Recent incarceration drives HIV and hepatitis C epidemics in people who inject drugs

01 November 2018

Recent incarceration is a driver of HIV and hepatitis C infections in people who inject drugs, according to a landmark global review.

A person sleeping rough in the street in a sleeping bag.

People who inject drugs who’ve recently been incarcerated have an 81% increased risk of acquiring HIV and 62% increased risk of hepatitis C (HCV) compared to those with no recent incarceration history. For those who have ever been incarcerated, the risk of HIV and HCV acquisition among people who inject drugs is much less significant, at 25% and 21% respectively.

While epidemics of injecting drug use, incarceration and blood-borne infections are overlapping – until now, no global systematic review and meta-analysis on HIV or HCV acquisition risk among people who inject drugs had been conducted.

This research is important because around 58% of all people who inject drugs report ever having been incarcerated, and incarceration is frequently associated with higher prevalence of HIV and HCV infection. What’s more, people who inject drugs are particularly vulnerable to illicit drug misuse relapse in the period immediately after they leave jail. This puts them at higher risk of drug-related deaths, homelessness and increased injecting risk-taking behaviour.

The authors from University of Bristol (UK) pooled data from 41 studies in total, including unpublished data from 21 studies. They did this by identifying studies of people who inject drugs that had measured HIV or HCV incidence, approaching study authors for unreleased data – doubling the overall number of studies included. The data originated in Australasia, Western and Eastern Europe, North America, Latin America, and East and Southeast Asia. They note a lack a data from Africa and the Middle East as a limitation of their study.

The data provides strong evidence that recent incarceration increases HIV and HCV transmission risk, even after adjusting for confounding variables such as recent homeless or exposure to opioid substitution therapy.

They conclude HIV and HCV prevention interventions should be developed to support people who inject drugs during this period. More broadly, the findings suggest that interventions need to also address the social vulnerabilities experienced by this group during this period.

“This work is essential for understanding how the incarceration of people who inject drugs, and consequently, international drug policy, can contribute to increasing the burden of HIV and HCV among people who inject drugs,” said Jack Stone, Senior Research Associate in Health Infectious Disease Mathematical Modelling in the Bristol Medical School: Population Health Sciences.

“Hopefully this work will help guide future evidence-based drug policies and interventions to reduce this risk.”

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Written by Caitlin Mahon

Content Specialist - HIV & Sexual Health