THE RISKS OF HCV AND HIV INCIDENCE AMONG PEOPLE WHO INJECT DRUGS WHO ALSO UNDERTAKE SEX WORK OR MALE-WITH-MALE SEXUAL ACTIVITY: A META-ANALYSIS COMBINING PUBLISHED AND UNPUBLISHED ESTIMATES

Author: Dawe J, Stone J, Hickman M, Abramovitz D, Aladashvili M, Artamonova I, Blouin K, Boyd A, Bruneau J, Debeck K, Des Jarlais D, Dietze P, Dumchev K, Hankins C, Havens J, Hope V, Kurth A, Maher LMehta S, Mitchell H, Morris M, Palmateer N, Platt L, Prins M, Jongen V, Rathnayak K, Saraswati LR, Roussos S, Sacks-Davis R, Sarna A, Solomon S, Strathdee S, Sypsa V, Trickey A, Van Santen D, Walker J, Young A, Zang G, Vickerman P, and Artenie A

Theme: Epidemiology & Public Health Research Year: 2025

Background:

People who inject drugs (PWID) engage in sexual risk behaviours that may increase HIV and hepatitis C virus (HCV) risk, including sex work and male-with-male sexual activity. We undertook a systematic review to assess whether PWID who recently (previous year) engaged in sex work or male-with-male sexual activity have increased HCV and HIV acquisition risks.

Methods:

We searched relevant databases for HCV and HIV incidence studies among PWID published between 01/01/2000 and 12/12/2022. We contacted studies which reported HIV or HCV incidence, but did not report an association with sex work or male-with-male sex, to request data. We extracted and pooled estimates of the association between recent male-with-male sex or sex work (selling sex only) and HIV or HCV incidence using random-effects meta-analysis. For sex work, we also conducted analyses gender-stratified analyses. We used adjusted estimates if reported, otherwise we used unadjusted estimates.

Results:

We included 47 studies, of which 21 were unpublished, and 121 estimates. Among male PWID, malewith-male sex was associated with increased HIV risk (RR:2.32; 95%CI:1.59–3.40; n=16) and increased (but inconclusive) HCV risk (RR:1.26; 95%CI:0.94–1.69; n=11 estimates). Overall analyses (including both males and females) suggest that recent sex work is associated with increased risk of HIV (pooled relative risk (RR):1.78; 95%CI:1.32–2.39; n=19) and HCV acquisition (RR:1.59; 95%CI:1.28–1.99; n=22) among PWID. In gender-stratified analyses, we found that recent sex work was associated with greater HIV risk among female PWID (RR:2.25; 95%CI:1.47–3.43; n=13), and greater HCV risk among male PWID (RR:1.44; 95%CI:1.15–1.79; n=14). Conclusion: Risk of HIV and HCV acquisition is higher among PWID who engage in sex work or male-with-male sex, but the magnitude depends on the virus (HIV/HCV) and gender. Services that provide healthcare and harm reduction for PWID should tailor their services to address these sexual risk behaviours.

Disclosure of Interest Statement:

None to declare.

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