Racial Disparities in Injection-Related HIV: A Case Study of Toxic Law

Abstract

Racial minorities suffer disproportionately high rates of almost all major diseases including heart disease, diabetes, cancer, and obesity. Few diseases reflect this process as clearly as HIV/AIDS. Since its emergence in the early 1980s, the incidence of HIV has been higher for African Americans than any other racial or ethnic group in the United States. Although African Americans only comprise about 13% of the United States population, they account for almost half of the people who get HIV and AIDS each year. The disparity in HIV between African American drug users and white drug users is among the most shocking in the country: African Americans who inject drugs are ten times more likely to contract HIV/AIDS than white injectors. This paper considers the disparity in HIV among injecting drug users and what the law has to do with it. It begins by summarizing the evidence on two key points: that criminal laws and law enforcement practices have fueled disparities in HIV among IDUs, and that syringe access programs (SEPs) can prevent HIV among drug users without increasing drug use or other social problems. In the heart of the legal story, this paper focuses on an area where immediate and dramatic change could and should happen within the national HIV prevention strategy and in the legislative agendas of state legislatures. In spite of the evidence and nearly two decades of experience, access to sterile syringes through SEPs and pharmacies remains the undernourished step-child of HIV prevention. Politics and ideology and the overall scarcity of prevention funding explain part of this, but as an immediate barrier to syringe access and SEPs the law stands out both for its force and as an example of how disparities happen. We explain the various federal, state and local restrictions on the implementation of SEPs. If we are serious about reducing racial disparities in HIV, we should make syringes available at pharmacies and syringe exchanges at a level and in the places necessary to reach black IDUs, which means removing legal barriers, scaling up programs and services, and eliminating harassment and other police practices that discourage IDUs from carrying syringes and depress the effectiveness of SEPs.

Keywords: HIV, Syringe Exchange, Pharmacy Law, Public Health Law