Costs and impact on HIV transmission of a switch from a criminalisation to a public health approach to injecting drug use in eastern Europe and central Asia: a modelling analysis

Ward, Zoe; Stone, Jack; Bishop, Chrissy; Ivakin, V. N.; Eritsyan, Ksenia; Deryabina, Anna; Low, Andrea; Cepeda, Javier; Kelly, Sherrie L; Heimer, Robert; Cook, Rob; Altice, Frederick L.; Litz, Taylor; Terlikbayeva, Assel; El‐Bassel, Nabila; Havarkov, Denis; Fisenka, Alena; Boshnakova, Anelia; Klepikov, Andrey; Saliuk, Tetiana; Deshko, Tetiana; Vickerman, Peter

doi:10.1016/s2352-3018(21)00274-5

Cited by 19 publications

(13 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…For instance, transactional sex motivated by financial instability may disincentivize condom use or constrain condom negotiation capacity altogether [ 2 , 3 ]. In the context of criminalized sex work and drug use, these same conditions also amplify the risk environment for condom coercion, violence, and acquisition of HIV and other sexually transmitted infections [ 4 – 8 ].…”

Section: Introductionmentioning

confidence: 99%

Selling sex in the context of substance use: social and structural drivers of transactional sex among men who use opioids in Maryland

et al. 2022

View full text Add to dashboard Cite

Background Transactional sex is an important driver of HIV risk among people who use drugs in the USA, but there is a dearth of research characterizing men’s selling and trading of sex in the context of opioid use. To identify contextually specific factors associated with selling or trading sex in a US population of men who use drugs, we cross-sectionally examined social and structural correlates of transactional sex among men who use opioids (MWUO) in Anne Arundel County and Baltimore City, Maryland. Methods Between July 2018 and March 2020, we used targeted sampling to recruit men reporting past-month opioid use from 22 street-level urban and suburban recruitment zones. MWUO completed a 30-min self-administered interview eliciting substance use histories, experiences with hunger and homelessness, criminal justice interactions, and transactional sex involvement. We identified correlates of recent (past 3 months) transactional sex using multivariable log-binomial regression with cluster-robust standard errors. Results Among 422 MWUO (mean age 47.3 years, 73.4% non-Hispanic Black, 94.5% heterosexual), the prevalence of recent transactional sex was 10.7%. In multivariable analysis, younger age (adjusted prevalence ratio [aPR] 0.98, 95% confidence interval [95% CI] 0.97–0.99, p < 0.001), identifying as gay/bisexual (aPR = 5.30, 95% CI 3.81–7.37, p < 0.001), past-month food insecurity (aPR = 1.77, 95% CI 1.05–3.00, p = 0.032), and injection drug use in the past 3 months (aPR = 1.75, 95% CI 1.02–3.01, p = 0.043) emerged as statistically significant independent correlates of transactional sex. Conclusions Synergistic sources of social and structural marginalization—from sexuality to hunger, homelessness, and injection drug use—are associated with transactional sex in this predominantly Black, heterosexual-identifying sample of MWUO. Efforts to mitigate physical and psychological harms associated with transactional sex encounters should consider the racialized dimensions and socio-structural drivers of transactional sex among MWUO.

show abstract

Section: Introductionmentioning

confidence: 99%

Selling sex in the context of substance use: social and structural drivers of transactional sex among men who use opioids in Maryland

et al. 2022

View full text Add to dashboard Cite

show abstract

“…However, the contribution of incarceration might be lower than the contribution of unstable housing in other settings, depending upon a setting’s incarceration dynamics and whether prison itself is associated with decreased infection risk, thereby offsetting the increased risk following release. 35 …”

Section: Discussionmentioning

confidence: 99%

The contribution of unstable housing to HIV and hepatitis C virus transmission among people who inject drugs globally, regionally, and at country level: a modelling study

Stone

Artenie

Hickman

et al. 2022

The Lancet Public Health

Self Cite

View full text Add to dashboard Cite

Background A considerable proportion of people who inject drugs are unstably housed. Although unstable housing is associated with HIV and HCV infection among people who inject drugs, its contribution to transmission is unknown. We estimated the global and national proportions of incident HIV and HCV infections among people who inject drugs attributed to housing instability from 2020 to 2029. MethodsIn this modelling study, we developed country-level models of unstable housing and HIV and HCV transmission among people who inject drugs in 58 countries globally, calibrated to country-specific data on the prevalences of HIV and HCV and unstable housing. Based on a recently published systematic review, unstably housed people who inject drugs were assumed to have a 39% (95% CI 6-84) increased risk of HIV transmission and a 64% (95% CI 43-89%) increased risk of HCV transmission. We used pooled country-level estimates from systematic reviews on HCV and HIV prevalence in people who inject drugs. Our models estimated the transmission population attributable fraction (tPAF) of unstable housing to HIV and HCV transmission among people who inject drugs, defined as the percentage of infections prevented from 2020 to 2029 if the additional risk due to unstable housing was removed. Findings Our models were produced for 58 countries with sufficient data (accounting for >66% of the global people who inject drugs population). Globally, we project unstable housing contributes 7•9% (95% credibility interval [CrI] 2•3-15•7) of new HIV infections and 11•2% (7•7-15•5) of new HCV infections among people who inject drugs from 2020 to 2029. Country-level tPAFs were strongly associated with the prevalence of unstable housing. tPAFs were greater in high-income countries (HIV 17•2% [95% CrI 5•1-30•0]; HCV 19•4% [95% CrI 13•8-26•0]) than in low-income or middle-income countries (HIV 6•6% [95% CrI 1•8-13•1]; HCV 8•3% [95% CrI 5•5-11•7]). tPAFs for HIV and HCV were highest in Afghanistan, Czech Republic, India, USA, England, and Wales where unstable housing contributed more than 20% of new HIV and HCV infections.Interpretation Unstable housing is an important modifiable risk factor for HIV and HCV transmission among people who inject drugs in many countries. The study emphasises the importance of implementing initiatives to mitigate these risks and reduce housing instability.

show abstract

“…Modeling studies that incorporate seamless OAT treatment in carceral and community settings are likely to have the greatest impact on mortality ( Degenhardt et al, 2019 ) and other post-release outcomes ( Stone et al, 2021 2018 ). A recent modeling study that included Central Asia of decriminalizing drug use for personal use or possession would markedly reduce HIV transmission and be cost saving ( Ward et al, 2022 ). Such an approach in Kyrgyzstan where sentencing guidelines for drug use are harsh and persons spending considerable time (>3 years) incarcerated could be an alternative strategy.…”

Section: Discussionmentioning

confidence: 99%

Implementation opportunities for scaling up methadone maintenance treatment in Kyrgyzstan: Methadone dosage and retention on treatment over two years

Ivasiy

Madden

Farnum

et al. 2022

Drug and Alcohol Dependence Reports

View full text Add to dashboard Cite

Costs and impact on HIV transmission of a switch from a criminalisation to a public health approach to injecting drug use in eastern Europe and central Asia: a modelling analysis

Cited by 19 publications

References 35 publications

Selling sex in the context of substance use: social and structural drivers of transactional sex among men who use opioids in Maryland

Selling sex in the context of substance use: social and structural drivers of transactional sex among men who use opioids in Maryland

The contribution of unstable housing to HIV and hepatitis C virus transmission among people who inject drugs globally, regionally, and at country level: a modelling study

Implementation opportunities for scaling up methadone maintenance treatment in Kyrgyzstan: Methadone dosage and retention on treatment over two years

Contact Info

Product

Resources

About