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Among injection drug users, HIV more prevalent in women than men

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February 14, 2019

Janni Leung, PhD
Janni Leung

Study findings showed a higher prevalence of HIV among women who inject drugs compared with men, and researchers recommended developing gender-sensitive harm reduction services.

According to the study, 20% of an estimated 15.6 million people who injected drugs (PWID) last year were women. Researchers said women may be at an elevated risk for bloodborne viruses because of stigma, marginalization and discrimination — common experiences among all PWID that can be “particularly salient for women.”

“There are also places where men who inject have higher HIV prevalence, but data in women are often lacking — so differences might be obscured by lack of data,” study authors Janni Leung, PhD, global addiction epidemiology research fellow at the National Drug & Alcohol Research Centre (NDARC) in Australia, and Sarah Larney, PhD, senior research fellow at NDARC, told Infectious Disease News. “We need to engage with communities to bring these ‘hard-to-reach’ groups into study designs, as they can help get better data to inform evidence-based policies.”

Leung, Larney and colleagues conducted a meta-analysis to estimate the prevalence of confirmed HIV, hepatitis C (anti-HCV) and hepatitis B (HBsAg) among PWID at country, regional and global levels, stratified by sex.

Globally, the prevalence of HIV among women who inject drugs was 19.1% (95% CI, 7.9-30.4) compared with 17.5% (95% CI, 7.2-27.8) for men. Additionally, the prevalence of anti-HCV and HBsAG among women who inject drugs was 48.9% (95% CI, 33.8-64) and 7.8% (95% CI, 0-16.1), respectively, vs. 55.7% (95% CI, 38.5-72.8) and 10.4% (95% CI, 0-21.6) among men.

According to the researchers, sex differences in prevalence varied by countries and regions. In sub-Saharan Africa (RR = 2.8; 95% CI, 1.8-4.36) and South Asia (RR = 1.71; 95% CI, 1.1-2.66), HIV prevalence was significantly higher among women than among men. However, in the Middle East and North Africa (RR = 0.56; 95% CI, 0.45-0.7) as well as East and Southeast Asia (RR = 0.79; 95% CI, 0.71-0.88), anti-HCV prevalence was significantly lower among women compared with men, the researchers reported.

According to the findings, differences determined by sex varied with the country levels of bloodborne viruses in the general population, human development and income distribution.

“Special efforts might have to be made in places where women who inject drugs are subject to particularly harsh censure,” Leung and Larney said. “This also applies to racial/ethnic minorities, and sexual/gender minorities.” - by Marley Ghizzone

Disclosures: Larney reports receiving investigator-initiated untied educational grants from Indivior. Leung reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

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