244094 Are females who inject drugs at higher risk for HIV infection than males who inject drugs: A meta-analysis from 14 high seroprevalence countries

Monday, October 31, 2011

Don C. Des Jarlais, PhD , Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center, New York, NY
Jonathan Feelemyer, MS , Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center, New York, NY
Kamyar Arasteh, PhD , Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center, New York, NY
Shilpa Modi, BA , Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center, New York, NY
Holly Hagan, PhD , College of Nursing, New York University, New York, NY
Objective: There are several reasons females who inject drugs may be at higher risk for HIV compared to male injectors: 1) females may have more difficulties obtaining sterile injection equipment, 2) females may be more likely to inject after males in group settings, and 3) females are more susceptible to sexual transmission. We conducted a systematic review/meta-analysis to assess the extent to which females have higher HIV prevalence than males. Methods: Countries with high seroprevalence (>20%) HIV epidemics among IDUs were identified from the Reference Group to the UN on HIV and Injecting Drug Use. Systematic literature reviews collected data on HIV prevalence by gender. Non-parametric and parametric tests along with meta-analytic techniques examined heterogeneity and differences in odds ratios across studies Results: Data were abstracted from 102 studies in 14 countries with high HIV prevalence; total sample size was 108,986. The mean weighted odds ratio for HIV prevalence among females to males was 1.34, 95% CI 1.03 to 1.90. There was great heterogeneity among studies, I squared = 94.9%. There was a Gaussian distribution of the ln ORs among studies. Conclusion: There is significant evidence for higher HIV prevalence among females than males who inject drugs in high seroprevalence settings. The extreme amount of heterogeneity and the Gaussian distribution suggest multiple causes of differences in HIV prevalence between females and males, with actual outcomes determined by local factors. Special programs to prevent HIV infection among females who inject drugs are clearly needed but should be tailored to local circumstances.

Learning Areas:
Biostatistics, economics
Public health or related research
Social and behavioral sciences

Learning Objectives:
1.Discuss how meta-analysis is conducted for epidemiological studies. 2.Demonstrate understanding of differences in HIV prevalence among female vs. males who injection. 3.Analyze implications of female/male differences in HIV prevalence for HIV prevention programs for people who inject drugs.

Keywords: HIV Risk Behavior, Intravenous Drug Use

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Dr. Des Jarlais began his research on AIDS in 1982 and is recognized as a world leader in research on the epidemiology of HIV transmission among injection drug users. He is also a pioneer in the evaluation of a variety of harm reduction interventions, particularly syringe exchange programs, and was instrumental in the development and expansion of syringe exchange programs in New York City during the 1980s. Dr. Des Jarlais has published more than 350 articles on these topics. In 1989, Dr. Des Jarlais was jointly appointed by the President and Congress to serve as a Commissioner on the US National Commission on AIDS, a role he played until 1993. He has testified on many occasions before city and state legislative and Congressional committees on HIV prevention and syringe exchange. Since 1994, his research group at Beth Israel Medical Center has conducted annual surveys of syringe exchange programs in the United States. He was recently nominated and is currently serving on the PEPFAR Scientific Advisory Board and a consultant to various institutions, including the Centers for Disease Control and Prevention, the National Institute on Drug Abuse, the National Academy of Sciences, the United Nations and the World Health Organization. Dr. Des Jarlais is currently working on research studies in 20 different countries.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.