Sex work among people who inject drugs in England, Wales & Northern

Ireland: Findings from a National Survey of Health Harms and

Behaviours

Sara Croxford, L Platt, V Hope, KJ Cullen, JV Parry, F NcubeHIV & STI Department, Centre for Infectious Disease Surveillance and Control (CIDSC)Public Health England

sara.croxford@phe.gov.uk

2 Sex work among people who inject drugs in England, Wales and Northern Ireland

Background

44% people who inject drugs (PWID) have antibodies to HCV

15% of PWID infected with HBV

18% of new HIV infections among PWID

3 Sex work among people who inject drugs in England, Wales and Northern Ireland

Unlinked Anonymous Monitoring Survey of

PWID• Each year, since 1990, a nationally reflective sample of PWID are recruited from >60 drug services across EW&NI.

• Clients who have ever injected psychoactive drugs are invited to: provide a dried blood spot (DBS)

self-complete a short questionnaire

4 Sex work among people who inject drugs in England, Wales and Northern Ireland

• No national surveillance of sex workers in the UK.

• UAM Survey of PWID questionnaire was revised in 2011 to include the following question on sex work:

“Have you ever received money, goods or drugs in exchange for sex?”

• This study presents the first analyses of these data.

Background

5 Sex work among people who inject drugs in England, Wales and Northern Ireland

Results

• Of the 2,400 eligible PWID recruited in 2011, 75% (1,810) were men.

• Overall 14% (330) of PWID reported a history of sex work.

• A higher proportion of women reported sex work (31%; 185/590) compared to men (8%; 145/1,810).

6 Sex work among people who inject drugs in England, Wales and Northern Ireland

Factors found to be significant among men who inject drugs

Male non-sex workers Male sex workers

Median injecting duration (IQR) 12 (6-17) 14 (7-19)Median age of first use of an NSP 22 (19-28) 18 (20-26)Median age first in prison 18 (16-21) 17 (15-19)

7 Sex work among people who inject drugs in England, Wales and Northern Ireland

Factors found to be significant among women who inject drugs

Female non-sex workers Female sex workers

Median injecting duration (IQR) 6 (2.5-10) 11 (6-17)Median age of first use of an NSP 23 (20-28) 21 (18-26)

8 Sex work among people who inject drugs in England, Wales and Northern Ireland

Sex work and BBVs

After adjustment, sex work was found NOT to be associated with increased likelihood of

either anti-HIV/HBV or anti-HCV.

9 Sex work among people who inject drugs in England, Wales and Northern Ireland

Conclusions• First national estimate of the prevalence of sex work

among PWID in EW&NI: 14%

Higher among women than men (1 in 3 vs.1 in 12).

• PWID engaging in sex work are a particularly vulnerable population with higher reported risk.

Longer history of drug taking and injecting

Higher rates of reported needle/syringe sharing

Higher prevalence of Injection site infections and BBVs

Significantly more experience of prison and homelessness

Riskier sexual behaviour (more partners, more same sex partners among men)

10 Sex work among people who inject drugs in England, Wales and Northern Ireland

Recommendations

• Need for a comprehensive range of services for PWID

Onsite BBV testing

HBV vaccination

Harm reduction interventions

Targeting to sub-groups of PWID including MSM, migrants and sex workers

• Maintained provision of effective interventions, particularly needle/syringe programmes.

• Continued public health surveillance of BBVs and risk behaviours among PWID is essential.

11 Sex work among people who inject drugs in England, Wales and Northern Ireland

Paper published as a short report via IJDP

DOI: 10.1016/j.drugpo.2014.09.014

12 Epidemiology of HIV in the United Kingdom, 2012

THANK YOU!

We gratefully acknowledge the continuing collaboration of participating PWID, drug services,

public health practitioners, microbiologists and other colleagues who contribute to the

surveillance of BBVs among PWID in the UK.

13 Epidemiology of HIV in the United Kingdom, 2012

References Hope, V. D., Eramova, I., Capurro, D., & Donoghoe, M. C. (2014). Prevalence and estimation of hepatitis B and C infections in the WHO European Region: a review of data focusing on the countries outside the European Union and the European Free Trade Association. Epidemiol.Infect., 142, 270-286.

Platt, L., Jolley, E., Hope, V., Latypov, A., Hickson, F., Reynolds, L. et al. (2013). The HIV Epidemics in Europe: Vulnerability and response Washington DC: The World Bank; World Helath Organisation Europe; London School of Hygiene and Tropical Medicine.