Highlights
- Smoking is the main way of cocaine and heroin consumption in Abidjan, Ivory Coast.
- People who use drugs in Abidjan can be considered at high risk of HIV, due to sexual transmission in women, sex workers, and men having sex with men using drugs.
- Social vulnerability is a major factor of illness in people who use drugs in Abidjan, with particularly high rates of active pulmonary TB associated with living conditions.
Background
The
number of people who use drugs (PWUD) has dramatically increased in West Africa
over the last 15 years, but targeted interventions are falling behind, notably
because of the lack of awareness of the health needs of PWUD. We aimed to
assess prevalence and factors associated with HIV and other infections in PWUD
in Abidjan, Ivory Coast, one of the countries most affected by HIV in Western
Africa.
Methods
We
used respondent-driven-sampling to obtain a representative sample of heroin or
cocaine/crack users aged 18 years or more. Socio-behavioral data were obtained
by face-to-face questionnaires. Blood samples were collected and tested for
HIV. Two sputa were obtained in tuberculosis (TB) symptomatic participants for
acid-fast-bacilli (AFB) smear testing. After a descriptive analysis, crude
prevalence were calculated, then weighted to take account of the sampling
method. Factors associated with HIV and TB were studied using adjusted
log-binomial regression. Population size was estimated by capture-recapture.
Results
450
PWUD were recruited in May 2014. The mean age was 33.5 years; 10.9% were women.
Smoking was the main mode of consumption, ever injecting was reported by 12.7%
of the participants (3.6% in the past month). Sex work was reported by 15.8% of
the PWUD (13.7% of the men), and 10.2% of the men reported sexual relationships
with other men (MSM). We found a weighted prevalence of 9.5% for HIV. Women
were 3.4 times more likely to be infected than men. Among men, being a sex
worker (SW) (adjusted OR 2.9 [95CI 1.06-7.98]) or MSM (adjusted OR 11.5 [95CI
4.22-31.42]) were the main factors associated with HIV infection in adjusted
analysis. Injection was not associated with HIV. TB weighted prevalence was
1.8%, associated with poor living arrangements in adjusted analysis. We
estimated that 3521; 95CI 3049–3993 PWUD live in Abidjan.
Conclusion
PWUD
in Abidjan are at high risk of HIV due to sexual transmission, especially in
women, SW and MSM who also use drugs. Interventions should be developed to
improve HIV prevention and linkage to care in these specific populations. More
generally, improving the health of PWUD involves a broader reflection on the
living environment and access to health care of slum residents in large African
cities.
Purchase full article at: http://goo.gl/vQo1be
By: Julie Bouscaillou, Jérome
Evanno, Myrtille Prouté, André Inwolé, Mathieu
Kabran, Thierry N’Guessan,
Samedi Djé-Bi, Souleymane
Sidibé, Marguerite Thiam-Niangoin,
Roger Nguessan Badou, Pascale
Blanchetière, Niklas Luhmann
julie.bouscaillou@medecinsdumonde.net
More at: https://twitter.com/hiv insight
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