European Journal of Epidemiology

, Volume 23, Issue 6, pp 435–440 | Cite as

Differences between women and men in serial HIV prevalence and incidence trends

  • Isabel Hurtado Navarro
  • I. Alastrue
  • J. del Amo
  • C. Santos
  • I. Ferreros
  • T. Tasa
  • S. Pérez-Hoyos


To measure trends in HIV incidence and serial prevalence by sex in a intravenous drug users (IDUs) and heterosexuals (HT) cohort recruited in a counselling centre in Valencia (1988–2005). Serial prevalence and incidence rates were calculated and modelled by logistic and Poisson regression respectively. 5948 IDUs and 13343 HT were recruited. Prevalence was higher among female IDUs (46% vs. 41%), and female HT (4.1% vs. 2%). For IDUs, an interaction (P = 0.005) between sex and calendar was detected. Age-adjusted prevalence showed faster yearly decline in men (OR = 0.87 95%CI: 0.85–0.88) than in women (OR = 0.91 95%CI: 0.88–0.93). Incidence was higher in female IDUs (9.79% p-y) than in men, (5.38% p-y) with an annual decrease for both of 11%. HIV incidence was higher in female HT (0.62% p-y) compared to men 0.23% p-y with a 21% yearly decline. Gender differences in HIV prevalence and incidence trends have been detected. Women showed an increased vulnerability to infection in a country whose HIV epidemic has been largely driven by IDUs.


HIV testing HIV incidence and prevalence Trends Gender 



Centre for AIDS Information and Prevention




Hepatitis A virus


Hepatitis B virus


Hepatitis C virus


Intravenous drug users


Rates ratio



Sponsorship: This work was financed through grants from Fondo de Investigación Sanitaria (FIS) (02/0639) and Becas de la Consellería de Sanitat de la Generalitat Valenciana B12/03 y B15/04.

Authorship: I. Hurtado, designed the study, I Hurtado and S Pérez-Hoyos carried out the statistical analysis. I. Alastrue, C. Santos and T. Tasa were responsible for the recruitment and data collection. S. Pérez-Hoyos set up the original study and collaborated in its design. I. Hurtado, S. Pérez-Hoyos and J. Del Amo wrote and interpreted the results. All the authors revised the different versions of the manuscript.


