High Prevalence and Incidence of HIV and HCV Among New Injecting Drug Users With a Large Proportion of Migrants—Is Prevention Failing?

ABSTRACT

Objectives: The aim of this study was to assess differences in the prevalence of HIV and HCV infection and associated risk factors between new (injecting for ≤5 years) and long-term injectors and to estimate HIV/HCV incidence among new injectors. Methods: Cross-sectional study among people who inject drugs (PWID) who attended harm reduction centers in Catalonia in 2010–11. Anonymous questionnaires and oral fluid samples were collected. Poisson regression models were applied to determine the association between HIV/HCV infection and risk factors. Results: Of the 761 participants, 21.4% were new injectors. New injectors were younger than long-term injectors (mean age = 31.6 vs. 37.8) and were more likely to be immigrants (59.0% vs. 33.4%). HIV and HCV prevalence was 20.6% and 59.4% among new injectors, and estimated HIV and HCV incidence 8.7 and 25.1 /100 person-years, respectively. Among new injectors, HIV infection was associated with homelessness (PR = 3.10) and reporting a previous sexually transmitted infection (PR = 1.79). Reporting front/backloading (PR = 1.33) and daily injection (PR = 1.35) were risk-factors for HCV infection. For long-term injectors, HIV risk factors were: having shared syringes (PR = 1.85), having injected cocaine (PR = 1.38), reporting front/backloading (PR = 1.30) and ever having been in prison (PR = 2.03). Conclusion: A large proportion of PWID in Catalonia are new injectors, a subgroup with a high level of both sexual and parenteral exposure and a high incidence rate of HIV/ HCV infections. It is important to improve early diagnosis of these infections among this group, in particular among migrants. To identify and address risk factors for homelessness PWID should be a priority.

Keywords:

• Hepatitis C
• HIV, injecting drug use
• migrants
• new injectors

Glossary

• Harm reduction: Policies, programmes, and approaches that seek to reduce the harmful health, social, and economic consequences associated with the use of psychoactive substances

• HCV: Hepatitis C virus

• HIV: Human immunodeficiency virus

• Incidence: The number of new cases which develop over a defined time period in a defined population at risk, divided by the number of people in that population at risk.

• Prevalence rate: The number of existing cases in a defined population at a given point in time or over a defined time period, divided by the number of people in that population.

• PWID: People who inject drugs

• STI: Sexually transmitted Infections

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Declaration of interest

The Ethics Committee of Hospital Universitari Germans Trias i Pujol approved the study. The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Additional information

Notes on contributors

Cinta Folch

Cinta Folch, MPH, PhD, is an epidemiologist at the Center for Epidemiological Studies on STIs, HIV and AIDS of Catalonia, Spain (CEEISCAT). She coordinates bio-behavioral HIV/STI surveillance studies among vulnerable populations since 2002 (men who have sex with men, female sex workers and intravenous drug users). She has published several national and international articles in this field, and collaborated in several European Union financed projects, such as SIALON I, SIALON II, and EMIS. Her areas of expertise include: HIV/STI Monitoring and Evaluation; Bio-behavioral Surveys, Sexual Health, Vulnerable populations.

Jordi Casabona

Jordi Casabona, MD, MPH, PhD (Spain), is a medical epidemiologist and the Director of the “Center for Epidemiological Studies on STIs, HIV and AIDS of Catalonia” (CEEISCAT). The Center is responsible for the regional surveillance activities on HIV and STIs and it also have an applied research component, from which he has coordinated and collaborated in several European Union financed projects, such as SIALON, SIALON II, HIV-COBATEST and Euro HIV EDAT (currently active). He is also President of the Fundació Sida i Societat and Associated Professor of Epidemiology and Preventive Medicine at the Autonomous University of Barcelona (UAB).

Albert Espelt

Albert Espelt is a Psychologist and a Statistician, and has a PhD in Public Health. He is in charge of the Drug Information System of Barcelona and works for the Public Health Agency of Barcelona (Department of Prevention and Treatment of Drug Addiction). He is an associate professor at the Universitat Autonoma de Barcelona (Department of Psychobiology and Methodology of Health Sciences (Faculty of Psychology)). He has published more than 60 papers on drug addiction and social determinants.

