Racialized risk environments in a large sample of people who inject drugs in the United States

Hannah L F Cooper, Sabriya Linton, Mary E. Kelley, Zev Ross, Mary E. Wolfe, Yen Tyng Chen, Maria Zlotorzynska, Josalin Hunter-Jones, Samuel R. Friedman, Don Des Jarlais, Salaam Semaan, Barbara Tempalski, Elizabeth DiNenno, Dita Broz, Cyprian Wejnert, Gabriela Paz-Bailey, Jennifer Taussig, Shacara Johnson, Jeff Todd, Colin FlynnDanielle German, Debbie Isenberg, Maura Driscoll, Elizabeth Hurwitz, Nikhil Prachand, Nanette Benbow, Sharon Melville, Richard Yeager, Jim Dyer, Alicia Novoa, Mark Thrun, Alia Al-Tayyib, Emily Higgins, Eve Mokotoff, Vivian Griffin, Aaron Sayegh, Jan Risser, Hafeez Rehman, Trista Bingham, Ekow Kwa Sey, Lisa Metsch, David Forrest, Dano Beck, Gabriel Cardenas, Chris Nemeth, Lou Smith, Carol Ann Watson, William T. Robinson, De Ann Gruber, Narquis Barak, for the National HIV Behavioral Surveillance Study Group

Research output: Contribution to journalArticlepeer-review

51 Scopus citations


Background: Substantial racial/ethnic disparities exist in HIV infection among people who inject drugs (PWID) in many countries. To strengthen efforts to understand the causes of disparities in HIV-related outcomes and eliminate them, we expand the "Risk Environment Model" to encompass the construct "racialized risk environments," and investigate whether PWID risk environments in the United States are racialized. Specifically, we investigate whether black and Latino PWID are more likely than white PWID to live in places that create vulnerability to adverse HIV-related outcomes. Methods: As part of the Centers for Disease Control and Prevention's National HIV Behavioral Surveillance, 9170 PWID were sampled from 19 metropolitan statistical areas (MSAs) in 2009. Self-reported data were used to ascertain PWID race/ethnicity. Using Census data and other administrative sources, we characterized features of PWID risk environments at four geographic scales (i.e., ZIP codes, counties, MSAs, and states). Means for each feature of the risk environment were computed for each racial/ethnic group of PWID, and were compared across racial/ethnic groups. Results: Almost universally across measures, black PWID were more likely than white PWID to live in environments associated with vulnerability to adverse HIV-related outcomes. Compared to white PWID, black PWID lived in ZIP codes with higher poverty rates and worse spatial access to substance abuse treatment and in counties with higher violent crime rates. Black PWID were less likely to live in states with laws facilitating sterile syringe access (e.g., laws permitting over-the-counter syringe sales). Latino/white differences in risk environments emerged at the MSA level (e.g., Latino PWID lived in MSAs with higher drug-related arrest rates). Conclusion: PWID risk environments in the US are racialized. Future research should explore the implications of this racialization for racial/ethnic disparities in HIV-related outcomes, using appropriate methods.

Original languageEnglish (US)
Pages (from-to)43-55
Number of pages13
JournalInternational Journal of Drug Policy
StatePublished - Jan 1 2016


  • Critical race theory
  • HIV
  • Injection drug use
  • National HIV Behavioral Surveillance
  • Residence characteristics
  • Risk environments

ASJC Scopus subject areas

  • Health Policy
  • Medicine (miscellaneous)


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