Marseille 2007
| Abstract #336 - Social vulnerability and practices at risk of HIV and HCV transmission among drug users The InVS-ANRS Coquelicot Study, France | ||||
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Session: 50.5: Transmission and social epidemiology (Parallel) on Wednesday @ 08.30-10.30 in PR Chaired by Brenda Spencer, Helene Sylvain Authors: Presenting Author: Mrs Jauffret Roustide Marie - Institut de Veille Sanitaire, France |
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| Additional Authors: Dr Emmanuelli Julien, Dr Couturier Elisabeth, Mr Le strat Yann, Prof Barin Francis, Dr Semaille Caroline, Mrs Oudaya Lila, Dr Desenclos Jean-Claude, | ||||
| Aim: Drug users (DUs) are particularly at risk from infections, especially by HIV and HCV. In late 2004, a cross-sectional epidemiological study examined the sociodemographic characteristics of DUs in France, along with their HIV and HCV seroprevalence rates, at-risk situations linked to drug use, and certain psychosocial determinants of at-risk behaviors. | ||||
| Method / Issue: Between September and December 2004, a cross-sectional multicenter survey was done among DUs having injected or snorted drugs at least once. DUs were recruited in 5 towns (Lille, Strasbourg, Paris, Bordeaux, Marseille) through low-threshold services, needle exchange programs, drug treatment centers, post-treatment centers, therapeutic apartments and general practitioners. DUs were included according to a two-stage stratified sampling design. First, services and survey days were randomly selected. Second, DUs were randomly selected among attendees in those days. A sociobehavioral questionnaire was administered by professional interviewers. Selected DUs were also asked to self-collect a fingerprick blood sample with a micro-blade on blotting paper. Blotting papers were tested for HIV and HCV antibodies by EIA. Prevalences and proportions were estimated taking into account the survey design using the Stata8 software. | ||||
| Results / Comments: Of all DUs selected (2389), 1462 (61%) accepted to participate, 74% were men and the mean age was 35 years. HCV seroprevalence was 59.8% [95% Confidence Interval (CI) : 50.7-68.3]. Of DUs under 30 years, 28% [95%CI : 17.1-41.8] were HCV seropositive. HIV seroprevalence was 10.8% [95%CI : 6.9-16.6]. Only 0.3% [95%CI : 0.6-1.5] of DUs under 30 years were HIV positive. At the time of the survey, two-thirds of the DUs were unemployed. Seventy-nine per cent said they had attended secondary school, while 1% said they had had no schooling, 7% only primary schooling, and only 12% a university education. Only 45% had stable accommodation (own home, or living with a partner or parent). Of the remaining 55%, 19% lived in a squat or in the street. At the time of the survey, 55% of the respondents were living alone. At age 16 years, 22% were no longer living with their parents or other family members, and by age 18 years 73% had slept in the street at least once because they did not have their own home. The illicit product most frequently used in the previous month was crack or free-base (30% of DUs), followed by cocaine (27%) and heroine (20%). During the month prior to interview,13% of DUs had shared syringe(s), 38% other injection equipments, 25% snorting equipments and 81% of DUs had shared a crack pipe. Most respondents (61%) had been in prison. Of these, 12% had injected drugs and 30% had shared a syringe in prison. | ||||
| Discussion: Overall, DUs who attend specialized centers or visit general practitioners are in a situation of severe social vulnerability. At-risk behaviors persist in this population, creating the conditions necessary for ongoing transmission of HIV and also HCV, especially among the youngest DUs. The results of the ANRS Coquelicot survey underline the urgent need to deal with this social vulnerability, which increases the risk of infections. | ||||
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