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Risk of HIV and hepatitis B and C over time among men who inject image and performance enhancing drugs in England and Wales: results from cross-sectional prevalence surveys, 1992-2013

Hope, VD and Harris, R and McVeigh, J and Cullen, KJ and Smith, J and Parry, JV and DeAngelis, D and Ncube, F (2015) Risk of HIV and hepatitis B and C over time among men who inject image and performance enhancing drugs in England and Wales: results from cross-sectional prevalence surveys, 1992-2013. Journal of Acquired Immune Deficiency Syndromes, 71 (3). pp. 331-337. ISSN 1525-4135

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Abstract

BACKGROUND:: Infection risks among people who inject drugs (PWID) are widely recognised, but few studies have focused on image and performance enhancing drugs (IPEDs). Globally, concern about IPED injection has increased and, in the United Kingdom, IPEDs injectors have become the largest group using Needle and Syringe Programmes. Blood borne virus (BBV) prevalence trends among IPED injectors are explored. METHOD:: Data from two surveys of IPED injectors (2010-11; 2012-13) and the national bio-behavioural surveillance system for PWID (1992-97; 1998-2003; 2004-09) were merged. Psychoactive drug injectors and women were excluded. Logistic regression analyses explored temporal changes. RESULTS:: Between 1992 and 2009, median age increased from 25 to 29 years (N=1,296), years injecting from 2 to 4. There were 53 men who had sex with men (MSM). Overall, 0.93% had HIV, 4.4% ever had hepatitis B (HBV), and 3.9% hepatitis C (HCV, from 1998, N=1,083). In multivariable analyses, HIV increased in 2004-09 (adjusted Odds Ratio (AOR)=10 [95%CI 0.94-106] vs. 1992-2003), and remained elevated (AOR=4.12, 95%CI 0.31-54, 2012-13); HBV also increased in 2004-09 (AOR=3.98, 95%CI 1.59-9.97). HCV prevalence increase was only borderline significant (AOR=2.47, 95%CI 0.90-6.77, 2010-11). HIV and HBV were associated with MSM, and HCV with sharing needles/syringes. Uptake of diagnostic testing for HIV and HCV, and HBV vaccination increased (to 43%, 32% and 44% respectively). Condom use was consistently poor; needle/syringe sharing occurred. CONCLUSION:: BBV prevalences among IPEDs injectors have increased, and for HIV is now similar to that among psychoactive drug injectors. Targeted interventions to reduce risks are indicated.

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