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/族裔群体差异是美国一个重要的公共卫生问题。这些差异在注射吸毒方面尤其显著。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%；西班牙裔占美国人口的14%，占注射吸毒艾滋病病例的24%。这些差异不是非洲裔美国人和西班牙裔美国人注射毒品使用者较多的结果，而是该国许多地区非洲裔美国人和西班牙裔注射吸毒者中艾滋病毒感染率较高的结果。在许多外国国家也观察到类似的差异——注射吸毒者中少数民族的艾滋病毒感染率更高。的确，在一些发展中国家，少数民族注射吸毒者的情况可被视为一种危机，其发病率、流行率和与艾滋病毒有关的死亡率极高。在非注射毒品使用者中也观察到差异，少数民族群体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合乎逻辑的下一步不是另一项单独研究，而是对迄今为止进行的大量相关研究进行系统回顾。我们提出的系统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中艾滋病毒感染的种族差异的数据。具体目标包括：制定程序，将单一地理区域内对注射吸毒者进行的多项研究所得的定性和定量数据结合成该地区“注射吸毒者中艾滋病毒流行史”。确定美国和国际上少数族裔注射吸毒者与多数族裔注射吸毒者在艾滋病毒感染方面存在或未出现实质性差异的艾滋病毒流行频率。确定可能导致种族/少数族裔与多数族裔注射吸毒者之间艾滋病毒流行率存在重大差异的潜在因果因素。确定可能长期维持或减少种族/民族之间艾滋病毒感染差异的潜在因果因素。确定流行病学情况，其中艾滋病毒风险行为的差异是否在统计上“解释”注射吸毒者种族/族裔群体之间艾滋病毒感染的差异。该研究还将创建一个关于少数民族药物使用者中艾滋病毒感染的极其丰富的数据集，该数据集将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HIV/ aids最重要的一个方面——在美国和许多其他国家，HIV感染在不同种族群体中经常存在巨大的差异。本研究将创新性地应用最先进的系统综述方法，包括广泛搜索已发表和未发表的研究，研究报告的定量编码，以及应用元回归/分层模型来解决这些问题。

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.