AIMS: We measured the association between a history of incarceration and HIV positivity among people who inject drugs (PWID) across Europe. DESIGN, SETTING AND PARTICIPANTS: This was a cross-sectional, multi-site, multi-year propensity-score matched analysis conducted in Europe. Participants comprised community-recruited PWID who reported a recent injection (within the last 12 months). MEASUREMENTS: Data on incarceration history, demographics, substance use, sexual behavior and harm reduction service use originated from cross-sectional studies among PWID in Europe. Our primary outcome was HIV status. Generalized linear mixed models and propensity-score matching were used to compare HIV status between ever- and never-incarcerated PWID. FINDINGS: Among 43 807 PWID from 82 studies surveyed (in 22 sites and 13 countries), 58.7% reported having ever been in prison and 7.16% (n = 3099) tested HIV-positive. Incarceration was associated with 30% higher odds of HIV infection [adjusted odds ratio (aOR) = 1.32, 95% confidence interval (CI) = 1.09-1.59]; the association between a history of incarceration and HIV infection was strongest among PWID, with the lowest estimated propensity-score for having a history of incarceration (aOR = 1.78, 95% CI = 1.47-2.16). Additionally, mainly injecting cocaine and/or opioids (aOR = 2.16, 95% CI = 1.33-3.53), increased duration of injecting drugs (per 8 years aOR = 1.31, 95% CI = 1.16-1.48), ever sharing needles/syringes (aOR = 1.91, 95% CI = 1.59-2.28) and increased income inequality among the general population (measured by the Gini index, aOR = 1.34, 95% CI = 1.18-1.51) were associated with a higher odds of HIV infection. Older age (per 8 years aOR = 0.84, 95% CI = 0.76-0.94), male sex (aOR = 0.77, 95% CI = 0.65-0.91) and reporting pharmacies as the main source of clean syringes (aOR = 0.72, 95% CI = 0.59-0.88) were associated with lower odds of HIV positivity. CONCLUSIONS: A history of incarceration appears to be independently associated with HIV infection among people who inject drugs (PWID) in Europe, with a stronger effect among PWID with lower probability of incarceration.

Acuity Systems Herndon VA USA

Agència de Salut Pública de Barcelona Barcelona Spain

Amsterdam UMC University of Amsterdam Department of Infectious Diseases Amsterdam Infection andd Immunity Institute Amsterdam the Netherlands

Biomedical Research Networking Centre in Epidemiology and Public Health Instituto de Salud Carlos 3 Madrid Spain

Blood Safety Hepatitis STI and HIV Division UK Health Security Agency London UK

Centre for Epidemiological Studies on Sexually Transmitted Infections and HIV AIDS of Catalonia Badalona Spain

Centre for Infectious Disease Control National Institute for Public Health and the Environment Bilthoven the Netherlands

Department of Addictology 1st Faculty of Medicine Charles University and General University Hospital Prague Czech Republic

Department of Computational Biology University of Lausanne Lausanne Switzerland

Department of Drug and Infectious Diseases Epidemiology National Institute for Health Development Tallinn Estonia

Department of Hygiene Epidemiology and Medical Statistics National and Kapodistrian University of Athens Medical School Athens Greece

Department of Infection and Immunity Luxembourg Institute of Health Luxembourg

Department of Infectious Diseases Epidemiology and Surveillance National Institute of Public Health NIH National Research Institute Warsaw Poland

Department of Infectious Diseases Public Health Service of Amsterdam Amsterdam the Netherlands

Department of Public Health and Maternal and Child Health Complutense University of Madrid Madrid Spain

Department of the Epidemiology of Microbial Diseases Center for Interdisciplinary Research on AIDS Yale School of Public Health New Haven CT USA

EMCDDA Polish National Focal Point National Bureau for Drug Prevention Warsaw Poland

Emeritus Professor of Public Health School of Education and Social Sciences University of West Scotland Paisley Scotland UK

EPIUnit Instituto de Saúde Pública Universidade do Porto Porto Portugal

European Monitoring Centre for Drugs and Drug Addiction Lisbon Portugal

Finnish Institute for Health and Welfare Helsinki Finland

Hungarian Reitox National Focal Point Budapest Hungary

Institute of Family Medicine and Public Health University of Tartu Tartu Estonia

Institute of Public Health Riga Stradins University Riga Latvia

Klinika Podané ruce Brno Czech Republic

National Drug and Alcohol Research Centre the University of New South Wales Sydney NSW Australia

National Institute for Infectious diseases 'Professor Dr Matei Bals' Bucharest Romania

National Public Health Center Budapest Hungary

National Research University Higher School of Economics St Petersburg Russia

National School of Public Health Carlos 3 Health Institute Madrid Spain

Non Profit Partnership ESVERO 12 Moscow Russia

Population Health Sciences Bristol Medical School University of Bristol Bristol UK

Public Health Institute Liverpool John Moores University Liverpool UK

Public Health Scotland Meridian Court Glasgow Scotland UK

School of Global Public Health New York University New York NY 10012 USA

School of Health and Life Sciences Glasgow Caledonian University Glasgow Scotland UK

Service National des Maladies Infectieuses Centre Hospitalier de Luxembourg Luxembourg

Společnost Podané ruce Brno Czech Republic

Trimbos Institute Utrecht the Netherlands

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