Differences between women and men in serial HIV prevalence and incidence trends

Abstract

To measure trends in HIV incidence and serial prevalence by sex in a intravenous drug users (IDUs) and heterosexuals (HT) cohort recruited in a counselling centre in Valencia (1988-2005). Serial prevalence and incidence rates were calculated and modelled by logistic and Poisson regression respectively. 5948 IDUs and 13343 HT were recruited. Prevalence was higher among female IDUs (46% vs. 41%), and female HT (4.1% vs. 2%). For IDUs, an interaction (P = 0.005) between sex and calendar was detected. Age-adjusted prevalence showed faster yearly decline in men (OR = 0.87 95%CI: 0.85-0.88) than in women (OR = 0.91 95%CI: 0.88-0.93). Incidence was higher in female IDUs (9.79% p-y) than in men, (5.38% p-y) with an annual decrease for both of 11%. HIV incidence was higher in female HT (0.62% p-y) compared to men 0.23% p-y with a 21% yearly decline. Gender differences in HIV prevalence and incidence trends have been detected. Women showed an increased vulnerability to infection in a country whose HIV epidemic has been largely driven by IDUs.

HIV Epidemics in the European Region: Vulnerability and Response

“…Proposals for HIV-related surveillance studies need to be conducted with full consultation with affected populations and with appropriate rights protections in place [44]. There are some useful lessons in good surveillance practice in Europe, including for instance, the European Men Who Have Sex with Men Internet Survey (EMIS) among MSM, the sentinel surveillance of HIV and risk among PWID in Italy, Spain, and the United Kingdom, and the sentinel surveillance among SWs in Central Asia [40,[46][47][48][49]. All countries within the region should regularly assess and estimate the sizes of the three main key populations at high risk-MSM, PWID, and SW.…”

“…Receipt of ART reduces the infectivity of HIV-positive PWID by 80%. This number is based on results of recent trials [47,48] adjusted downward for the lower adherence levels characteristic of PWID [49][50][51], which has been shown to increase viral load [52][53][54][55]. For simplicity, it is assumed that all HIVpositive PWID (except those in the initial acute phase) can be recruited for ART at a fixed rate.…”

“…This information is used to assess homophily, or the extent to which recruiters are likely to recruit individuals similar to themselves, and to weight the sample to compensate or control for differences in network size, homophily, and recruitment success. RDS has been increasingly used in Europe and internationally to recruit samples of SWs [44,45], MSM [46] and PWID [47][48][49][50], and it has been championed for its ability to provide more representative estimates of risk behavior and HIV prevalence [46,[50][51][52][53]. There have been recent ethical concerns that the use of incentives may negatively affect participants' social and economic relationships in populations of PWID.…”

“…In Estonia, between 58% and 66% of PWID have been in prison at least once. Even among new injectors with less than three years of injecting between 32% and 40% have been incarcerated [47]. Reports of arrest or imprisonment, although varied, were consistently high across the region: in Georgia between 6% and 21% of PWID were arrested and in Russia the number was between 6% and 37%.…”

“…Experience of violence has similarities with HIV in that it is concentrated among marginalized, vulnerable populations [45]. The interplay of violence and HIV among SWs has direct pathways, such as forced unprotected sex, as well as indirect pathways, such as reducing self-esteem and the ability to negotiate safer practices for fear of further violence, increasing drug use, or forced relocation of sex work to less familiar or safe areas [46][47][48][49]. Data from Europe show that levels of sexual and physical violence among SWs were universally high, particularly among minority groups such as Roma populations and transvestites [47,50].…”