  1. 1.
    Rice BD, Payne LJ, Sinka K, Patel B, Evans BG, Delpech V. The changing epidemiology of prevalent diagnosed HIV infections in England, Wales, and Northern Ireland, 1997 to 2003. Sex Transm Infect. 2005;81:223–9. doi: 10.1136/sti.2004.012070.PubMedCrossRefGoogle Scholar
  2. 2.
    UNAIDS. Report on the global AIDS epidemic. Geneva. (2006).Google Scholar
  3. 3.
    EuroHIV. HIV/AIDS surveillance in Europe. Saintt-Maurice: Institut de la Veille Sanitarie; 2005.Google Scholar
  4. 4.
    Quinn TC, Overbaugh J. HIV/AIDS in women: an expanding epidemic. Science. 2005;308:1582–3. doi: 10.1126/science.1112489.PubMedCrossRefGoogle Scholar
  5. 5.
    ONUSIDA. Situación sobre la epidemia de SIDA. (2005).
  6. 6.
    De La Fuente L, Bravo MJ, Toro C, et al. Injecting and HIV prevalence among young heroin users in three Spanish cities and their association with the delayed implementation of harm reduction programmes. J Epidemiol Community Health. 2006;60:537–42. doi: 10.1136/jech.2005.037333.PubMedCrossRefGoogle Scholar
  7. 7.
    De La Fuente L, Bravo MJ, Barrio G, et al. Lessons from the history of the human immunodeficiency virus/acquired immunodeficiency syndrome epidemic among Spanish drug injectors. Clin Infect Dis. 2003;37(Suppl 5):S410–5. doi: 10.1086/377562.CrossRefGoogle Scholar
  8. 8.
    Barrasa A, del Romero J, Pueyo I, et al. Prevalence of the HIV infection in patients seen at specialized diagnosis centers in 9 cities in Spain from 1992 to 2001. Aten Primaria. 2004;33:483–8. doi: 10.1157/13061610.PubMedCrossRefGoogle Scholar
  9. 9.
    Jesús Castilla J, Lorenzo JM, Izquierdo A, et al. Características y tendencias de los nuevos diagnósticos de infección por el VIH, 2000–2004. Gac Sanit. 2006;20(6):442–8. doi: 10.1157/13096525.PubMedCrossRefGoogle Scholar
  10. 10.
    Hurtado I, Alastrue I, Ferreros I, et al. Trends in HIV testing, serial HIV prevalence and HIV incidence among persons attending a Center for AIDS Prevention from 1988 to 2003. Sex Transm Infect. 2007;83:23–8. doi: 10.1136/sti.2005.019299.PubMedCrossRefGoogle Scholar
  11. 11.
    Kim H-J, Fay MP, Feuer EJ, Midthune DN. Permutation tests for joinpoint regression with applications to cancer rates. Stat Med. 2000;19:335–51. doi: 10.1002/(SICI)1097-0258(20000215)19:3≤335::AID-SIM336≥3.0.CO;2-Z.PubMedCrossRefGoogle Scholar
  12. 12.
    National Cancer Institute. Statistical research and applications branch [on-line]. 19-3-2005.
  13. 13.
    Stata Corp. Stata Statistical Sofware:Release 8.0. 2003.Google Scholar
  14. 14.
    Spittal PM, Craib KJ, Wood E, et al. Risk factors for elevated HIV incidence rates among female injection drug users in Vancouver. CMAJ. 2002;166:894–9.PubMedGoogle Scholar
  15. 15.
    Lum PJ, Sears C, Guydish J. Injection risk behavior among women syringe exchangers in San Francisco. Subst Use Misuse. 2005;40:1681–96. doi: 10.1080/10826080500222834.PubMedCrossRefGoogle Scholar
  16. 16.
    Riehman KS, Kral AH, Anderson R, Flynn N, Bluthenthal RN. Sexual relationships, secondary syringe exchange, and gender differences in HIV risk among drug injectors. J Urban Health. 2004;81:249–59. doi: 10.1093/jurban/jth111.PubMedGoogle Scholar
  17. 17.
    Mehta SH, Galai N, Astemborski J, et al. HIV incidence among injection drug users in Baltimore, Maryland (1988–2004). J Acquir Immune Defic Syndr. 2006;43:368–72. doi: 10.1097/01.qai.0000243050.27580.1a.PubMedCrossRefGoogle Scholar
  18. 18.
    Fuente de Hoz L, Brugal Puig MT, Ballesta Gómez R, et al. Metodología del estudio de cohortes del proyecto ITINERE sobre consumidores de heroína en tres ciudades españolas y características básicas de los participantes. Rev Esp Salud Publica. 2005;79:475–91. doi: 10.1590/S1135-57272005000400005.PubMedCrossRefGoogle Scholar
  19. 19.
    Jarlais D. The first and second decades of AIDS among injecting drug users. Br J Addict. 1992;87:347–53. doi: 10.1111/j.1360-0443.1992.tb01935.x.PubMedCrossRefGoogle Scholar
  20. 20.
    Whynot EM. Women who use injection drugs: the social context of risk. CMAJ. 1998;159:355–8.PubMedGoogle Scholar
  21. 21.
    Barrasa A, Castilla J, del Romero J, et al. Sentinel surveillance of HIV infection in HIV test clinics, Spain 1992–2002. Euro Surveill. 2004;9:27–9.PubMedGoogle Scholar
  22. 22.
    Turmen T. Gender and HIV/AIDS. Int J Gynaecol Obstet. 2003;82:411–8. doi: 10.1016/S0020-7292(03)00202-9.PubMedCrossRefGoogle Scholar
  23. 23.
    Gatali M, Archibald C. Women and HIV. BMC Womens Health. 2004;4(Suppl 1):S27. doi: 10.1186/1472-6874-4-S1-S27.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2008

Authors and Affiliations

  • Isabel Hurtado Navarro
    • 1
    • 2
  • I. Alastrue
    • 3
  • J. del Amo
    • 4
  • C. Santos
    • 3
  • I. Ferreros
    • 1
    • 2
  • T. Tasa
    • 3
  • S. Pérez-Hoyos
    • 1
    • 2
    • 5
  1. 1.Ciber en Epidemiología y Salud Pública (CIBERESP)BarcelonaSpain
  2. 2.Unitat d’Epidemiologia i EstadísticaEscola Valenciana d’Estudis en Salut (EVES)ValenciaSpain
  3. 3.Centro de Información y Prevención del SIDA de ValenciaValenciaSpain
  4. 4.Dpto. Salud PúblicaUniversidad Miguel Hernández de AlicanteAlicanteSpain
  5. 5.Dpto. Enfermería Comunitaria, Medicina Preventiva y Salud Pública e Historia de la CienciaUniversidad de AlicanteAlicanteSpain

Personalised recommendations