Prevalence of HIV, HCV and other sexually transmitted infections and associated risk behaviours among Spanish and immigrant IDU in Catalonia, Spain

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Prevalence of HIV, HCV and other sexually transmitted infections and associated risk behaviours among Spanish and immigrant IDU in Catalonia,

1 Prevalence of HIV, HCV and other sexually transmitted infections and associated risk behaviours among Spanish and immigrant IDU in Catalonia, Spain Folch C, Casabona J, Majó X, Brugal T, Meroño M, González V, and Working group REDAN IHRA s 21st International Conference. Liverpool 26 April 21

2 Where is Catalonia? Barcelona

3 Background In Catalonia foreign population in 2 accounted for less than 3 of the overall population and in 29 that percentage had increased up to 16. We have also observed an increase of the immigrant UDIs which probably have a greater vulnerability to infections due to risk factors such as marginality, social exclusion and low contact with drug and health services. IDUs in Catalonia have still a high HIV prevalence due to the dramatic epidemic in the late 8s. This along with a still high sexual risk behaviour makes knowing the ITS prevalence an important objective in order to decrease HIV and ITS transmission

4 Aims To describe HIV, HCV, Chlamydia trachomatis and Neisseria gonorrhoeae prevalences among IDUs recruited in Catalonia To describe Risk behaviour prevalences related to these infections To compare HIV, HVC and ITS and risk behaviour prevalences between Spanish and Immigrant drug injectors

current injectors (Last 6 months) Anonymous interview with a structured

5 Methodology 748 UDIs recruited from Harm Reduction Services in Catalonia October 28 December 29 Stratified sample by service and country Inclusion criterion: current injectors (Last 6 months) Anonymous interview with a structured questionnaire Collection of biological samples VIH and VHC C. Trachomatis and N. gonorrhoeae

6 Results Sample breakdown by country 7, 6, 58,7 5, 4, 3, 23,5 2, 1, 9,2 6,6,,8,1 1,1

7 Sociodemographics: Spanish n=439 Immigrants n=39 Total p Mean age (DE) 38,5 (7,1) 33,4 (6,9) 36,4 (7,5) <,1 Men 78,1 88, 82,2 <,1 Living in Barcelona 8, 95,1 86,2 <,1 University degrees 1,1 18,3 8,2 <,1 Working situation*: <,1 Working 22,6 24,1 23,2 Unemployed 4,6 56, 47, On Social benefits 28,1 4,9 18,5 Others (begging, stealing...) 8,8 15, 11,3 Ever in prison 67,8 58,9 64,1,12 * Last 6 months

8 Spanish n=439 Immigrants n=39 Total Accommodation (last 6 months) <,1 Own house 49,9 25,6 39,8 Hostel 8,9 15,2 11,5 House with other people 8,9 7,1 8,2 Without a fixed place 19,1 35,3 25,8 Prison 1,8 2,6 2,1 Squatted house 8, 11,3 9,4 Others 3,4 2,9 3,2 Living with (last 6 months):* Alone 29,8 48,9 37,7 <,1 Partner 24,1 23,1 23,7 ns Parents or relatives 35,8 7,8 24,2 <,1 Children 11,4 3,2 8, <,1 Friends or other adults 17,1 32,8 23,6 <,1 p * Non mutually exclusive categories

9 Drug consumption characteristics: Spanish n=439 Immigrants n=39 Total p Ever in treatment 93,6 74,4 85,7 <,1 Meant time of drug injection (DE) 18,1 (8,7) 1,8 (6,7) 15,1 <,1 Most often drug injected** <,1 Heroin 41,3 4,3 4,9 Cocaine 42,5 23,1 34,5 Heroin plus cocaine 16,2 35,7 24, Others* -,9,6 Injecting daily** 43,7 57,6 49,5 <,1 methadone, amphetamine, ketamine, morphine, buprenorphine, LSD, MDMA ** Last 6 months

10 Syringe sharing prevalences P<,1 Spanishs Immigrants ,5 42,9 51,5 Total ,5 19,2 19,4 23,3 22,3 22,9 1 Has ever shared Has accepted syringes (last 6 months) Has passed syringes (last 6 months)

11 Indirect sharing prevalences (Last 6 months)* with a used syringe * p>,5 Spanishs Immigranst Total ,9 5 49,9 54,9 52, Front/backloading Sharing other m aterial

