HIV Infection in Ethnic Minority IDUs: An International Systematic Review

描述(由申请人提供)：艾滋病毒/艾滋病的种族/民族差异在美国是一个严重的公共卫生问题。在注射吸毒方面，这些差距尤为显著。非洲裔美国人占美国人口的13%，占美国近期注射吸毒艾滋病病例的52%；拉美裔美国人占美国人口的14%，占注射吸毒艾滋病病例的24%。这些差异不是由于非洲裔美国人和西班牙裔注射吸毒者更多，而是该国许多地区非裔美国人和西班牙裔注射吸毒者艾滋病毒感染率较高造成的。在许多外国也观察到了类似的差异--少数民族注射吸毒者中艾滋病毒感染率较高。事实上，一些发展中国家的少数民族注射吸毒者的情况可以被视为一种危机，其发病率、流行率和与艾滋病毒有关的死亡率都极高。在非注射吸毒者中也观察到了差异，少数民族成员的艾滋病毒感染率较高。解决这些差异和这一流行病学难题的下一步合乎逻辑的步骤不是另一项个别研究，而是对迄今已进行的大量相关研究进行系统审查。我们提议的系统性审查将使用最先进的方法，并包括美国和国际上关于吸毒者感染艾滋病毒的种族差异的数据。具体目标包括：制定程序，将单一地理区域内对注射吸毒者的多项研究的定性和定量数据合并成该地区“注射吸毒者中艾滋病毒流行史”。确定艾滋病毒流行的频率，即在美国和国际上，少数族裔注射吸毒者与少数族裔注射吸毒者之间存在和没有出现艾滋病毒感染的显著差异。确定可能导致少数族裔与多数族裔注射吸毒者之间艾滋病毒流行率有很大差异的潜在原因。确定可能随着时间的推移保持或减少种族/民族差异中艾滋病毒感染差异的潜在原因。确定流行病学情况，在这些情况下，艾滋病毒危险行为的差异可以或不能在统计上“解释”注射吸毒者种族/民族之间艾滋病毒感染的差异。这项研究还将创建一个极其丰富的关于少数民族毒品使用中艾滋病毒感染的数据集，供其他研究人员和艾滋病毒预防服务提供者使用。这项研究解决了艾滋病毒/艾滋病最重要的一个方面--美国和许多其他国家的种族群体之间艾滋病毒感染的频繁巨大差异。这项研究将是系统回顾最先进方法的创新应用，包括广泛搜索已发表和未发表的研究，对研究报告进行量化编码，并应用元回归/分层建模来解决这些问题。 公共卫生相关性：非裔美国人和西班牙裔注射吸毒者中艾滋病毒感染率较高是美国的一个主要健康差距。非洲裔美国人占美国人口的13%，占注射吸毒艾滋病病例的52%，拉美裔占人口的14%，占病例的24%。在许多外国也观察到了类似的差异，即少数民族注射吸毒者中艾滋病毒感染率较高。国际系统的审查和荟萃分析应该会极大地促进我们对这些差距的理解，并提出如何改善这些差距的建议。

DESCRIPTION (provided by applicant): Racial/ethnic group disparities in HIV/AIDS are a critical public health issue in the US. These disparities are particularly dramatic with respect to injecting drug use. African-Americans constitute 13% of the US population and 52% of recent US injecting drug use AIDS cases; Hispanics constitute 14% of the US population and 24% of the injecting drug use AIDS cases. These disparities are not the result of more injecting drug users among African-Americans and Hispanics, but of higher rates of HIV infection among African- American and Hispanic IDUs in many areas of the country. Similar disparities-higher rates of HIV infection among ethnic minority IDUs-have also been observed in many foreign countries. Indeed the situation of ethnic minority IDUs in some developing countries can be considered a crisis, with extremely high incidence, prevalence and HIV-related mortality. Disparities have also been observed among non-injecting drug users, with ethnic minority group members having higher rates of HIV infection. The logical next step for addressing these disparities and this epidemiological conundrum is not another individual study, but a systematic review of the large number of relevant studies that have been conducted to date. Our proposed systematic review will use state-of-the-art methods and include the US and the international data on ethnic group differences in HIV infection among drug users. The specific aims include: Developing procedures for combining qualitative and quantitative data from multiple research studies of IDUs in a single geographic area into a "history of the HIV epidemic among IDUs" in that area. Determining the frequency of HIV epidemics in which substantial differences in HIV infection have and have not arisen in ethnic minority IDUs vs. ethnic majority IDUs in the US and internationally. Identifying potential causal factors that may generate substantial differences in HIV prevalence among racial/ethnic minority vs. ethnic majority IDUs. Identifying potential causal factors that may perpetuate or reduce differences in HIV infection among racial/ethnic differences over time. Identifying epidemiologic situations in which differences in HIV risk behaviors do or do not statistically "explain" differences in HIV infection among racial/ethnic groups of IDUs. The research will also create an extremely rich dataset on HIV infection among ethnic drug uses that will be made available for use by other researchers and HIV prevention service providers. The research addresses one of the most important aspects of HIV/AIDS-the frequent large disparities in HIV infection among ethnic groups in the US and in many other countries. The research will be an innovative application of state of the art methods for systematic review, including extensive searching for published and unpublished studies, quantitative coding of research reports, and applying meta-regression/hierarchical modeling to these problems. PUBLIC HEALTH RELEVANCE: Higher rates of HIV infection among African-American and Hispanic IDUs are a major health disparity in the US. African-Americans comprise 13% of the US population and 52% of injection drug use AIDS cases, Hispanics 14% of the populations and 24% of cases. Similar disparities, higher rates of HIV infection among ethnic minority IDUs, have also been observed in many foreign countries. An international systematic review and meta-analysis should greatly advance our understanding of these disparities and suggest how they might be ameliorated.