Abstract
Aims
We measured the association between a history of incarceration and HIV positivity among people who inject drugs (PWID) across Europe.
Design, Setting and Participants
This was a cross-sectional, multi-site, multi-year propensity-score matched analysis conducted in Europe. Participants comprised community-recruited PWID who reported a recent injection (within the last 12 months).
Measurements
Data on incarceration history, demographics, substance use, sexual behavior and harm reduction service use originated from cross-sectional studies among PWID in Europe. Our primary outcome was HIV status. Generalized linear mixed models and propensity-score matching were used to compare HIV status between ever- and never-incarcerated PWID.
Findings
Among 43 807 PWID from 82 studies surveyed (in 22 sites and 13 countries), 58.7% reported having ever been in prison and 7.16% (n = 3099) tested HIV-positive. Incarceration was associated with 30% higher odds of HIV infection [adjusted odds ratio (aOR) = 1.32, 95% confidence interval (CI) = 1.09–1.59]; the association between a history of incarceration and HIV infection was strongest among PWID, with the lowest estimated propensity-score for having a history of incarceration (aOR = 1.78, 95% CI = 1.47–2.16). Additionally, mainly injecting cocaine and/or opioids (aOR = 2.16, 95% CI = 1.33–3.53), increased duration of injecting drugs (per 8 years aOR = 1.31, 95% CI = 1.16–1.48), ever sharing needles/syringes (aOR = 1.91, 95% CI = 1.59–2.28) and increased income inequality among the general population (measured by the Gini index, aOR = 1.34, 95% CI = 1.18–1.51) were associated with a higher odds of HIV infection. Older age (per 8 years aOR = 0.84, 95% CI = 0.76–0.94), male sex (aOR = 0.77, 95% CI = 0.65–0.91) and reporting pharmacies as the main source of clean syringes (aOR = 0.72, 95% CI = 0.59–0.88) were associated with lower odds of HIV positivity.
Conclusions
A history of incarceration appears to be independently associated with HIV infection among people who inject drugs (PWID) in Europe, with a stronger effect among PWID with lower probability of incarceration.
We measured the association between a history of incarceration and HIV positivity among people who inject drugs (PWID) across Europe.
Design, Setting and Participants
This was a cross-sectional, multi-site, multi-year propensity-score matched analysis conducted in Europe. Participants comprised community-recruited PWID who reported a recent injection (within the last 12 months).
Measurements
Data on incarceration history, demographics, substance use, sexual behavior and harm reduction service use originated from cross-sectional studies among PWID in Europe. Our primary outcome was HIV status. Generalized linear mixed models and propensity-score matching were used to compare HIV status between ever- and never-incarcerated PWID.
Findings
Among 43 807 PWID from 82 studies surveyed (in 22 sites and 13 countries), 58.7% reported having ever been in prison and 7.16% (n = 3099) tested HIV-positive. Incarceration was associated with 30% higher odds of HIV infection [adjusted odds ratio (aOR) = 1.32, 95% confidence interval (CI) = 1.09–1.59]; the association between a history of incarceration and HIV infection was strongest among PWID, with the lowest estimated propensity-score for having a history of incarceration (aOR = 1.78, 95% CI = 1.47–2.16). Additionally, mainly injecting cocaine and/or opioids (aOR = 2.16, 95% CI = 1.33–3.53), increased duration of injecting drugs (per 8 years aOR = 1.31, 95% CI = 1.16–1.48), ever sharing needles/syringes (aOR = 1.91, 95% CI = 1.59–2.28) and increased income inequality among the general population (measured by the Gini index, aOR = 1.34, 95% CI = 1.18–1.51) were associated with a higher odds of HIV infection. Older age (per 8 years aOR = 0.84, 95% CI = 0.76–0.94), male sex (aOR = 0.77, 95% CI = 0.65–0.91) and reporting pharmacies as the main source of clean syringes (aOR = 0.72, 95% CI = 0.59–0.88) were associated with lower odds of HIV positivity.
Conclusions
A history of incarceration appears to be independently associated with HIV infection among people who inject drugs (PWID) in Europe, with a stronger effect among PWID with lower probability of incarceration.
| Original language | English |
|---|---|
| Pages (from-to) | 2177-2192 |
| Number of pages | 16 |
| Journal | Addiction |
| Volume | 118 |
| Issue number | 11 |
| Early online date | 3 Aug 2023 |
| DOIs | |
| Publication status | E-pub ahead of print - 3 Aug 2023 |
Bibliographical note
Funding Information:The study sponsors had no role in study design; in the collection, analysis and interpretation of data; in the writing of the report; nor in the decision to submit the paper for publication. Jack Stone and Peter Vickerman acknowledge funding from the Wellcome Trust [WT 226619/Z/22/Z] and the NIHR Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol. For the purpose of Open Access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission. Viktor Mravcik would like to acknowledge the project Sustainability for the National Institute of Mental Health, No. LO1611 with financial support from the Ministry of Education, Youth and Sports of the Czech Republic under the NPU I program, and the Charles University institutional support Progres No. Q06/LF1. Anda Ķīvīte-Urtāne would like to acknowledge the Latvian Centre for Disease Prevention and Control who is funding the cohort study of problem drug users and has co-financed the RDS study. Henrique Barros and Paula Meireles would like to acknowledge the national funds of Fundação para a Ciência e Tecnologia (FCT), under the scope of the project UIDB/04750/2020 - Research Unit of Epidemiology–Institute of Public Health of the University of Porto (EPIUnit). This study contributes to the work of the ‘European Study Group for Mathematical Modelling and Epidemiological Analysis of Drug-Related Infectious Diseases’, coordinated by EMCDDA and RIVM with funding from WHO/Europe and the government of The Netherlands.
Funding Information:
The study sponsors had no role in study design; in the collection, analysis and interpretation of data; in the writing of the report; nor in the decision to submit the paper for publication. Jack Stone and Peter Vickerman acknowledge funding from the Wellcome Trust [WT 226619/Z/22/Z] and the NIHR Health Protection Research Unit in Behavioural Science and Evaluation at University of Bristol. For the purpose of Open Access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission. Viktor Mravcik would like to acknowledge the project Sustainability for the National Institute of Mental Health, No. LO1611 with financial support from the Ministry of Education, Youth and Sports of the Czech Republic under the NPU I program, and the Charles University institutional support Progres No. Q06/LF1. Anda Ķīvīte‐Urtāne would like to acknowledge the Latvian Centre for Disease Prevention and Control who is funding the cohort study of problem drug users and has co‐financed the RDS study. Henrique Barros and Paula Meireles would like to acknowledge the national funds of Fundação para a Ciência e Tecnologia (FCT), under the scope of the project UIDB/04750/2020 ‐ Research Unit of Epidemiology–Institute of Public Health of the University of Porto (EPIUnit). This study contributes to the work of the ‘European Study Group for Mathematical Modelling and Epidemiological Analysis of Drug‐Related Infectious Diseases’, coordinated by EMCDDA and RIVM with funding from WHO/Europe and the government of The Netherlands.
Publisher Copyright:
© 2023 Society for the Study of Addiction.
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