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Systematic Literature Review on Stimulant Use and HIV (A) Part 3/5

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Systematic Literature Review on Stimulant Use and HIV (A) Part 3/5 Systematic Literature Review on Stimulant use and HIV (A) Part 3/5 Cocaine and Crack-Cocaine Risk and Transmission The literature review was conducted by UNODC consultant Dr Anna V. Williams (King’s College London, Addictions Department), under the supervision of Fabienne Hariga, UNODC HIV Senior adviser. Riku Lehtovuori, UNODC HIV Monitoring & Evaluation Adviser provided comments on the different drafts. This report is part of a series of five documents: A. Stimulant use: HIV risk and transmission 1. Systematic Literature Review on HIV and Stimulant use: Methodology and summary of the findings of 2. Systematic Literature Review on HIV and Stimulant use: ATS and HIV Risk and Transmission 3. Systematic Literature Review on HIV and Stimulant use: Cocaine use and HIV Risk and Transmission 4. Systematic Literature Review on HIV and Stimulant use: NPS and HIV Risk and Transmission B. Prevention of HIV, HCV & HBV and treatment 5. Systematic Literature Review on HIV and Stimulant use: Treatment and Prevention of HIV, HCV & HBV and treatment Recommended citation United Nations Office on Drugs and Crime. Systematic Literature Review on HIV and Stimulant use – A -. Part 3/5. Cocaine use and HIV Risk and Transmission . UNODC; Vienna 2017. © United Nations Office on Drugs and Crime 2017 The content of this document does not necessarily reflect the views of UNODC. The description and classification of countries and territories in this publication and the arrangement of the material do not imply the expression of any opinion whatsoever on the part of the Secretariat of the United Nations concerning the legal status of any country, territory, city or area, or of its authorities, or concerning the delimitation of its frontiers or boundaries, or regarding its economic system or degree of development. This publication has not been formally edited 2 Contents 1. Overview ......................................................................................................................................... 5 2. Non-Injecting Drug Users .................................................................................................................... 7 Brazil (12 studies): ............................................................................................................................... 7 Uruguay and Argentina (4 studies): .................................................................................................... 8 Caribbean (2 Studies) .......................................................................................................................... 9 USA (22 studies): ............................................................................................................................... 10 Canada (2 studies): ............................................................................................................................ 13 Spain (2 studies): ............................................................................................................................... 13 Australia (1 study): ............................................................................................................................ 14 3. People who Inject Drugs .................................................................................................................... 15 Canada (7 studies): ............................................................................................................................ 15 USA (8 studies): ................................................................................................................................. 16 Brazil (12 studies): ............................................................................................................................. 18 Colombia (1 study): ........................................................................................................................... 20 4. Men who have Sex with Men (MSM) Only ........................................................................................ 21 USA (2 studies) .................................................................................................................................. 21 5. Sex Workers ....................................................................................................................................... 22 Australia (1 study) ............................................................................................................................. 22 Canada (2 studies) ............................................................................................................................. 22 USA (3 studies) .................................................................................................................................. 22 Mexico (1 study) ............................................................................................................................... 23 6. Summary of the Findings .................................................................................................................. 24 HIV Prevalence .................................................................................................................................. 24 HCV Prevalence ................................................................................................................................. 26 HBV Prevalence ................................................................................................................................. 27 Sexual Risk Behaviour ....................................................................................................................... 28 Exchange Sex for Money/drugs ........................................................................................................ 29 Injecting Risk Behaviour .................................................................................................................... 30 Sharing Smoking Equipment ............................................................................................................. 30 Length of Exposure ........................................................................................................................... 30 Gender .............................................................................................................................................. 31 Non-injectors vs Injectors ................................................................................................................. 31 Cocaine vs Heroin ............................................................................................................................. 31 3 Network ............................................................................................................................................ 32 7. References ......................................................................................................................................... 33 Appendix: Data Extraction: Cocaine and Crack-cocaine Review ........................................................... 41 1. Non-Injecting Drug Users .................................................................................................................. 41 2. Injecting Drug Users Only .................................................................................................................. 64 3. Men who have Sex with Men (MSM) Only ........................................................................................ 78 4. Sex Workers ....................................................................................................................................... 79 4 1. Overview Out of 1,048 full-texts examined, a total of 83 studies on cocaine and crack-cocaine use and HIV, HCV and HBV risk and transmission were initially included in the present review. The great majority of the studies were cross-sectional surveys (63), followed by longitudinal cohort studies (10), case-control studies (8) and systematic literature reviews (2) (Figure 1). Most studies were published between 2005 and 2010 (Figure 2). Systematic reviews Longitudinal Case-control Cross-sectional 0% 20% 40% 60% 80% Figure 1: Study Designs 16 14 12 10 8 6 4 2 0 2003 2005 2007 2009 2011 2013 2015 Figure 2: Year of Publication The figure below shows in which countries the studies took place. There are 11 countries represented. About a third of the studies (27) took place in 4 countries with low to upper-middle income economies and two-thirds (55) took place in 7 countries with high income economies (Figure 3). One systematic literature review with a worldwide focus was also included. 5 Figure 3: Countries in which the studies took place In order to analyse the evidence in more detail, the studies were divided into subcategories in accordance to the type of population they targeted. The categories are: non-injecting drug users (NIDUs), people who inject drugs (PWID), men who have sex with men (MSM) and sex workers (SWs). Most of the studies focused on non-injecting drug use populations, followed by non-injecting drug users. Sex Workers 7 Men who have Sex with Men 2 People who Inject Drugs 28 Non-injecting Drug Users 45 Figure 4: Target Populations 6 2. Non-Injecting Drug Users There were 45 studies whose participants mainly used non-injecting drugs (smoke crack or snorted cocaine). The average pooled age distribution of the participants was around 33 years old (mean or median ranging from 21 to 47). Most commonly, two-thirds of the study
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