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ID: 1089

Type of submission: Oral

Conference track: Research

Topics: Harm Reduction for Non-Injectors and/or Stimulant Users

Presenting author: Fabienne Hariga

Presenting author biography:

Fabienne Hariga, UNODC Senior Adviser, global focal point for HIV and people who use drugs, is a medical doctor, specialised in public health and epidemiology. She has 20+ years’ experience in harm reduction programme development & evaluation and in research on health and drugs including in prison settings

Stimulant Drug Use, new psychoactive drugs (NPS) and HIV Risk and Transmission: A Global Systematic Literature Review

Anna Williams, Fabienne Hariga

Background: While the focus in HIV prevention among drug users has concentrated on injection of opiate users, reports indicate that there are also HIV-related risks attached to other forms of drugs, particularly among stimulant users that need to be addressed. The use of crack cocaine has been associated with sexual transmission of HIV often mediated through sex. The use of Amphetamine-type-stimulants (ATS) has been linked to increases in HIV risk taking, particularly among men who have sex with men (MSM). New epidemics of HIV among people who use NPS drugs have been recently reported particularly linked to the use of “bath salts” or Synthetic Cathinones (SCs) This study reviewed the evidence of stimulant drugs use (injecting and non-injecting ATS and cocaine/crack-cocaine/NPS) and their possible link to HIV.

Methods: eight scientific databases were searched from 2004 up to April 2015. Grey literature was also searched and key informants were consulted. Data were systematically reviewed, extracted in a standardised format and analysed. Studies were included if they reported HIV rates and/or injecting/sexual risk behaviour among cocaine/crack or ATS users.

Results: 1,048 were screened and 111 studies were identified on ATS, and 83 studies on cocaine/crack users and only 15 on NPS. 1) ATS non-injectors: there was great variability in the HIV prevalence rates among non-injecting ATS users (ranging from <1% up to 18.50%). Several studies identified an independent positive association between methamphetamine use and HIV infection among MSM. 2) ATS injectors: HIV prevalence rates in studies among ATS injectors ranged from 2.9% up to 28%. Differences in HIV prevalence appeared less evident when ATS-injectors were compared to people who injected other drugs. 3) Cocaine/crack non-injectors: HIV prevalence rate of 23 studies among cocaine/crack cocaine non-injectors ranged from 0.4% up to 37%. 4) Cocaine/crack injectors: among cocaine/crack injector, HIV seroprevalence were markedly higher in most countries. HIV prevalence rates ranged from 2.6% up to 52%. Studies among other vulnerable populations were scarce. 5). SCs injecting has risen sharply in the last decade in Europe, with a significant proportion of people who inject drugs switching to SCs. “Chemsex” as reported in the UK among MSM might increase the risk of acquiring/transmitting HIV

Conclusion: Some groups of stimulant users are at risk of HIV transmission. Studies among non-injecting and injecting cocaine/crack and ATS users reported high HIV prevalence rates. Studies still lack the adequate design and quality to confirm a causal relationship between these two factors. There is also dearth of evidence on other vulnerable groups, such as MSM, prison-based populations and sex workers.