Burden of HIV infection among aboriginal injection drug users in Vancouver, British Columbia

Abstract

Objectives: We sought to examine whether there were differential rates of HIV incidence among Aboriginal and non-Aboriginal injection drug users in a Canadian setting.

Methods: Data were derived from 2 prospective cohort studies of injection drug users in Vancouver, British Columbia. Using the Kaplan-Meier method and Cox proportional hazards regression, we compared HIV incidence among Aboriginal and non-Aboriginal participants.

Results: Overall, 2496 individuals were recruited between May 1996 and December 2005. Compared with that of non-Aboriginal persons, the baseline HIV prevalence was higher among Aboriginal persons (16.0% vs 25.1%; P<.001). Among participants who were HIV negative at baseline, the cumulative HIV incidence at 48 months was higher among Aboriginal persons (18.5% vs 9.5%; P<.001). In multivariate analyses, Aboriginal ethnicity was independently associated with elevated HIV incidence (relative hazard=1.59; 95% confidence interval=1.12, 2.26; P=.009).

Conclusions: Aboriginal persons in Vancouver had a significantly elevated burden of HIV infection, which calls for a culturally sensitive and evidence-based response. Policymakers in other settings with at-risk Aboriginal populations should seek to avert similar public health emergencies by being proactive with evidence-based HIV-prevention programs.

FIGURE 1—

Cumulative HIV incidence rates, by ethnicity: Scientific Evaluation of Supervised Injecting Study and the Vancouver Injection Drug Users Study, Vancouver, British Columbia, 1996–2005. Note. Log-rank = P < .001

FIGURE 2—

Cumulative HIV incidence, by ethnicity, among younger injection drug users (a), older injection drug users (b), women (c), and men (d): Scientific Evaluation of Supervised Injecting Study and the Vancouver Injection Drug Users Study, Vancouver, British Columbia, 1996–2005. Note. Younger and older age were defined on the basis of the median age. The log-rank for a was P = .001; for b, P = .343; for c, P = .101; for d, P = .028.