International Journal of Epidemiology 2000;29:734-743
© International Epidemiological Association 2000
Women, drugs and HIV/AIDS: results of a multicentre European study
a Departamento de Salud Pública, Universidad Miguel Hernández, San Juan de Alicante, Spain.
b Faculté de Médecine, Université de Montréal, Canada.
c Group on Risk Behaviour in Female Injecting Drug Users. Escuela Nacional de Sanidad, Madrid, Spain: Isabel Cifuentes; Médicine du Monde, Paris, France: Françoise Aeberhaard, Catherine Bilger; Osservatorio Epidemiológico, Roma, Italy: Annette Verster; Frei University, Berlin, Germany: Klaus Stark; Centre for Reseach on Drugs and Health Behaviour, UK: Gillian Hunter; Centre for Drug Misuse Research, University of Glasgow, UK: Marina Barnard.
Reprint requests to: Pilar Estébanez, Universidad Miguel Hernández, Departamento de Salud Pública, Carretera de Alicante—Valencia Km 87, 03550 San Juan de Alicante, Spain. E-mail: mdm.sec-admin{at}apdo.com
Background In the light of rising human immunodeficiency virus (HIV) incidence rates amongst women in Western Europe, a multicentred, cross-sectional study was undertaken to explore the multitude of possible factors associated with HIV in a population of female injecting drug users (IDU).
Methods Face-to-face interviews were conducted with 1198 female IDU recruited from a variety of settings in Paris, Madrid, Rome, London and Berlin. Their HIV status was determined from antibody testing of blood or saliva samples or from written confirmation of HIV test results from a physician. A hierarchical logistic regression model was used to identify direct and indirect associations between socioeconomic factors, marginalization and risk behaviour with HIV prevalence.
Results The HIV prevalence in the sample of female IDU was 27.8% (range: 1.4% in London and 52.6% in Madrid). Factors independently associated with HIV prevalence in the regression analysis included: age >25 years (OR = 2.0–2.9), left full-time education before age 14 (OR = 2.4), no fixed address (OR = 2.2), previous imprisonment (OR = 1.4), commercial sex (OR = 1.3), having a regular HIV positive sexual partner (OR = 6.6), ever shared needles (OR = 1.5) and any sexually transmitted disease (STD) infection in the last year (OR = 1.7).
Conclusions The sexual behaviour and partners of female IDU in Western Europe are as important a component in explaining the HIV epidemic in this population as other risk factors, including high-risk drug taking behaviour. Homeless IDU women may be an important residual risk group warranting future preventive interventions and women with a history of STD should be a particular target for health education. Differences in HIV prevalence across cities are very large and may be related to differences in harm reduction policies.
Keywords HIV, injecting drug use, women, sexual behaviour
Accepted 12 November 1999
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