Commentary
Income inequality, drug-related arrests, and the health of people who inject drugs: Reflections on seventeen years of research

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Abstract

This paper reviews and then discusses selected findings from a seventeen year study about the population prevalence of people who inject drugs (PWID) and of HIV prevalence and mortality among PWID in 96 large US metropolitan areas. Unlike most research, this study was conducted with the metropolitan area as the level of analysis. It found that metropolitan area measures of income inequality and of structural racism predicted all of these outcomes, and that rates of arrest for heroin and/or cocaine predicted HIV prevalence and mortality but did not predict changes in PWID population prevalence. Income inequality and measures of structural racism were associated with hard drug arrests or other properties of policing. These findings, whose limitations and implications for further research are discussed, suggest that efforts to respond to HIV and to drug injection should include supra-individual efforts to reduce both income inequality and racism. At a time when major social movements in many countries are trying to reduce inequality, racism and oppression (including reforming drug laws), these macro-social issues in public health should be both addressable and a priority in both research and action.

Section snippets

Findings from five analyses

Our first analyses looked at the predictors of three variables that Holmberg (1996) had generated in a creative effort to estimate the size of three Key Populations (men who have sex with men, PWID, and high-risk heterosexuals) and HIV prevalence and incidence among these populations as of approximately 1992. We analyzed the predictors of PWID population prevalence (per 10,000 adult population), of HIV prevalence among PWID, and of HIV incidence among PWID. In one analysis, we showed that

Discussion

These results suggest that macro-social factors such as income inequality and racial/ethnic residential segregation are associated with higher rates of injection drug use, of HIV among PWID, and of mortality among PWID living with AIDS, and that drug arrests do not reduce injection drug use but do contribute to HIV and AIDS among PWID. There are of course limitations on what these associations mean. They are limited geographically, and notably do not include data from outside the USA. They by

Acknowledgements

We gratefully acknowledge support from National Institute on Drug Abuse Grants R01 DA13336 (Community Vulnerability and Responses to Drug-User-Related HIV/AIDS), R01 DA037568 (Metropolitan Trajectories of HIV Epidemics, Drug Use, and Responses in US Key Populations), R01 DA031597 (Developing measures to study how structural interventions may affect HIV risk), T32 DA 023356 (Program in Substance Use, HIV and Related Infections) and P30 DA11041 (Center for Drug Use and HIV Research). The content

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