Radicalized Risk Environment: occurs when racial/ethnic groups inhabit places that do not have protective resources (for example, substance abuse treatment programs).
Risk Environment Model: addresses social situations, structures, and places that generate vulnerability to HIV transmission and other drug-and HIV-related harms among people who inject drugs (PWID).
The sample included 9170 people who inject drugs from 15 states across the United States.
– Across all measures black PWID were more likely than white PWID to live in areas associated with vulnerability to HIV and poorer outcomes for those living with HIV.
– Black PWID lived in more socially and economically distressed areas, had poorer access to substance abuse treatment, experienced greater exposure to drug-related law enforcement, were isolated in environments that lacked ethnic diversity and were more likely to experience the combination of hyper segregation and concentrated poverty.
– Black PWID participants tended to live in states with laws that did not facilitate access to sterile syringes (where a prescription was required for purchase and possession of syringes). Laws restricting syringe access are connected with higher HIV prevalence. Laws limiting sterile syringe access may exacerbate racial/ethnic disparities in HIV prevalence.
– Interestingly, the authors found a tendency for a law and order approach in states where people who misuse substances are more likely to be thought of as black and a more public health approach where people who misuse substances are thought to be white.
– Black PWID had better spatial access to HIV testing than white PWID, yet they had worse access to substance abuse treatment. The US public health system made an effort to increase HIV testing amongst black adults; the authors suggest that similar initiatives are needed to increase access to substance abuse treatment as well.
– The authors encourage those outside of the US to explore the “racialized risk environment” in their own countries. Previous studies have found large disparities in HIV prevalence in Canada among First Nations, the ethnic minority PWID, vs. the ethnic majority PWID. This may result from systematic differences in exposure to high-risk environments that perpetuate social inequality.
The environments of people who inject drugs appear to be racialized in the US. Future research should assess risk environments in other countries.
Cooper, H.L.F., Linton, S.L., Kelley, M.E. (2016). Racialized risk environments in a large sample of people who inject drugs in the United States. International Journal of Drug Policy. 27: pp.43-55.