Incarceration history is associated with HIV infection among community‐recruited people who inject drugs in Europe: A propensity‐score matched analysis of cross‐sectional studies

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