摘要：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. During the past 2 decades, the HIV epidemic has transitioned from primarily a sexually driven epidemic to one in which syringe sharing among illicit injection drug users contributes to a significant proportion of new infections. 1 The United Nations Program on HIV/AIDS estimates that one third of new HIV infections outside sub-Saharan Africa is attributable to injection drug use. 2 In North America, injection drug use accounts for approximately 1 in 4 cases of HIV, 1 and in some areas where HIV is spreading most rapidly, such as Eastern Europe and Central Asia, more than 80% of all HIV cases occur among injection drug users. 2 Among populations of injection drug users, recent surveillance reports have suggested that ethnic minorities may be particularly vulnerable to HIV infection. 1 At the same time, there are growing concerns about the health of Aboriginal and Indigenous populations. 3 The health status of Aboriginal populations varies across settings around the globe, as has recently been well articulated. 3 – 6 However, Aboriginal persons have been shown to commonly have lower life expectancy as a result of higher rates of chronic diseases, such as heart disease and diabetes, and lower access to healthcare and prevention services. Access not only means physical access but also culturally appropriate and meaningful access to health services. 3 – 6 High rates of poverty and illicit drug use, including injection drug use, have also been documented among Aboriginal populations. 7 These conditions may make Aboriginal populations particularly vulnerable to the spread of HIV, although few studies have examined this issue. 8 , 9 Therefore, we sought to examine rates of HIV infection among Aboriginal and non-Aboriginal injection drug users in a Canadian setting.
