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Evan Wood, MD, PhD, Julio S.G. Montaner, MD, Kathy Li, PhD, Ruth Zhang, MSc, Lucy Barney, MSN, Steffanie A. Strathdee, PhD, Mark W. Tyndall, MD, ScD and Thomas Kerr, PhD

Evan Wood, Julio S. G. Montaner, Mark W. Tyndall, and Thomas Kerr are with the British Columbia Centre for Excellence in HIV/AIDS, St Paul’s Hospital, Vancouver, and the Department of Medicine, University of British Columbia, Vancouver. Kathy Li and Ruth Zhang are with the British Columbia Centre for Excellence in HIV/AIDS, St Paul’s Hospital, Vancouver. Lucy Barney is with the British Columbia Centre for Disease Control, Vancouver. Steffanie A. Strathdee is with the British Columbia Centre for Excellence in HIV/AIDS, St Paul’s Hospital, Vancouver, and the Division of International Health and Cross Cultural Medicine, University of California, San Diego.

Correspondence: Requests for reprints should be sent to Evan Wood, BC Centre for Excellence in HIV/AIDS, St Paul’s Hospital, 608-1081 Burrard St, Vancouver, BC V6Z 1Y6, Canada (e-mail: uhri{at}cfenet.ubc.ca).

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.