Differences by country of origin and by gender among people who inject drugs attending low threshold agencies in Catalonia

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1 Differences by country of origin and by gender among people who inject drugs attending low threshold agencies in Catalonia Folch C 1,3, Casabona J 1,3, Espelt A 2,3, Major X 4, Meroño M 5, Gonzalez V 1,6, Colom J 1, Brugal T 2,3, REDAN Study Group 1 Centre for Epidemiological Studies on Sexually Transmitted Infections and HIV/AIDS of Catalonia 2 Public Health Agency of Barcelona 3 Biomedical Research Consortium of Epidemiology and Public Health (CIBERESP), Spain. 4 Programme on Substance Abuse. Public Health Agency of Catalonia 5 Àmbit Prevenció Foundation. Catalonia 6 Microbiology Service. Hospital Universitari Germans Trias i Pujol. Badalona. Catalonia

2 Methodology Cross sectional Study ( ) Harm Reduction Services a1 Stratified Sample by centre and country Inclusion criteria: Injection last 6 months Informed consent Questionnaire administered face to face Oral fluid samples for HIV and HCV 2

3 Slide 2 a1 JO no crec que calgui posar aquest punt com a central. Elcentral és que pocs accedeixen a tractament, sovint ni els que estan estables en metadona. argo, 27/07/2014

4 Immigrants Spanish Total N 290 (39.5%) 444 (60.4%) 734 p Age (mean) SD 34.2 (7.7) 40.5 (7.3) 38.0 (8.1) < Sex: men 86.6 % 80.0 % 82.6% Drug Treatment Centres (TDI Cocaine/heroin 2013): Immigrants: 11.8% Spaniards: 88.2 % 3

5 Sample Distribution by country of origin Marroc 53,3% Argelia 23,3% Altres 23,4% Country Itàlia 72,8% Romania 28% Geòrgia 25,4% Rússia 8,3% Altres 38,3%

6 Starting injection (Mean Age)(SD) Years of Injection (SD) Immigrants Spanish Total p 23,0 (7,6) 21,7 (7,4) 22,2 (7,5) 0,025 11,2 (7,9) 18,8 (9,9) 15,8 (9,7) <0,001 Main drug a11 P< Spanish Immigrants 5

7 Slide 5 a11 JO no crec que calgui posar aquest punt com a central. Elcentral és que pocs accedeixen a tractament, sovint ni els que estan estables en metadona. argo, 27/07/2014

8 Immigrants compared to Spanish Lower access to drug treatment Immigrants Spanish p Currently in treatment 41.4% 58.6% Never in treatment 24.8% 5.9% <0.001 a12 Less use of health services (last 6 months) Immigrants Spanish p Health card 66.9% 100% Attending GP 31% 69.8% <0.05 Attending Hospital 23.5% 35% Prison Health Services 12.8% 7% 6

9 Slide 6 a12 JO no crec que calgui posar aquest punt com a central. Elcentral és que pocs accedeixen a tractament, sovint ni els que estan estables en metadona. argo, 27/07/2014

10 Immigrants compared to Spanish a12 Lower access to shelter (last 6 months) Immigrants Spanish p Homeless 30.1% 15.1 Squatting 19.4% 7.9% Home (own or relatives) 27.7% 48.9% <

11 Slide 7 a12 JO no crec que calgui posar aquest punt com a central. Elcentral és que pocs accedeixen a tractament, sovint ni els que estan estables en metadona. argo, 27/07/2014

12 Immigrants compared to Spanish More irregular income (last 6 months) Immigrants Spanish p Unemployment benefit 2.8% 8.8% Other social benefits 10.7% 56,0% <0.001 Stealing, pickpocketing, % 33.6% Selling drugs 23.1% 13.2% <0.001 Selling in the streets or begging 45.9% 36.5% informal jobs 6.2% 3.2%

13 Immigrants compared to Spanish Source of Sterile syringes (last 6 months) Immigrants Spanish p Pharmacies NSP 6.3% 20.5% < Use of DCR (BCN) (last 6 months) Immigrants Spanish p Never 9.1% 22.5% <0.001 a12 Acces to condoms(last 6 months) Immigrants Spanish p All for free 41.7% 57.6% < None for free 36.4% 17% 9

14 Slide 9 a12 JO no crec que calgui posar aquest punt com a central. Elcentral és que pocs accedeixen a tractament, sovint ni els que estan estables en metadona. argo, 27/07/2014

15 80,0 Changes in injecting risk behaviour Among Spanish and Immigrants ( ) 70,0 67,6 64,9 % 60,0 50,0 40,0 54,9 49,9 44, ,8 53,1 52,6 50,0 58,1 51,7 30,0 20,0 10,0 22,7 22,3 15,9 19,1 14,2 14,9 13,3 14,7 19,0 15,5 13,3 13,3 11,8 10,6 12,5 12,2 11,8 10,1 0, ESPANYOLS IMMIGRANTS Spanish Immigrants Ha acceptat XU Ha passat XU Front Back Loading Front Back Loading amb XU Ha compartit altre material p<0.001

16 HIV and HCV prevalence among Spanish and immigrants ( ) HCV 75,2 74,4 71,8 72,1 67, % HIV 43 40,8 35,9 Espanyols VIH* Espanyols VHC* Inmigrants VIH Inmigrants VHC 20 22,4 21,1 22, * Tendència significativa que es manté a l ajustar per anys d injecció, situació laboral, nivell d estudis, sexe i viure o no al carrer

17 Women compared with men Have riskier sexual partners Stable Partner Women (55) Spanish Men (136) Immigrant Women (33) Men (126) Injecting Partner 64.3% 38.3% 84.6% 50.2% HIV Partner 18.9%% 21.3%% 6.5% 2.5% Have riskier sexual activities Women (86) Spanish Men (355) Immigrant Women (39) Men (251) Sex with Clients 16.3% 2.3% 15.4% 3.2% 12 a25

18 Slide 12 a25 JO no crec que calgui posar aquest punt com a central. Elcentral és que pocs accedeixen a tractament, sovint ni els que estan estables en metadona. argo, 27/07/2014

19 Women compared with men Less use of condoms with occasional partners women men p a25 Not always 69.2% 33.6% <0.001 Suffering from more violence women men p Physical aggression 52.1% 34.8% <0.001 Sexual assault 6.6% 1.8% <

20 Slide 13 a25 JO no crec que calgui posar aquest punt com a central. Elcentral és que pocs accedeixen a tractament, sovint ni els que estan estables en metadona. argo, 27/07/2014

21 Reproductive Health Spanish women Immigrant women Ever pregnant 86.7% 76.3% Ever abortion 68.1% 79.3% or more 39.6% 33.3% p

22 HIV and HCV prevalence among Women and Men ( ) ,2 30,4 26,4 VIH positiu 66,4 64,9 57,6 VHC positiu** MenHomes Dones Women Total Total **p=0.05

23 CONCLUSIONS Immigrants and women are 2 minorities among IDUs with special needs that put them in several higher risk situations The predominantly male and native population in services make them overlook the immigrant and women differential needs. HRS access much more easily immigrants that mainstream health services 16

24 CONCUSIONS In spite of the decrease on risk injecting behaviour, it still exist a high percentage. Indirect sharing is still too high and what is worse, it is increasing among migrants Prevalences on HIV and HCV decrease very slowly in Spaniards but not in immigrants 17

25 I would like to acknowledge the collaboration of the Harm Reduction Services and facilities Thank you 18

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