AIMS: The Ethnic Minority Meta-Analysis (EMMA) aims to assess racial/ethnic disparities in HIV infection among people who inject drugs (PWID) across various countries. This is the first report of the data. METHODS: Standard systematic review/meta-analysis methods were utilized, including searching for, screening, and coding published and unpublished reports, and meta-analytic statistics. We followed the PRISMA Statement and MOOSE Guidelines for reporting METHODS: Disparities were measured with the odds ratio for HIV prevalence among ethnic minority PWID compared to ethnic majority PWID; an odds ratio> 1.0 indicated higher prevalence among ethnic minorities. RESULTS: Racial/ethnic disparities in HIV prevalence among PWID were examined in 131 prevalence reports, with 214 racial/ethnic minority to majority comparisons, comprising 106,715 PWID. Overall, the pooled OR indicates an increased likelihood of higher HIV prevalence among racial/ethnic minority compared to racial/ethnic majority PWID (OR=2.09, 95% CI 1.92-2.28). Among 214 comparisons, 106 produced a statistically significant higher OR for minorities; in 102 comparisons the OR was not significantly different from 1.0; six comparisons produced a statistically significant higher OR for majority group members. Disparities were particularly large in the US, pooled OR = 2.22 (95% CI 2.03 – 2.44). There was substantial variation in ORs-I squared = 75.3%: IQR = 1.38 – 3.56-and an approximate Gaussian distribution of the log ORs. CONCLUSIONS: Among people who inject drugs, ethnic minorities are approximately twice as likely to be HIV seropositive than ethnic majorities. The great heterogeneity and Gaussian distribution suggest multiple causal factors and a need to tailor interventions to local conditions.
Racial/ethnic disparities in HIV infection among people who inject drugs: An international systematic review and meta-analysis
Addiction, 107 (12), 2087-2095. doi: 10.1111/j.1360-0443.2012.04027.x. PMCID: PMC3504180.