A Global Meta-analysis of the Prevalence of HIV, Hepatitis C Virus, and Hepatitis B Virus Among People Who Inject Drugs—Do Gender-Based Differences Vary by Country-Level Indicators?

Janni Leung, Amy Peacock, Samantha Colledge, Jason Grebely, Evan B Cunningham, Matthew Hickman, Peter Vickerman, Jack Stone, Adam Trickey, Kostyantyn Dumchev, Michael Lynskey, Lindsey Hines, Paul Griffiths, Richard P Mattick, Louisa Degenhardt, Sarah Larney

Research output: Contribution to journalArticle (Academic Journal)

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Abstract

BACKGROUND: Women-specific factors exist that increases vulnerability to drug-related harms from injection drug use, including blood-borne viruses (BBVs), but gender-based differences in BBV prevalence have not been systematically examined. METHODS: We conducted meta-analyses to estimate country, regional, and global prevalence of serologically confirmed human immunodeficiency virus (HIV), hepatitis C virus (HCV; based on detection of anti-HCV antibody), and hepatitis B virus (HBV; based on detection of HBV surface antigen) in people who inject drugs (PWID), by gender. Gender-based differences in the BBV prevalence (calculated as the risk among women relative to the risk among men) were regressed on country-level prevalence and inequality measures (Gender inequality index, Human development index, Gini coefficient, and high, low or middle income of the country). RESULTS: Gender-based differences varied by countries and regions. HIV prevalence was higher among women than men in sub-Saharan Africa (relative risk [RR], 2.8; 95% confidence interval [CI], 1.8-4.4) and South Asia (RR, 1.7; 95% CI, 1.1-2.7); anti-HCV was lower among women in the Middle East and North Africa (RR, 0.6; 95% CI, .5-.7) and East and Southeast Asia (RR, 0.8; 95% CI, .7-.9). Gender-based differences varied with country-levels of the BBV prevalence in the general population, human development, and income distribution. CONCLUSION: HIV was more prevalent in women who inject drugs as compared to their male counterparts in some countries, but there is variation between and within regions. In countries where women are at higher risks, there is a need to develop gender-sensitive harm-reduction services for the particularly marginalized population of women who inject drugs.

Original languageEnglish
Article numberjiz058
Pages (from-to)78-90
Number of pages13
JournalJournal of Infectious Diseases
Volume220
Issue number1
Early online date6 Feb 2019
DOIs
Publication statusPublished - 5 Jun 2019

Keywords

  • HIV
  • hepatitis b
  • hepatitis c antibodies
  • gender
  • viruses
  • drug usage
  • gender differences
  • women who inject drugs
  • injecting drug use
  • substance use
  • intravenous
  • HIV seroprevalence
  • HBV
  • HCV
  • hepatitis
  • blood-borne virus
  • blood born pathogens

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