12 Most usual places were syringes are obtained (last 6 months) p<,5 Potentially non sterile sources p<,5 2 1 Buying in pharmacy Most used source for 58 of Spaniards outreach worker NSP Consumption rooms Drug treat. or health facilities Colleagues Partner Drug dealer Most used source for 56 of immigrants Spanish Immigrants

13 Sexual behaviour (Last 6 months): Spanish n=439 Immigrants n=39 Total p Has had sexual intercourse 67,4 72,8 69,7 ns Heterosexual (stable partner) 47,2 5, 48,3 ns With UDI stabel partner* 41,5 44,2 42,6 ns With HIV + stable partner* 24,9 4, 16, <,1 Heterosexual (occasional partners) 31,9 37,9 34,4 ns Sex with clients 8,5 5,8 7,4 ns Homosexual 2,7 3,6 3,1 ns * base: 27 Spanish and 154 immigrants with stable partner

14 Use of condoms by type of sexual partner (Last 6 months) p>, Last sexual intercourse Stable partner Last 6 months sexual interc. p>, Last sexual interc. Occasional partner Last 6 month sexual interc. Spanish Immigrants Total 1 Clients p>,5 Last sexual interc. Last 6 month sexual interc.

15 Use of health services (last 6 months)* ITS centre Family planning centre Hospital Immigrants Spanish Private doctor Drug treatment Prison A&E rooms GP p<,5 * categorías no excluyentes

16 Prevalence of HIV, HVC and STI (biological samples)

17 By country Spanish Immigrants Total 1 HIV p<,1 1 HCV p=, ,2 74,4 74, ,4 34, Chlamydia trachomatis p=,49 1 Neisseria gonorrhoeae p=, ,4 3,6 2,6 2,9,3,7

18 By country and sex Sanish Men Spanish Women Immig. Men Immig. Women 1 HIV 1 HCV ,4 52,6 22,5 21, , ,1 62,2 P<,5 No sign No sign P=,6 3 STI urine ,9 6,3 3,3 8,1 P<,1 No sign

19 Conclusiones There is still a high prevalence of HIV, which is higher among Spanish injectors compared to immigrants. HCV prevalence is very high and similar between the two groups. Immigrants are younger with a shorter injecting career. They have a smaller social network and lower contact with health and drug services apart from harm reduction services. All these may increase their vulnerability to acquire these infections Health and drug treatment services should be more sensitive to the new cultural and ethnic diversity of our society Low prevalence of STI among this population, higher in immigrants. However condom use is low More and better sexual prevention education should be done, especially regarding condom use among stable partners HIV transmission is mainly by risk injecting behaviour We should still expand and improve our harm reduction strategies

20 Acknowledges REDAN WORKING GROUP CEEISCAT: Jordi Casabona, Cinta Folch; Anna Esteve, Alexandra Montoliu; Rafa Muñoz Servei Microbiologia HUGTiP: Victoria González, Elisabeth Bascuñana, Vicenç Ausina Agència de Salut Pública de Barcelona: M. Teresa Brugal, Albert Espelt, Carmen Vecino Sudirecció General de Drogodependències: Xavier Majó, Joan Colom Àmbit Prevenció: Mercè Meroño, Anna Altabas Harm reduction services: Barcelona: Sant Adrià del Besós L Hospitalet de L: Sta Coloma de G Badalona: Reus: Terrassa: Lleida: Constantí: Girona: Àmbit Prevenció (AP), SAPS, Baluard, CAS Vall d Hebrón; El Local Sant Adrià; AEC-Gris ASAUPA M CAS, ARSU AIDE, Alba Arrels, F Mercè Fontanilles Creu Roja IAS Interviewers: Carmen Stanescu; Constanza Daigre; Pau Freixa; Alba Mestres; Silvia Isabel Moreira; Fabio Boccali; Pedro Sánchez; Rosa Kistmacher; Karla Cornejero; Sebastián Riveros; Esteve Lafita; Marc Muñoz; Marta Pardell; Joan Obiols; Concepció Escué

High prevalence and incidence of HIV and HCV among new injecting drug users with a large proportion of migrants Is prevention failing?

High prevalence and incidence of HIV and HCV among new injecting drug users with a large proportion of migrants Is prevention failing? Cinta Folch on behalf of REDAN Study Group Viral Hepatitis Prevention