine the prevalence of HCU, defined as seeing a health-care provider in the past year. Poisson regression assessed correlates of HCU. Participants were 61% male; 23% self-reported HIV seropositivity. Nearly 90% reported unemployment and/or disability; HCU prevalence was 85%. Significant negative correlates of HCU included age and higher injection frequency; positive correlates included previous incarceration and moderate financial stability. Interaction analyses showed unemployed publicly insured individuals had 30% higher HCU than unemployed and uninsured individuals (χ2 = 2.52; p < .05). There is a need to improve health-care utilization among PWID. High prevalence of disability was still found, despite insurance coverage and access to care in this population. While the recent Affordable Care Act has increased health-care coverage and access, our results suggest that is only a first step to improving health outcomes among PWID; targeted intervention to integrate these individuals is still needed.


African Americans; HIV/AIDS; health disparities; health-care utilization; injection drug use

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