title: Incarceration is associated with used syringe lending among active injection drug users with detectable plasma HIV-1 RNA: a longitudinal analysis.
abstract: BACKGROUND
  Informed by recent studies demonstrating the central role of plasma HIV-1 RNA viral load (VL) on HIV transmission, interventions to employ HIV antiretroviral treatment as prevention (TasP) are underway. To optimize these efforts, evidence is needed to identify factors associated with both non-suppressed VL and HIV risk behaviours. Thus, we sought to assess the possible role played by exposure to correctional facilities on VL non-suppression and used syringe lending among HIV-seropositive people who use injection drugs (PWID).
  
  
  METHODS
  We used data from the ACCESS study, a community-recruited prospective cohort. We used longitudinal multivariate mixed-effects analyses to estimate the relationship between incarceration and plasma HIV-1 RNA > 500 copies/mL among antiretroviral therapy (ART)-exposed active PWID and, during periods of non-suppression, the relationship between incarceration and used syringe lending.
  
  
  RESULTS
  Between May 1996 and March 2012, 657 ART-exposed PWID were recruited. Incarceration was independently associated with higher odds of VL non-suppression (Adjusted Odds Ratio [AOR] = 1.54, 95% Confidence Interval [95% CI]: 1.10, 2.16). In a separate multivariate model restricted to periods of VL non-suppression, incarceration was independently associated with lending used syringes (AOR = 1.81, 95% CI: 1.03, 3.18).
  
  
  CONCLUSIONS
  The current findings demonstrate that incarceration is associated with used syringe lending among active PWID with detectable plasma HIV-1 RNA. Our results provide a possible pathway for the commonly observed association between incarceration and increased risk of HIV transmission. Our results suggest that alternatives to incarceration of non-violent PWID and evidence-based combination HIV prevention interventions for PWID within correctional facilities are urgently needed.
authors.forename: M-J
authors.initials: MJ
authors.lastname: Milloy
authors.forename: Thomas
authors.initials: T
authors.lastname: Kerr
authors.forename: Kate
authors.initials: K
authors.lastname: Salters
authors.forename: Hasina
authors.initials: H
authors.lastname: Samji
authors.forename: Silvia
authors.initials: S
authors.lastname: Guillemi
authors.forename: Julio
authors.initials: J
authors.lastname: Montaner
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St, Paul's Hospital, Vancouver, British Columbia, Canada. uhri-ew@cfenet.ubc.ca.
authors.forename: Evan
authors.initials: E
authors.lastname: Wood
mesh_terms: D000328:Adult; D055030:Drug Users / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000097:blood / Q000209:etiology / Q000635:transmission / Q000821:virology*; D015497:HIV-1 / Q000235:genetics / Q000302:isolation & purification* / Q000502:physiology; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016485:Needle Sharing; D016017:Odds Ratio; D011329:Prisoners / Q000706:statistics & numerical data; D011446:Prospective Studies; D012367:RNA, Viral / Q000097:blood* / Q000235:genetics; D015819:Substance Abuse, Intravenous / Q000150:complications*; D013594:Syringes / Q000009:adverse effects / Q000821:virology*; D019562:Viral Load
chemical_list: D012367:RNA, Viral