AEGiS-13IAC: Long-term cocaine injectors at highest risk for HIV acquisition.

13th International AIDS Conference

Durban, South Africa - July 9-July 14, 2000

Long-term cocaine injectors at highest risk for HIV acquisition.

Int Conf AIDS 2000 Jul 9-14; 13:(abstract no. WeOrC503)

Hankins C, Alary M, Parent R, Noel L, Claessens C; C. Hankins, Direction de la Sante Publique de Montreal-Centre, 1301 Sherbrooke St. East, Montreal, (Quebec), H2L 1M3, Canada, Tel.: +1 514 528 240, Fax: +1 514 528 2452

BACKGROUND: To determine HIV incidence and associated risk factors among injection drug users (IDU) in the province of Quebec and the city of Ottawa, Ontario.

METHODS: IDU who had injected drugs during the previous 6 months gave informed consent to provide a saliva sample, answer a questionnaire and be assigned a unique identifier allowing the detection of multiple visits by a same IDU (repeater). Cox regression was used for multivariate analysis of HIV incidence.

RESULTS: 5,087 IDU completed 7,552 questionnaires. 74 % were men with a median age of 32 years (vs 25 for women). 88% reported cocaine injection during the previous 6 months with more IDU aged > 25 years reporting heroin injection than their elders (58% vs 28%). HIV prevalence was 14% overall (729/5049; 95%CI = 13.5-15.4): 17% in Montreal (367/2144), 10% in Quebec City (166/1725), 4% in semi-urban areas (11/258) and 21% in Ottawa-Hull (183/889). Among the 1112 initially HIV negative repeaters, the overall HIV incidence rate (IR) was 5.4 per 100 person-years (PY), `88/1642 PY; 95%CI = 4.2-6.5' and highest in Montreal and Ottawa, at respectively 7.7 (40/519 PY; 95%CI = 5.3-10.1) and 7.6 per 100 PY (15/198; 95%CI = 3.7-11.4). In multivariate analysis, risk factors associated at p > 0.02 with higher HIV incidence were: injecting with borrowed dirty needles (adjusted relative risk `ARR' = 2.4), cocaine as the most often injected drug (ARR = 2.3), injecting with strangers (ARR = 2.1), 6 years or more of injecting drugs (ARR = 2.1) and male sex (ARR = 2.0).

CONCLUSION: HIV incidence remains unacceptably high in this population with needle borrowing/lending the main risk factor for HIV infection. Cocaine use among heavily dependent long term male injectors appears to be facilitating the maintenance of the epidemic and reducing the effectiveness of HIV prevention programmes among IDU.

Keywords: AEGIS, HIV Infections, Substance Abuse, Intravenous, Incidence, Prevalence, Risk Factors, HIV Seropositivity, Quebec, Questionnaires, Ontario, Human, Female, Male
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