Prevalence of HIV infection among young adult injecting and non-injecting heroin users in Spain in the era of harm reduction programmes: gender differences and other related factors

Abstract

The aims were to assess the prevalence of HIV infection among young adult heroin users, including injecting heroin users (IHUs) and non-injecting heroin users (NIHUs), and to explore the differences by gender and other factors. The design was a cross-sectional cohort study between April 2001 and December 2003, which included 961 current heroin users (HU), aged 18-30 years: 422 in Madrid, 351 in Barcelona and 188 in Seville; 621 were IHUs and 340 were NIHUs. All were street-recruited by chain referral methods. Face-to-face interviews were conducted using a structured questionnaire with computer-assisted personal interviewing (CAPI). Samples for HIV testing (dried blood spot) were collected and tested with ELISA and Western Blot. Bivariate, logistic regression, and classification and regression tree analyses were performed. The overall prevalence of HIV infection among IHUs was 25.8% (95% CI 22.3-29.3) [32.4% (95% CI 26.6-38.1) in Madrid, 20.5% (95% CI 15.6-25.4) in Barcelona, and 20.6% (95% CI 9.8-31.4) in Seville], whereas in NIHUs it was 4.0% (95% CI 2.1-6.7), with no differences among cities. The prevalence was significantly higher in women than in men in NIHUs (10.9%, 95% CI 4.3-17.5 vs. 1.7%, 95% CI 0.5-4.2) and was non-significantly higher in IHUs (30.4%, 95% CI 23.0-37.8 vs. 24.1%, 95% CI 20.1-28.1). HIV prevalence in short-term IHUs was 12.9% (CI 8.8-17.02), with no differences among cities. In the logistic analysis, the variables associated with infection in IHUs were ever having injected with used syringes (OR 3.4, 95% CI 2.2-5.3), ever having been in prison (OR 2.6, 95% CI 1.6-4.0), and heroin as the first drug injected at least weekly (OR 2.3, 95% CI 1.1-4.5). Factors positively associated with HIV infection in NIHUs were female sex (OR 8.7, 95% CI 2.6-29.2) and age >25 years (OR 3.1, 95% CI 0.9-11.1), while primary educational level was inversely associated (OR 0.26, 95% CI 0.1-0.9). Although there are important geographic differences, HIV prevalence in IHUs remains high, even in short-term IHUs, whereas it was almost six times lower in NIHUs. The prevalence in women is higher than in men, particularly among NIHUs. A wide range of preventive strategies should be developed, aimed primarily at empowering women to negotiate safe sex.

Human Immunodeficiency Virus, Hepatitis B and Hepatitis C Virus Infections Among Injecting and Non-Injecting Drug Users in Inner City Neighborhoods

“…Several studies have shown that crack cocaine users engage in more unprotected sexual acts, trade sex for money or drugs and have more sexually transmitted diseases, all factors contributing to greater risk for HIV infection [17,21,[23][24][25][26]. One third of the study participants had a history of injection drug use, but no associations were identified between IDU and HIV infection in males or females in this study, a conflicting finding from other studies [27][28][29][30][31]. Therefore, crack cocaine use and resulting sexual behaviors from its use infer the most likely way HIV is transmitted amongst drug users in this population.…”

HIV Testing in Non-Injection Drug Users: Prevalence and Associated Factors

“…Furthermore, 46.8% of the individuals reported performing the test in the private healthcare network, which highlights the need to widen free access to the test. Finally, the prevalence of self-reported HIV infection was 3.2% (95% CI: 1.4-7.2%), similar to that estimated for NIDU in Argentina (14), Luxembourg (13), Spain (12), and Mexico (11). However, it was lower than that found in the USA (15).…”

“…Studies have shown elevated prevalence of HIV infection among NIDU worldwide, ranging from 3.7% in México to 16.0% in the United States of America (11)(12)(13)(14)(15).…”

An uncontrolled, feasibility study of a group intervention to reduce hepatitis C transmission risk behaviours and increase transmission knowledge among women who inject drugs

“…The closer the proximity of injecting partners/peers, the less perceived risk with sharing injecting equipment (MacRae & Aalto, 2000;Smyth & Roche, 2007). Women who inject drugs are often marginalised and socially isolated, and as a result often engage in smaller social networks increasing the likelihood of sharing injecting equipment (De et al, 2007). A high proportion of female drug users meet criteria for a depressive disorder (Torrens et al, 2011).…”

“…The risk of sexual acquisition of HCV for HIV negative women is extremely low. HCV prevention interventions for people who inject drugs may result in their rationalising sharing injecting equipment with a sexual partner they are having unprotected sex with, if they perceive an equivalent risk of HCV from both behaviours (Harris & Rhodes, 2013 (Barrio et al, 2007). Moreover, in countries such as Poland, with elevated HIV prevalence among people who inject drugs (18%), co-infection with HCV is reported to be 17% (Rosinska et al, 2015).…”