title: High Prevalence and Incidence of HIV and HCV Among New Injecting Drug Users With a Large Proportion of Migrants--Is Prevention Failing?
abstract: OBJECTIVE
  The aim of this study was to assess differences in the prevalence of HIV and HCV infection and associated risk factors between new (injecting for ≤5 years) and long-term injectors and to estimate HIV/HCV incidence among new injectors.
  
  
  METHODS
  Cross-sectional study among people who inject drugs (PWID) who attended harm reduction centers in Catalonia in 2010-11. Anonymous questionnaires and oral fluid samples were collected. Poisson regression models were applied to determine the association between HIV/HCV infection and risk factors.
  
  
  RESULTS
  Of the 761 participants, 21.4% were new injectors. New injectors were younger than long-term injectors (mean age = 31.6 vs. 37.8) and were more likely to be immigrants (59.0% vs. 33.4%). HIV and HCV prevalence was 20.6% and 59.4% among new injectors, and estimated HIV and HCV incidence 8.7 and 25.1 /100 person-years, respectively. Among new injectors, HIV infection was associated with homelessness (PR = 3.10) and reporting a previous sexually transmitted infection (PR = 1.79). Reporting front/backloading (PR = 1.33) and daily injection (PR = 1.35) were risk-factors for HCV infection. For long-term injectors, HIV risk factors were: having shared syringes (PR = 1.85), having injected cocaine (PR = 1.38), reporting front/backloading (PR = 1.30) and ever having been in prison (PR = 2.03).
  
  
  CONCLUSIONS
  A large proportion of PWID in Catalonia are new injectors, a subgroup with a high level of both sexual and parenteral exposure and a high incidence rate of HIV/ HCV infections. It is important to improve early diagnosis of these infections among this group, in particular among migrants. To identify and address risk factors for homelessness PWID should be a priority.
authors.affiliation: a Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Agéncia de Salut Pública de Catalunya (ASPC), Generalitat de Catalunya , Badalona , Spain.|b CIBER Epidemiología y Salud Pública (CIBERESP) , Spain.|c Fundació Institut d'Investigació Germans Trias i Pujol (IGTP) , Badalona , Spain.
authors.forename: Cinta
authors.initials: C
authors.lastname: Folch
authors.affiliation: a Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Agéncia de Salut Pública de Catalunya (ASPC), Generalitat de Catalunya , Badalona , Spain.|b CIBER Epidemiología y Salud Pública (CIBERESP) , Spain.|c Fundació Institut d'Investigació Germans Trias i Pujol (IGTP) , Badalona , Spain.|d Departament de Pediatria, d'Obstetrícia i Ginecologia i de Medicina Preventiva i de Salut Pública, Facultat de Medicina, Universitat Autònoma de Barcelona , Bellaterra (Cerdanyola del Vallés) , Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Casabona
authors.affiliation: b CIBER Epidemiología y Salud Pública (CIBERESP) , Spain.|e Agéncia de Salut Pública de Barcelona , Spain.|f Departament de Psicologia i Metodologia de les Ciéncies de la Salut, Universitat Autònoma de Barcelona , Bellaterra (Cerdanyola del Vallés) , Spain.
authors.forename: Albert
authors.initials: A
authors.lastname: Espelt
authors.affiliation: g Subdirecció General de Drogodependéncies, Agéncia Salut Pública de Catalunya (ASPC), Departament de Salut de la Generalitat de Catalunya.
authors.forename: Xavier
authors.initials: X
authors.lastname: Majó
authors.affiliation: h Ámbit Prevenció , Barcelona , Spain.
authors.forename: Mercè
authors.initials: M
authors.lastname: Meroño
authors.affiliation: a Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Agéncia de Salut Pública de Catalunya (ASPC), Generalitat de Catalunya , Badalona , Spain.|b CIBER Epidemiología y Salud Pública (CIBERESP) , Spain.|i Microbiology Service, Hospital Universitari Germans Trias i Pujol , Badalona , Spain.
authors.forename: Victoria
authors.initials: V
authors.lastname: Gonzalez
authors.affiliation: j European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) , Lisbon , Portugal.
authors.forename: Lucas
authors.initials: L
authors.lastname: Wiessing
authors.affiliation: g Subdirecció General de Drogodependéncies, Agéncia Salut Pública de Catalunya (ASPC), Departament de Salut de la Generalitat de Catalunya.
authors.forename: Joan
authors.initials: J
authors.lastname: Colom
authors.affiliation: b CIBER Epidemiología y Salud Pública (CIBERESP) , Spain.|e Agéncia de Salut Pública de Barcelona , Spain.
authors.forename: M Teresa
authors.initials: MT
authors.lastname: Brugal
mesh_terms: D000328:Adult; D000367:Age Factors; D003430:Cross-Sectional Studies; D042241:Early Diagnosis; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology*; D040261:Harm Reduction; D006526:Hepatitis C / Q000175:diagnosis / Q000453:epidemiology*; D006703:Ill-Housed Persons / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016485:Needle Sharing / Q000706:statistics & numerical data*; D016012:Poisson Distribution; D015995:Prevalence; D012044:Regression Analysis; D012307:Risk Factors; D012309:Risk-Taking; D011477:Sex Work / Q000706:statistics & numerical data*; D012725:Sexual Behavior / Q000706:statistics & numerical data; D012749:Sexually Transmitted Diseases / Q000453:epidemiology; D013030:Spain / Q000453:epidemiology; D015819:Substance Abuse, Intravenous / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D013997:Time Factors; D055815:Young Adult
keywords: HIV, injecting drug use; Hepatitis C; migrants; new injectors