Univariable associations between a history of incarceration and HIV and HCV prevalence among people who inject drugs across 17 countries in Europe 2006 to 2020 - is the precautionary principle applicable?

Lucas Wiessing,Ioanna Yiasemi,Lavinius Sava,Thomas Seyler,Vana Sypsa,Anastasios Fotiou,Peyman Altan,Ruth Zimmermann,Luk Van Baelen,Peter Vickerman,Liis Lemsalu,Magdalena Rosińska,Lina Jurgelaitienė,Adeeba Kamarulzaman,Eleni Kalamara,Anna Tarján,Jack Stone,Anneli Uusküla,Branko Kolarić,Bruno Guarita,Vivian Hope,Martin Kåberg,Kate Dolan,Ilonka Horváth,Marica Ferri,Linda Montanari,Marie Jauffret‐Roustide ,Anda Ķīvīte‐Urtāne ,João Goulão ,D Centrón Garcìa

doi:10.2807/1560-7917.es.2021.26.49.2002093

Abstract

BackgroundPeople who inject drugs (PWID) are frequently incarcerated, which is associated with multiple negative health outcomes.AimWe aimed to estimate the associations between a history of incarceration and prevalence of HIV and HCV infection among PWID in Europe.MethodsAggregate data from PWID recruited in drug services (excluding prison services) or elsewhere in the community were reported by 17 of 30 countries (16 per virus) collaborating in a European drug monitoring system (2006–2020; n = 52,368 HIV+/−; n = 47,268 HCV+/−). Country-specific odds ratios (OR) and prevalence ratios (PR) were calculated from country totals of HIV and HCV antibody status and self-reported life-time incarceration history, and pooled using meta-analyses. Country-specific and overall population attributable risk (PAR) were estimated using pooled PR.ResultsUnivariable HIV OR ranged between 0.73 and 6.37 (median: 2.1; pooled OR: 1.92; 95% CI: 1.52–2.42). Pooled PR was 1.66 (95% CI 1.38–1.98), giving a PAR of 25.8% (95% CI 16.7–34.0). Univariable anti-HCV OR ranged between 1.06 and 5.04 (median: 2.70; pooled OR: 2.51; 95% CI: 2.17–2.91). Pooled PR was 1.42 (95% CI: 1.28–1.58) and PAR 16.7% (95% CI: 11.8–21.7). Subgroup analyses showed differences in the OR for HCV by geographical region, with lower estimates in southern Europe.ConclusionIn univariable analysis, a history of incarceration was associated with positive HIV and HCV serostatus among PWID in Europe. Applying the precautionary principle would suggest finding alternatives to incarceration of PWID and strengthening health and social services in prison and after release (‘throughcare’).

Highlights

People who inject drugs (PWID) are frequently incarcerated, which is associated with multiple negative health outcomes
Sample sizes for human immunodeficiency virus (HIV) were large in most countries, with a median of 916 (interquartile range (IQR): 528–1,943) and a mean of 3,273, they varied considerably, from 181 PWID tested in Poland to 29,061 in the UK (Table 1 and Supplementary Table S1)
Of those tested for HIV, 62.1% (n = 32,524) had ever been in prison, of whom 5.7% were HIV-positive

Summary

Introduction

People who inject drugs (PWID) are frequently incarcerated, which is associated with multiple negative health outcomes. Incarceration of PWID is associated with higher risks of drug-related problems [4,5] including human immunodeficiency virus (HIV) and hepatitis C virus (HCV) transmission [6,7,8,9], fatal overdose [10,11], mental illness and social disruption [5] and poor or no access to care and treatment [12] – including for women [13] – as well as unfavourable HIV treatment (anti-retroviral treatment (ART)) outcomes [14,15,16]. Injecting and other risks (e.g. sex work, nonfatal overdose and death) have been found to increase immediately after release from prison [21,2831] This may be due to the disruption of protective factors and social conditions (e.g. interruption of OST, unemployment), which could be especially marked in countries with repressive policies and insufficient needle and syringe programmes (NSP), opioid substitution treatment (OST), ART and HCV treatment and other services [23,28,32,33]

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