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HIV Risks Among Injection Drug Using Populations: Past, Present, and Projections for the future

HIV Risks Among Injection Drug Using Populations: Past, Present, and Projections for the future. ( 1) University of California San Diego, Department of Medicine, CA, USA (2) Imperial College London, London, United Kingdom (3) University College London, United Kingdom

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HIV Risks Among Injection Drug Using Populations: Past, Present, and Projections for the future

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  1. HIV Risks Among Injection Drug Using Populations: Past, Present, and Projections for the future (1) University of California San Diego, Department of Medicine, CA, USA (2) Imperial College London, London, United Kingdom (3) University College London, United Kingdom (4) London School of Hygiene & Tropical Medicine, University of London, UK (5) University of Colorado at Denver, CO, USA (6) UNODC, Regional Office for Eastern Africa, Kenya (7) Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland Steffanie A. Strathdee (1) Timothy B. Hallett (2) Natalia Bobrova (3) Tim Rhodes (4) Robert Booth (5) Reychad Abdool (6) Catherine Hankins (7) Funding: NIDA R01DA027772-S1 & DA17620; Office of AIDS Research Wellcome Trust 2010

  2. The HIV risk environment • Levels: • Macro • Micro • Types: • Physical • Social • Economic • Policy Adapted from Rhodes 1999 and Glass and McAttee 2006

  3. Objectives 1) Review research on HIV risk factors among IDUs over the last decade To what extent is this literature consistent with the risk environment framework? 2) Illustrate how varying levels of environmental influence affect IDUs’ risk behaviours, HIV incidence and attributable risks in 3 cities

  4. Review of HIV epidemiology literature among IDUs: 1999-2009 2,722 documents collected from peer-reviewed literature 146 documents selected after reviewing title, keywords, abstracts • 94 documents with data on risk factors, correlates, determinants Only 25% aimed to identify at least one micro- or macro- level environmental determinant , but 86% nevertheless did so

  5. Results of Review Over the past decade: • Only 31% of studies were conducted in countries with high HIV burdens among IDUs. • Most studies identified: • Micro- rather than macro-level influences • Physical and social rather than economic or policy influences • Future studies should draw from social science literature, using a mixed methods approach

  6. Modelling Scenarios • How HIV epidemics may continue with and without future changes in proximate determinants of HIV risk in 3 cities:

  7. Inadequate ART provision and Sexual transmission can play key roles in some IDU-related epidemics Karachi Odessa

  8. Impact of Scaling up Combination HIV Interventions: Example from Odessa Reducing unmet need of OST, NSP and ART by 60% could prevent 41% of incident HIV infections

  9. Need to Optimize Intervention Coverage and Efficacy when Force of Infection is High: Nairobi

  10. Local HIV epidemics are sensitive to different types of structural changes: Karachi 8-12% reduction in transition from non-injecting to injecting could prevent 65–98% of incident HIV infections in Karachi

  11. Eliminating laws prohibiting OST and scaling up NSP and OST to 80% coverage could prevent 29% of new HIV infections among IDUs in Nairobi by 2015

  12. Conclusions • HIV epidemics among IDUs can be significantly curtailed if interventions are: • -Evidence and Rights-based • -Including scale up of OST, NSP and ART • - Take into account local risks operating at multiple levels of influence • Structural HIV prevention interventions are a crucial element of a combination prevention approach • Shifts responsibility for change away from individuals, towards social/political contexts.

  13. Acknowledgements • Study Coauthors • Drs. Hallett, Bobrova, Rhodes, Booth, Abdool, Hankins • Reviewers (incl. D. Burrows, P. Vickerman, G. Stimson, R.White) • US National Institute on Drug Abuse grants: -R01 DA027772-S1, R01 DA17620 • Office of AIDS Research • The Wellcome Trust (UK)

  14. Acknowledgments Carl Latkin Robert Malow Bradley Mathers Lisovska Oksana Jane Marie Ongo’lo Samiran Panda Natalia Rehtina Diana Rossi Richard Rothenberg Tatyana Saliuk Oleg Semeryk Ani Shakarishvili Alexandra Thomas Emily To Lucas Wiessing Daniel Wolfe Christy Anderson Richard Armenta AnnickBorquez Philippe Bourgois David Celentano Jessica Cubeta Penny Coppernoll-Blach Anna Dovbahk Faran Emmanuel Samuel R. Friedman Micah Gell-Redman Eleanor Gouws Mauro Guarinieri Peter Hartsock Brian Houle Francisco Inacio Bastos Natalia Kitsenko

  15. Extra Slides

  16. Example: HIV infections averted by eliminating Police Beatings in Three Cities in Ukraine Strathdee SA, Hallett TB, Bobrova N, et al. HIV and the Risk Environment among People Who Inject Drugs: Past, Present, and Projections for the Future. Lancet. In press.

  17. Model projection, Odessa Strathdee SA, Hallett TB, Bobrova N, et al. HIV and the Risk Environment among People Who Inject Drugs: Past, Present, and Projections for the Future. Lancet. In press.

