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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?

Wiessing L 1 , Kalamara E 2 , Stone J 3 , Altan P 4 , Van Baelen L 5 , Fotiou A 6 Show all authors , Garcia D 7 , Goulao J 8 , Guarita B 1 , Hope V 9 , Jauffret-Roustide M 10 , Jurgelaitienė L 11 , Kåberg M 12 , Kamarulzaman A 13 , Lemsalu L 14 , Kivite-Urtane A 15 , Kolarić B 16 , Montanari L 1 , Rosińska M 17 , Sava L 18 , Horváth I 19 , Seyler T 1 , Sypsa V 20 , Tarján A 21 , Yiasemi I 22 , Zimmermann R 23 , Ferri M 1 , Dolan K 24 , Uusküla A 25 , Vickerman P 3

Affiliations 

  • 1 European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Public Health Unit, Lisbon, Portugal
  • 2 EASO MTC Block A, Winemakers Wharf, Grand Harbour Valletta, Malta
  • 3 Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
  • 4 Ministry of Health, Public Health General Directorate, Ankara, Turkey
  • 5 Sciensano, Epidemiology and public health, Lifestyle and chronic diseases, Brussels, Belgium
  • 6 University Mental Health, Neurosciences, & Precision Medicine Research Institute, Athens, Greece
  • 7 NOVA FCSH - Universidade Nova de Lisboa, Lisbon, Portugal
  • 8 General Director on Addictive Behaviours and Dependencies, Ministry of Health, Lisbon, Portugal
  • 9 Public Health Institute, Liverpool John Moores University, Liverpool, United Kingdom
  • 10 Santé Publique France, Saint-Maurice, France
  • 11 Social Innovations and Science Centre, Vilnius, Lithuania
  • 12 Department of Medicine Huddinge, Division of Infection and Dermatology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
  • 13 Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
  • 14 Centre for Prevention of Drug Addiction and Infectious Diseases, National Institute for Health Development, Tallinn, Estonia
  • 15 Riga Stradins University, Institute of Public Health, Riga, Latvia
  • 16 Medical Faculty, University of Rijeka, Rijeka, Croatia
  • 17 National Institute of Public Health NIH - National Research Institute, Warsaw, Poland
  • 18 National Antidrug Agency - Ministry of Internal Affairs, Bucharest, Romania
  • 19 Gesundheit Österreich GmbH - Austrian National Public Health Institution, International Affairs and Consulting, Vienna, Austria
  • 20 Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
  • 21 Hungarian Reitox National Focal Point, Budapest, Hungary
  • 22 Monitoring Department, Cyprus National Addictions Authority, Nicosia, Cyprus
  • 23 Robert Koch Institute, Department of Infectious Disease Epidemiology, Berlin, Germany
  • 24 Program of International Research and Training, National Drug and Alcohol Research Centre, Sydney, Australia
  • 25 Department of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
Euro Surveill, 2021 12;26(49).
PMID: 34886941 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').

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