Recent Incarceration and HIV Risk Among Women Who Use Heroin

Area of Science:

• Public Health
• Epidemiology
• Substance Use and HIV Research

Background:

• Women who use heroin in sub-Saharan Africa face significant HIV risks due to structural vulnerabilities, including frequent incarceration.
• Limited data exists on the specific associations between incarceration, drug use patterns, and HIV outcomes in this population.

Purpose of the Study:

• To estimate the associations between recent incarceration and adverse HIV-related and drug use-related outcomes among women who use heroin in sub-Saharan Africa.

Main Methods:

• A cross-sectional study was conducted in Dar es Salaam, Tanzania, recruiting 195 women who use heroin using respondent-driven sampling.
• Data on recent incarceration (past 6 months), HIV testing, HIV status, lifetime nonfatal overdose, and associated vulnerabilities were collected.
• Modified Poisson regression was used to examine associations between incarceration and outcomes.

Main Results:

• 61% of participants reported recent incarceration, which was associated with transactional sex, anxiety, violence victimization, and stigma.
• Adjusted analyses revealed incarceration was linked to higher prevalence of sexual concurrency, stimulant use, and lifetime nonfatal overdose.
• Among women living with HIV, incarceration was significantly associated with stopping HIV care (aPR, 9.74).

Conclusions:

• Incarceration among women who use heroin in sub-Saharan Africa is associated with increased behavioral and structural vulnerabilities, potentially worsening HIV disparities.
• Elevated stimulant use and disrupted HIV care among recently incarcerated women are critical concerns requiring targeted interventions.
• Interventions should address policing practices and ensure continuity of HIV and substance use services during incarceration and reentry.