- Recent incarceration is associated with an increased risk of HIV and hepatitis C virus (HCV) acquisition in people who inject drugs (PWID).
- Incarceration could be a significant driver of HIV and HCV transmission among PWID in many settings.
- The findings support the need for the development of effective strategies to reduce the risk of HIV and HCV transmission in PWID, including an evaluation of the impact of drug laws and excessive incarceration.
When it comes to determining the risk of HIV and HCV infection in people who inject drugs (PWID), the incarceration history counts. “The short-term risk substantially goes up after recent incarceration, while past incarceration is only weakly associated with elevated risk of either infection,” said Jack Stone, first author of a paper published in Lancet Infectious Disease.
The systematic review and subsequent meta-analysis included published results from 20 studies and unpublished results from 21 studies with the aim to determine the association between incarceration history and the risk of HIV and HCV acquisition in PWID. “58 percent of PWID have ever been incarcerated and their history of incarceration frequently being associated with prevalent HIV and HCV infection” researchers explained, underlining that many studies suggested the importance of transmission prevention strategies in the period following release.
To better understand the mechanism and the magnitude of the risk elevation after incarceration, Stone and colleagues analysed data from studies conducted in Australasia, Western and Eastern Europe, North and Latin America, East and Southeast Asia, showing that a recent incarceration history (past 3, 6, 12 months or last follow-up) is associated with an 81% increase in the HIV acquisition risk (relative risk [RR]: 1.81) and a 62% increase in the HCV acquisition risk. In both cases a moderate heterogeneity between studies was observed (I2=63.5% [p=0,001] and I2=57.3% [p=0,002] for HIV and HCV, respectively).
“Our results suggest that incarceration could be a significant driver of HIV and HCV transmission in PWID and studies are now needed to understand how incarceration increases the risk of acquisition of those infections” Stone claimed. “Addressing the multiple social vulnerabilities of PWID is necessary to fully reduce the risks associated with incarceration” he concluded.