Xavier Majó

Xavier Majó is a Medical doctor, working since 1990 on the Programme on Substance Abuse of the Department of Health (Autonomous Government of Catalonia). From 1995 until 2014 he was in charge of policy planning and strategic development of Harm reduction programmes in Catalonia, and from 2014 he is in charge of Epidemiological surveillance of drug consumption and problems related to drug abuse. He worked for 5 years as a clinician in different drug care centres and he did a post medical degree on addictions in the National Addiction Centre of London (UK) in 1992–93 and later on, he got the specialization in Public Health (2003). He has participated in different papers and presentations, mostly on harm reduction and surveillance problems related to drug abuse.

Mercè Meroño

Mercè Meroño is a Psychologist and Master in Public Health. She is a coordinator of health and social care (harm reduction) programs targeting IDUs and men, transgenders and female sex workers in Àmbit Prevenció. Other activities: Pre and Post Counselling on HIV/AIDS and other sexually transmitted diseases; Participation and Coordination of the Workshops “Empowering”, “Gender Violence”, “Transgender”; Trainer of health professionals on issues related to immigrant women and sexuality; Training and Awareness for change in attitudes and knowledge for health professionals (nurses and doctors), local service professionals (municipal councils and associations…) police professionals and the general public.

Victoria Gonzalez

Victoria Gonzalez, MPH, PhD, is a microbiologist at the Center for Epidemiological Studies on STIs, HIV and AIDS of Catalonia, Spain (CEEISCAT). She works at the Microbiology Service of “Hospital Universitari Germans Trias i Pujol” (Badalona, Barcelona, Spain) analyzing the biological specimens collected to perform bio-behavioral HIV/STI surveillance studies among vulnerable populations. She has several national and international publications in the HIV/HCV/STIs field. Her areas of expertise include serological and molecular diagnosis of HIV, hepatitis C, hepatitis B, and STIs.

Lucas Wiessing

Lucas Wiessing is an epidemiologist and Principal scientist at the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) in Lisbon. He co-ordinates international projects to monitor, analyze and improve data on drug use and drug related consequences—e.g. HIV and viral hepatitis in injecting drug users-–and interventions, in the European Union. Lucas is from the Netherlands, where he worked at the National Institute of Public Health and the Environment (RIVM), organizing multiple bio-behavioral HIV studies in different risk groups, in particular injecting drug users. He has published extensively and works with many relevant organizations and colleagues in his field, including key international expert and advisory groups and scientific conferences.

Joan Colom

Joan Colom, MPH, PhD medical doctor with experience in the organization of drug addiction care network in Catalonia. He is currently the Director of the Program on Substance Abuse of the Department of Health (Autonomous Government of Catalonia). Diploma in Public Health (National Health School), Masters in Directing ESADE professor Master Drug Addiction at the University of Barcelona, author of articles and national and international publications in the field of drug addiction, author lectures and papers in meetings and conferences of national and international advisor to the World Health Organization, a member of 20 scientific societies and committees, “White Cross” of Merit of the National Plan on Drugs, “Queen Sofia” Prize for drug prevention Prize for the best Research (Diario Médico), Chairman of the Public Management Club of the College of Business Administration, founder INEBRIA.

M. Teresa Brugal

M. Teresa Brugal, MD, PhD, MPH (Barcelona Autonomous University), is senior researcher on epidemiology of drug abuse and related diseases. She works in the Public Health Agency of Barcelona as Chief of department of Prevention and Treatment of Addictions. Her works consists in planning and evaluate drug plans, policies in the drug field, as well as to evaluate the efficacy of interventions and treatments implemented by the different Spanish health administrations. In recent years she has developed several applied research studies, mainly in the field of drug addiction and associated diseases (psychiatric and infectious) and in evaluating treatments (methadone, naloxone, etc.). She has also conducted cohort studies among drug users, to analyze the evolution of consumer habits, practices and associated mortality risk. These investigations have resulted in over 100 scientific papers published in international medical literature.

REDAN Study Group is comprised of Jordi Casabona, Cinta Folch, Anna Esteve, Alexandra Montoliu, and Rafa Muñoz (CEEISCAT); Victoria Gonzalez and Vicenç Ausina (Servei Microbiologia HUGTiP); M. Teresa Brugal, Albert Espelt, and Carmen Vecino (Agéncia de Salut Pública de Barcelona); Xavier Majó and Joan Colom (Subdirecció General de Drogodependéncies); and Mercé Meroño and Anna Altabas (Ámbit Prevenció).