HCV infection risk and gender vulnerability of women who inject drugs.

Author: Valencia J, Gutiérrez J, Troya J, Cuevas G, Ramón C, Ryan P

Theme: Epidemiology & Public Health Research Year: 2019

Background: Women who use drugs (WWUD) have a higher prevalence of HCV compared to
women who do not inject drugs. WWUD have considerably more frequent and intense
experiences with interpersonal violence (IPV), sexual abuse and trauma.
The aim of our study was to evaluate the characteristics of WWUD and identify issues related
to vulnerability in those women who participated in an alternative HCV screening
implementation program in a low-threshold harm reduction mobile unit (LTMHRU) in Spain.
Methods: Proactive screening for HCV and other viruses (HIV, HBV, HDV) was carried out using
dried blood spot (DBS) samples from drug users at a LTMHRU located in Madrid.
Sociodemographic data were recorded, and personal interviews were carried out to identify
vulnerability issues when the drug user was a female.
Results: 109 female drug users were screened, median age 41 (SD 9.3) years, 84.4% Spanish
born, 22.9% were homeless, 26.6% injected drugs, 25.5% had relapsed in less than a year,
27.5% received opioid substitution therapy (OST) and 32% had not been tested/screened for
hepatitis C in the last year.
Regarding gender related vulnerability in all the WWUD interviewed: 31 (29.5%) exchanged sex
for money, 47 (44.3%) had a stable partner, 92 (88.5%) had ever suffered emotional or
psychological damage, 74 (71.2%) reported repeatedly physical abuse and 51 (49%) reported
non-consensual sexual acts by her partner.
The prevalence rate of positive HCV antibodies test was 27.2%, 22.4% had a positive RNA PCR.
In the adjusted multivariate analysis, WWUD intravenously were more likely to have a positive
HCV test (aOR 7.64; 95% CI =2.85-20.45; P < 0.001) and those WWUD not engaged on OST where more likely to have a positive HCV test (aOR 4.41; 95%CI= 1.65-11.81; P=0.003). Conclusions: WWUD intravenously or not engaged on OST were more likely to be infected by HCV. We found a high rate of gender related vulnerability and abuse. Multidisciplinary approaches should be implemented in harm reduction interventions. Disclosure of interest: This project received funds of Gilead and Abbie.

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