  18. Projected number of HIV infections, 2010-15, Odessa Strathdee SA, Hallett TB, Bobrova N, et al. HIV and the Risk Environment among People Who Inject Drugs: Past, Present, and Projections for the Future. Lancet. In press.

  19. Estimated attributable risk, 2010-15, Odessa Strathdee SA, Hallett TB, Bobrova N, et al. HIV and the Risk Environment among People Who Inject Drugs: Past, Present, and Projections for the Future. Lancet. In press.

  20. Number of HIV infections among IDUs, 2010-15, Karachi Strathdee SA, Hallett TB, Bobrova N, et al. HIV and the Risk Environment among People Who Inject Drugs: Past, Present, and Projections for the Future. Lancet. In press.

  21. Model projections, Karachi Strathdee SA, Hallett TB, Bobrova N, et al. HIV and the Risk Environment among People Who Inject Drugs: Past, Present, and Projections for the Future. Lancet. In press.

  22. Projected number of HIV infections, 2010-15, Karachi Strathdee SA, Hallett TB, Bobrova N, et al. HIV and the Risk Environment among People Who Inject Drugs: Past, Present, and Projections for the Future. Lancet. In press.

  23. Estimated attributable risk, 2010-15, Karachi Strathdee SA, Hallett TB, Bobrova N, et al. HIV and the Risk Environment among People Who Inject Drugs: Past, Present, and Projections for the Future. Lancet. In press.

  24. Number of HIV infections among IDUs, 2010-15, Karachi Strathdee SA, Hallett TB, Bobrova N, et al. HIV and the Risk Environment among People Who Inject Drugs: Past, Present, and Projections for the Future. Lancet. In press.

  25. Projected number of HIV infections, Kenya Strathdee SA, Hallett TB, Bobrova N, et al. HIV and the Risk Environment among People Who Inject Drugs: Past, Present, and Projections for the Future. Lancet. In press.

  26. Number of HIV infections in IDUs, 2010-15, Kenya Strathdee SA, Hallett TB, Bobrova N, et al. HIV and the Risk Environment among People Who Inject Drugs: Past, Present, and Projections for the Future. Lancet. In press.

  27. Search criteria Databases searched: BIOSIS (ISI-CE Biosis previews), PubMed, and EMBASE for the period 2000 to 2009 Search components: • "HIV"OR "HIV Infections“ or “HIV” or “AIDS” or "human immunodeficiency virus" or "acquired immunodeficiency syndrome" or "acquired immune deficiency syndrome" • "Substance Abuse, Intravenous“ or “IDU” or “IDUs” or "injecting drug" or "intravenous drug" or "intravenous substance" or "injecting substance" or “injecting drug use” • “Risk factor” or “correlate” or “determinant” Strathdee SA, Hallett TB, Bobrova N, et al. HIV and the Risk Environment among People Who Inject Drugs: Past, Present, and Projections for the Future. Lancet. In press.

  28. Physical risk factors: Summary of HIV risks among IDUs according to the risk environment framework* (2000-2009) *adapted from Rhodes and Simic, 2005 (12) (will seek appropriate permissions) Strathdee SA, Hallett TB, Bobrova N, et al. HIV and the Risk Environment among People Who Inject Drugs: Past, Present, and Projections for the Future. Lancet. In press.

  29. Social risk factors: Summary of HIV risks among IDUs according to the risk environment framework* (2000-2009) *adapted from Rhodes and Simic, 2005 (12) (will seek appropriate permissions) Strathdee SA, Hallett TB, Bobrova N, et al. HIV and the Risk Environment among People Who Inject Drugs: Past, Present, and Projections for the Future. Lancet. In press.

  30. Economic risk factors: Summary of HIV risks among IDUs according to the risk environment framework* (2000-2009) *adapted from Rhodes and Simic, 2005 (12) (will seek appropriate permissions) Strathdee SA, Hallett TB, Bobrova N, et al. HIV and the Risk Environment among People Who Inject Drugs: Past, Present, and Projections for the Future. Lancet. In press.

  31. Policy risk factors: Summary of HIV risks among IDUs according to the risk environment framework* (2000-2009) *adapted from Rhodes and Simic, 2005 (12) (will seek appropriate permissions) Strathdee SA, Hallett TB, Bobrova N, et al. HIV and the Risk Environment among People Who Inject Drugs: Past, Present, and Projections for the Future. Lancet. In press.

  32. Search methods • Abstracts examined to determine eligibility for inclusion • Search included all languages • Excluded manuscripts where: • HIV infection was not an outcome, • no primary data presented, • data on IDUs not presented separately • manuscripts were commentaries, editorials or reviews • Data extracted by two independent reviewers and entered into a systematic coding form • Random 10% verified by a third reviewer • Coded data mapped onto various levels and types of environmental influence according to the risk environment framework Strathdee SA, Hallett TB, Bobrova N, et al. HIV and the Risk Environment among People Who Inject Drugs: Past, Present, and Projections for the Future. Lancet. In press.

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