Date Published: June 17, 2019
Publisher: Public Library of Science
Author(s): Maria Jose Fuster-RuizdeApodaca, Vanessa Castro-Granell, Noé Garin, Ana Laguía, Ángeles Jaén, Carlos Iniesta, Santiago Cenoz, María José Galindo, Henry F. Raymond.
This study assessed the prevalence and patterns of drug use among people living with HIV (PLHIV) in Spain. We conducted an observational cross-sectional study including 1401 PLHIV. Data were collected through 33 sites across Spain using an online computer-assisted self-administered interview. The survey measured use of illicit drugs and other substances, treatment adherence and health-related variables. To analyse patterns of drug use we performed cluster analysis in two stages. The most frequently consumed substances were: alcohol (86.7%), tobacco (55.0%), illicit drugs (49.5%), other substances (27.1%). The most prevalent illicit drugs used were cannabis (73.8%), cocaine powder (53.9%), and poppers (45.4%). Results found four clusters of PLHIV who used drugs. Two of them were composed mainly of heterosexuals (HTX): Cluster 1 (n = 172) presented the lowest polydrug use and they were mainly users of cannabis, and Cluster 2 (n = 84) grouped mostly men who used mainly heroin and cocaine; which had the highest percentage of people who inject drugs and presented the lowest level of treatment adherence (79.8±14.2; p < .0001). The other two clusters were composed mainly of men who have sex with men (MSM), who were mostly users of recreational drugs. Cluster 3 (n = 285) reported moderate consumption, both regarding frequency and diversity of drugs used, while Cluster 4 (n = 153) was characterized by the highest drug polyconsumption (7.4±2.2; p < .0001), and 4 grouped MSM who injected recreational drugs, and who reported the highest frequency of use of drugs in a sexual context (2.6±0.8; p < .0001) and rates of sexually transmitted infections (1.8±1.1; p < .01). This is the largest multi-centre cross-sectional study assessing the current prevalence and patterns of drug use among PLHIV in Spain. The highest prevalence of drug use was found among MSM, although HTX who used heroin and cocaine (Cluster 2) had the most problems with adherence to HIV treatment and the worst health status.
The human immunodeficiency virus (HIV) continues to be a major public health challenge in Spain, with 145,000 people living with HIV (PLHIV) in 2016 . Among the new HIV cases that year, sexual transmission accounted for 79.6% of them, 53.1% of whom corresponded to men who have sex with men (MSM) and 26.5% to heterosexuals (HTX), while only 3.6% were attributed to people who inject drugs (PWID) . Regarding prevalence, HTX and PWID were still the largest subgroups of PLHIV, 32.5%, and 30.9% respectively, although their relative weight continued to decrease gradually in favour of MSM . Both the effectiveness of the highly active antiretroviral therapy (ART) and the high rate of access to treatment − nine out of ten PLHIV in Spain − have led to a substantial mortality reduction over the last decades .
The present research revealed the prevalence of illicit drug use as well as the particular patterns of consumption among PLHIV in Spain. The most frequently consumed substances among PLHIV in Spain, according to our results, were: alcohol (86.7%), tobacco (55.0%), illicit drugs (49.5%) and other substances (27.1%). The prevalence of last-year alcohol consumption among PLHIV was higher than that reported for the general Spanish population (77.6%), although daily consumption resulted in similar results . The prevalence of active smoking was high compared with the general population (30.8%) . Studies in other countries focusing on PLHIV have reported similar results to those we found [36,37].
The present research is the largest multi-centre study assessing the current prevalence and patterns of drug use among PLHIV in Spain. Our results showed a relatively high prevalence of illicit drug use among the PLHIV in Spain. Prevalence of drug use in PLHIV was higher in MSM than in HTX. MSM were mostly users of recreational and most recent drugs. Most of them presented a moderate profile of drug consumption, although there was a specific subgroup of MSM with high polyconsumption, which was associated with a higher risk of STIs. HTX tend to use mainly cannabis, heroin or cocaine. Although the use of heroin and the injection route of consumption have decreased among them, PLHIV who still used heroin and cocaine showed the most problems to adhere to HIV treatment and the worst health status. Future studies should monitor the evolution of the patterns of drug use, and the longitudinal impact of recreational drug use in their users’ health. Furthermore, it will be necessary to design strategies that provide adequate responses to the diverse problems associated with each pattern of drug use.