Incarceration is likely to increase HIV and HCV transmission among people who inject drugs, new study finds

October 30, 2018, University of Bristol
Credit: CC0 Public Domain

Injecting drug use, through the sharing of needles, syringes and other injecting equipment, is a primary route of transmission for both HIV and hepatitis C virus (HCV), blood-borne infections that cause considerable morbidity and mortality worldwide. New research led by the University of Bristol has found among people who inject drugs, that recent incarceration was associated with an 81 per cent and 62 per cent increase in HIV and HCV acquisition risk, respectively.

The study, published in The Lancet Infectious Diseases, is the first and meta-analysis to assess whether incarceration history, either recent incarceration or past incarceration, raises the of HIV or HCV infection among people who inject drugs (PWID).

Through a systematic search of MEDLINE, Embase and PsycINFO databases and contacting authors of incidence studies not presenting on outcomes of interest, the research team identified 41 studies (21 of which were unpublished) with available data on these outcomes to be included in meta-analyses.

The researchers found strong evidence that recent incarceration is associated with an 81 per cent and 62 per cent increase in the risk of HIV and HCV acquisition, respectively. These findings were robust to sensitivity analyses, including the exclusion of studies at high risk of bias.

Jack Stone, Senior Research Associate in Health Infectious Disease Mathematical Modelling in the Bristol Medical School: Population Health Sciences, said: "This is the first global systematic review of quantitative studies on the effect of incarceration history on HIV and HCV transmission among people who inject drugs. Our findings provide strong evidence that recent incarceration increases HIV and HCV transmission risk.

"We found evidence of this effect in settings where HCV transmission is known to be very low during periods of incarceration, suggesting increases in transmission risk occur following release from prison. This work is essential for understanding how the incarceration of PWID, and consequently, international drug policy, can contribute to increasing the burden of HIV and HCV among PWID. Hopefully this work will help guide future evidence-based drug policies and interventions to reduce this risk."

It is well known that PWID experience high rates of incarceration (an estimated 58 per cent have ever been incarcerated globally), with a history of incarceration frequently being associated with higher HIV and HCV infection. The period immediately following release from prison represents a high risk for relapse to illicit drug use and poses an increased risk for multiple adverse outcomes, including drug-related deaths but also increased injecting risk behaviours, homelessness and reduced access to interventions.

Incarceration is likely to be a significant driver of HIV and HCV transmission among PWID in many settings because of the high rates of incarceration that PWID experience, as supported by previous mathematical modelling studies performed by this research team.

The study has important implications for policy and public health, including:

  • international drug policy whose overwhelming focus on the criminalization of people who use drugs has led to of incarceration among PWID;
  • the need for improved prison-based harm reduction which is absent in most countries and often inadequate in those in which it is provided; and
  • the need for improved linkage upon release to harm reduction as well as other services to address many of the multiple social vulnerabilities experienced by PWID that are amplified following incarceration (including for example homelessness).

The research team's findings also add to the growing body of evidence for the harms associated with international drug policy and support calls for the decriminalisation of illicit use.

The team suggest further research is needed to better explain the factors associated with incarceration that increase HIV and HCV acquisition risk, to help the development of interventions to reduce these risks. It also unknown, whether the effects of incarceration differ by type of detention (jail or prison etc.) or length of .

Explore further: Retention in HIV care drops after release from incarceration

More information: Jack Stone et al. Incarceration history and risk of HIV and hepatitis C virus acquisition among people who inject drugs: a systematic review and meta-analysis, The Lancet Infectious Diseases (2018). DOI: 10.1016/S1473-3099(18)30469-9

Related Stories

Retention in HIV care drops after release from incarceration

October 9, 2018
Fewer than half of people with HIV are retained in care three years after release from incarceration, according to a study in the U.S. published October 9 in the open-access journal PLOS Medicine by Kelsey Loeliger of Yale ...

Prisoners pose biggest risk for HIV infection rates in Eastern Europe

July 27, 2016
Prisoners are likely to be the primary risk group for HIV infections in Eastern Europe in the next 15 years, researchers from the University of Bristol have found.

History of incarceration linked to subsequent homelessness, study finds

March 1, 2017
People who have been incarcerated in Canada are more likely to subsequently experience unstable housing or homelessness compared with those who have not, new research suggests.

Reducing the harm of drug use for men in prison

July 11, 2014
The prevalence of drug use prior to incarceration among men in Ontario correctional institutions remains very high, underlining the need for drug intervention programs and services.

Missed opportunities for HIV diagnosis among those at risk

June 27, 2018
(HealthDay)—Considerable numbers of men who have sex with men (MSM) and persons who inject drugs (PWID) who are unaware of their HIV infection report missed opportunities for diagnosis, according to a research letter published ...

Recommended for you

Zika may hijack mother-fetus immunity route

November 14, 2018
To cross the placenta, Zika virus may hijack the route by which acquired immunity is transferred from mother to fetus, new research suggests.

Discovery suggests new route to fight infection, disease

November 14, 2018
New research reveals how a single protein interferes with the immune system when exposed to the bacterium that causes Legionnaires' disease, findings that could have broad implications for development of medicines to fight ...

Maternally acquired Zika immunity can increase dengue disease severity in mouse pups

November 14, 2018
To say that the immune system is complex is an understatement: an immune response protective in one context can turn deadly over time, as evidenced by numerous epidemiological studies on dengue infection, spanning multiple ...

New research aims to help improve uptake of hepatitis C testing

November 14, 2018
New research published in Scientific Reports shows persisting fears about HIV infection may impact testing uptake for the hepatitis C Virus (HCV).

Synthetic DNA-delivered antibodies protect against Ebola in preclinical studies

November 13, 2018
Scientists at The Wistar Institute and collaborators have successfully engineered novel DNA-encoded monoclonal antibodies (DMAbs) targeting Zaire Ebolavirus that were effective in preclinical models. Study results, published ...

Scientists illuminate causes of hepatitis B virus-associated acute liver failure

November 13, 2018
National Institutes of Health scientists and their collaborators found that hepatitis B virus (HBV)-associated acute liver failure (ALF)—a rare condition that can turn fatal within days without liver transplantation—results ...

2 comments

Adjust slider to filter visible comments by rank

Display comments: newest first

Anonym216579
3 / 5 (2) Oct 30, 2018
Wow, people who share needles are more likely to contract HIV... and oddly enough its even more common in prison settings... Thank you once again captain obvious.
Anonym518498
not rated yet Nov 10, 2018
The commies will of course use this to support their platform of emptying prisons. Please note though that they will not destroy the prisons as they plan to use them for political prisoners once they regain power.

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.