Objectives. 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.
Methods. 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.
Results. 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%).
Conclusions. 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.
TABLE 2
Distribution of Geographical Characteristics Among 9077 People Who Inject Drugs: 2009 National HIV Behavioral Surveillance System, United States
| Geographical Characteristics | Total No. Geographical Units | Total No. Metropolitan Statistical Areas | Participants, No. (%) or Mean ±SD (25th, 50th, 75th Percentiles) |
| Overall | |||
| Zip code | 968 | 9.4 ±19.8 (1, 3, 8) | |
| County | 51 | 178.0 ±225.0 (2, 23, 449) | |
| Metropolitan statistical area | 19 | 477.7 ±93.7 (426, 499, 534) | |
| Region | |||
| Northeast | 5 | 2136 (23.5) | |
| South | 7 | 3644 (40.2) | |
| Midwest | 2 | 937 (10.3) | |
| West | 5 | 2360 (26.0) | |
| Non-Hispanic Whites | |||
| Zip code | 594 | 4.6 ±9.8 (1, 2, 4) | |
| County | 43 | 64.0 ±87.0 (2, 21, 95) | |
| Metropolitan statistical area | 19 | 144.7 ±93.0 (75, 128, 202) | |
| Region | |||
| Northeast | 5 | 817 (29.7) | |
| South | 7 | 669 (24.3) | |
| Midwest | 2 | 150 (5.5) | |
| West | 5 | 1114 (40.5) | |
| Non-Hispanic Blacks | |||
| Zip code | 540 | 8.7 ±16.6 (1, 2, 8) | |
| County | 38 | 123.3 ±153.2 (3, 31, 230) | |
| Metropolitan statistical area | 19 | 246.7 ±139.5 (113, 230, 364) | |
| Region | |||
| Northeast | 5 | 729 (15.6) | |
| South | 7 | 2650 (56.5) | |
| Midwest | 2 | 611 (13.0) | |
| West | 5 | 697 (14.9) | |
| Latinos | |||
| ZIP code | 415 | 4.0 ±7.1 (1, 2, 4) | |
| County | 34 | 48.2 ±63.6 (1, 11, 81) | |
| Metropolitan statistical area | 18 | 91.1 ±79.6 (13, 76, 154) | |
| Region | |||
| Northeast | 5 | 590 (36.0) | |
| South | 7 | 325 (19.8) | |
| Midwest | 1 | 176 (10.7) | |
| West | 5 | 549 (33.5) | |
TABLE 3
Percentage Variance in the Odds of Testing Positive for HIV by Geographical Unit Among 9077 People Who Inject Drugs: 2009 National HIV Behavioral Surveillance System, United States
| Geographical Units | Percentage Variance in HIV Apportioned to Geographical Units |
| Zip code | 6.5 |
| County | 2.3 |
| Metropolitan statistical area | 9.8 |
| Total | 18.6 |
TABLE 4
Percentage Variance in the Odds of Testing Positive for HIV by Geographical Unit and Race/Ethnicity Among 9077 People Who Inject Drugs: 2009 National HIV Behavioral Surveillance System, United States
| Percentage Variance in HIV Apportioned to Geographical Units | ||||
| Geographical Units | Non-Hispanic/Latino White (n = 2750) | Non-Hispanic/Latino Black (n = 4687) | Hispanic/Latino (n = 1640) | All PWID (n = 9077) |
| Zip code | 4.3 | 0.0 | 0.0 | 4.3 |
| County | 0.2 | 6.9 | 0.0 | 7.1 |
| Metropolitan statistical area | 7.5 | 0.0 | 10.1 | 17.6 |
| Total | 12.0 | 6.9 | 10.1 | 29.0 |
Full article at:
By: 
Hannah L. F. Cooper, ScD, Mary E. Kelley, PhD, Conny C. Karnes, MA, Zev Ross, MS,Mary E. Wolfe, MPH, Don Des Jarlais, PhD, Salaam Semaan, DrPH, Barbara Tempalski, PhD, MPH, Elizabeth DiNenno, PhD, Teresa Finlayson, PhD, Catlainn Sionean, PhD, Cyprian Wejnert, PhD, Gabriela Paz-Bailey, MD, PhD, and for the National HIV Behavioral Surveillance Study Group
Hannah L. F. Cooper, ScD, Mary E. Kelley, PhD, Conny C. Karnes, MA, Zev Ross, MS,Mary E. Wolfe, MPH, Don Des Jarlais, PhD, Salaam Semaan, DrPH, Barbara Tempalski, PhD, MPH, Elizabeth DiNenno, PhD, Teresa Finlayson, PhD, Catlainn Sionean, PhD, Cyprian Wejnert, PhD, Gabriela Paz-Bailey, MD, PhD, and for the National HIV Behavioral Surveillance Study Group
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.
Corresponding
author.
Correspondence should be sent to Sabriya L. Linton, PhD,
MPH, Rollins School of Public Health at Emory University, Department of
Behavioral Sciences and Health Education, 1518 Clifton Rd NE, Office 734,
Atlanta, GA 30322 (e-mail: ude.yrome@notnil.ayirbas).
Reprints can be ordered at http://www.ajph.org by clicking the “Reprints” link.
More at: https://twitter.com/hiv_insight
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