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Don C. Des Jarlais, PhD, Kamyar Arasteh, PhD, Holly Hagan, PhD, Courtney McKnight, MPH, David C. Perlman, MD and Samuel R. Friedman, PhD

At the time of the study, Don C. Des Jarlais, Kamyar Arasteh, Courtney McKnight, and David C. Perlman were with Beth Israel Medical Center, New York, NY. Holly Hagan and Samuel R. Friedman were with the National Development and Research Institutes, New York, NY.

Correspondence: Correspondence should be sent to Don C. Des Jarlais, PhD, Beth Israel Medical Center, 160 Water St—24th Fl, New York, NY 10038 (e-mail: dcdesjarla{at}aol.com). Reprints can be ordered at http://www.ajph.org by clicking on the "Reprints/Eprints" link.

Objectives. We examined racial/ethnic disparities in HIV infection among injection drug users (IDUs) before and after implementation of large-scale syringe exchange programs in New York City.

Methods. Participants were recruited from IDUs entering the Beth Israel drug detoxification program in New York City. Participants (n = 1203) recruited from 1990 through 1994, prior to large-scale syringe exchange programs (pre-exchange), were compared with 1109 participants who began injecting in 1995 or later and were interviewed in 1995 through 2008 (post-exchange).

Results. There were large differences in HIV prevalence among pre-exchange vs post-exchange participants (African Americans, 57% vs 15%; Hispanics, 53% vs 5%; Whites, 27% vs 3%). Pre- and post-exchange relative disparities of HIV prevalence were similar for African Americans vs Whites (adjusted odds ratio [AOR] = 3.46, 95% confidence interval [CI] = 2.41, 4.96 and AOR = 4.02, 95% CI = 1.67, 9.69, respectively) and Hispanics vs Whites (AOR = 1.76, 95% CI = 1.49, 2.09 and AOR = 1.49, 95% CI = 1.02, 2.17). Racial/ethnic group differences in risk behavior did not explain differences in HIV prevalence.

Conclusions. New interventions are needed to address continuing disparities in HIV infection among IDUs, but self-reported risk behaviors by themselves may not be adequate outcome measures for evaluating interventions to reduce racial/ethnic disparities in HIV infection.