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Meta-Analysis
. 2012 Jul 1;124(1-2):95-107.
doi: 10.1016/j.drugalcdep.2011.12.020. Epub 2012 Jan 17.

Are females who inject drugs at higher risk for HIV infection than males who inject drugs: an international systematic review of high seroprevalence areas

Don C Des Jarlais  1 , Jonathan P Feelemyer, Shilpa N Modi, Kamyar Arasteh, Holly Hagan
Affiliations
Meta-Analysis

Are females who inject drugs at higher risk for HIV infection than males who inject drugs: an international systematic review of high seroprevalence areas

Don C Des Jarlais et al. Drug Alcohol Depend. .

Abstract

Objective: There are multiple reasons why females who inject drugs may be more likely to become infected with HIV than males who inject drugs. Where this is the case, special HIV prevention programs for females would be needed.

Design: International systematic review and meta-analysis of studies across 14 countries.

Methods: Countries with high seroprevalence (>20%) HIV epidemics among persons who inject drugs (PWID) were identified from the Reference Group to the UN on HIV and Injecting Drug Use. Systematic literature reviews collected data on HIV prevalence by gender for these countries. Non-parametric and parametric tests along with meta-analytic techniques examined heterogeneity and differences in odds ratios (OR) across studies.

Results: Data were abstracted from 117 studies in 14 countries; total sample size N = 128,745. The mean weighted OR for HIV prevalence among females to males was 1.18 [95% CI 1.10-1.26], with high heterogeneity among studies (I(2)= 70.7%). There was a Gaussian distribution of the log ORs across studies in the sample.

Conclusion: There was a significantly higher HIV prevalence among females compared to males who inject drugs in high seroprevalence settings, but the effect size is extremely modest. The high level of heterogeneity and the Gaussian distribution suggest multiple causes of differences in HIV prevalence between females and males, with a specific difference determined by local factors. Greater understanding of factors that may protect females from HIV infection may provide insights into more effective HIV prevention for both females and males who inject drugs.

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Conflict of interest statement

Conflict of Interest

All authors have no conflicts of interest with respect to the submitted manuscript

Figures

Figure 1
Figure 1
Prisma diagram of eligible studies in review
Figure 2
Figure 2
Funnel plots of female/male HIV log odds ratio (OR) in high income countries
Figure 3
Figure 3
Funnel plots of female/male HIV log odds ratio (OR) in low/middle income countries
Figure 4
Figure 4
Gaussian distribution of log odds ratios (OR)
Figure 5
Figure 5
Forest plot of female/male HIV log odds ratio (OR) in high income countries
Figure 6
Figure 6
Forest plot of female/male HIV log odds ratio (OR) in low/middle income countries
See this image and copyright information in PMC

References

    1. Abdala N, White E, Toussova OV, Krasnoselskikh TV, Verevochkin S, Kozlov AP, Heimer R. Comparing sexual risks and patterns of alcohol and drug use between injection drug users (IDUs) and non-IDUs who report sexual partnerships with IDUs in St. Petersburg, Russia. BMC Public Health. 2010;10:676. - PMC - PubMed
    1. Azim T, Rahman M, Alam MS, Chowdhury IA, Khan R, Reza M, Chowdhury EI, Hanifuddin M, Rahman AS. Bangladesh moves from being a low-prevalence nation for HIV to one with a concentrated epidemic in injecting drug users. Int J STD AIDS. 2008;19:327–331. - PubMed
    1. Banks SE, Brown LS, Jr, Ajuluchukwu D. Sexual behaviors and HIV infection in intravenous drug users in New York City. J Addict Dis. 1991;10:15–23. - PubMed
    1. Barrio G, De La Fuente L, Toro C, Brugal TM, Soriano V, Gonzalez F, Bravo MJ, Vallejo F, Silva TC. Prevalence of HIV infection among young adult injecting and non-injecting heroin users in Spain in the era of harm reduction programmes: gender differences and other related factors. Epidemiol Infect. 2007;135:592–603. - PMC - PubMed
    1. Benotsch EG, Somlai AM, Pinkerton SD, Kelly JA, Ostrovski D, Gore-Felton C, Kozlov AP. Drug use and sexual risk behaviours among female Russian IDUs who exchange sex for money or drugs. Int J STD AIDS. 2004;15:343–347. - PubMed

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