학술논문
Incarceration history is associated with HIV infection among community-recruited people who inject drugs in Europe: A propensity-score matched analysis of cross-sectional studies.
Document Type
Article
Author
Uusküla, Anneli; Rannap, Jürgen; Weijler, Lisa; Abagiu, Adrian; Arendt, Vic; Barrio, Gregorio; Barros, Henrique; Brummer-Korvenkontio, Henrikki; Casabona, Jordi; Croes, Esther; Jarlais, Don Des; Seguin-Devaux, Carole; Dudás, Mária; Eritsyan, Ksenia; Folch, Cinta; Hatzakis, Angelos; Heimer, Robert; Heinsbroek, Ellen; Hope, Vivian; Jipa, Raluca
Source
Subject
*HIV infection complications
*HIV-positive persons
*CORRECTIONAL institutions
*SUBSTANCE abuse
*CONFIDENCE intervals
*PRISONERS
*CROSS-sectional method
*HUMAN sexuality
*COMMUNITIES
*REGRESSION analysis
*HARM reduction
*SURVEYS
*SEX customs
*DESCRIPTIVE statistics
*RESEARCH funding
*SOCIODEMOGRAPHIC factors
*STATISTICAL models
*ODDS ratio
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Language
ISSN
0965-2140
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. [ABSTRACT FROM AUTHOR]