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 Ncube HIV & STI Department, Centre for Infectious Disease Surveillance and Control (CIDSC) Public Health England

2Sex 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

3Sex 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

4Sex 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

5Sex 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).

6Sex 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 workersMale sex workers Median injecting duration (IQR)12 (6-17)14 (7-19) Median age of first use of an NSP22 (19-28)18 (20-26) Median age first in prison18 (16-21)17 (15-19)

7Sex 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 workersFemale sex workers Median injecting duration (IQR)6 (2.5-10)11 (6-17) Median age of first use of an NSP23 (20-28)21 (18-26)

8Sex 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.

9Sex 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)

10Sex 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.

11Sex work among people who inject drugs in England, Wales and Northern Ireland Paper published as a short report via IJDP DOI: /j.drugpo

12Epidemiology 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.

13Epidemiology 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, 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.