Prevalence and Risk Factors of HIV, HBV, and HCV Among Women Who Inject Drugs in Five Mozambican Cities: A Cross-Sectional Biological and Behavioral Survey, 2023–2024

Prevalence and Risk Factors of HIV, HBV, and HCV Among Women Who Inject Drugs in Five Mozambican Cities: A Cross-Sectional Biological and Behavioral Survey, 2023–2024 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Prevalence and Risk Factors of HIV, HBV, and HCV Among Women Who Inject Drugs in Five Mozambican Cities: A Cross-Sectional Biological and Behavioral Survey, 2023–2024 Áuria Ribeiro Banze, Rachid Muleia, Samuel Nuvunga, Isabel Craveiro, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8679000/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 14 You are reading this latest preprint version Abstract Background Women who inject drugs (WWID) are disproportionately affected by HIV and viral hepatitis, yet data on prevalence and risk factors in Mozambique remain scarce. This study aimed to estimate the prevalence of Human Immunodeficiency Virus (HIV), Hepatitis B surface antigen (HBsAg), and Hepatitis C (HCV) among WWID and to identify associated sociodemographic and behavioral risk factors. Methods A cross-sectional biological and behavioral survey was conducted among 524 WWID in five Mozambican cities (Maputo, Beira, Tete, Quelimane, Nampula) between July 2023 and March 2024, using respondent-driven sampling (RDS). Participants completed structured questionnaires and underwent rapid testing for HIV, HBV, and HCV. RDS-weighted prevalence estimates were calculated for all outcomes. Modified Poisson regression with robust standard errors was used to identify factors associated with HIV infection. Results The weighted prevalence was 28.5% (95% CI: 23.3–33.9) for HIV, 4.3% (95% CI: 2.2–6.4) for HBsAg positivity, and 17.9% (95% CI: 13.9–22.0) for HCV. HIV prevalence increased markedly with age and duration of injection and was highest in Maputo City. In adjusted analyses, compared to those aged 16–17, older age (≥ 35 years; aRR = 13.8; 95% CI: 4.7–40.8), longer injecting duration (≥ 7 years), and residence in Maputo were independently associated with HIV infection, while secondary or higher education and absence of recent STI symptoms were protective. Among WWID living with HIV, 85.0% were aware of their status, 86.6% of those aware were on antiretroviral therapy, and 75.7% of those on treatment were virally suppressed. Conclusion WWID in Mozambique face a high burden of HIV and HCV, with significant geographic disparities. Losses along with the HIV care continuum, particularly gaps in retention and viral suppression, highlight critical issues in sustained treatment and adherence access rather than initial diagnosis. Urgent interventions integrating harm reduction, gender-sensitive HIV/HCV services, and targeted prevention in high-burden areas are needed. HIV hepatitis injecting drug use harm reduction women's health Mozambique Figures Figure 1 Background People Who Inject Drugs (PWID) remain one of the populations most affected by HIV and viral hepatitis worldwide. Without access to harm reduction programs such as needle and syringe distribution or opioid substitution therapy, PWID are at elevated risk of acquiring Human Immunodeficiency Virus (HIV), Hepatitis B (HBV), and Hepatitis C (HCV) ( 1 , 2 ). Yet, in many low- and middle-income countries, reliable data on the size and characteristics of this population remains scarce, limiting their visibility in national surveillance systems and hindering evidence-based policy and service delivery planning. Globally there were an estimated 14 million PWID in 2023 ( 3 ), including approximately 2.8 million women ( 4 ). The global median HIV prevalence among PWID is 5%, nearly seven times higher than among adults aged 15–49 years in the general population across 47 reporting countries ( 1 ). In addition, PWID experience high burdens of HBV and HCV, with global prevalence estimates of 6% and 60%, respectively ( 5 ). Yet, Women Who Inject Drugs (WWID) are consistently reported to have higher HIV prevalence than men, reflecting compounded biological, social, and structural risks ( 5 ). These include exposure to gender-based violence, reliance on transactional sex, reduced negotiating power in relationships, and less access to prevention and treatment services ( 6 , 7 ). The intersection of these risks situates WWID at the confluence of the HIV, HBV, HCV, and gender inequality epidemics. In sub-Saharan Africa, the geography of HIV is changing. While heterosexual transmission remains dominant, emerging evidence points to injection drug use as a growing but under-recognized contributor to new infections ( 8 , 9 ). Regional estimates suggest HIV prevalence of 24%, HBV prevalence of 5%, and HCV prevalence of 38% among PWID ( 5 ). However, these figures mask profound gender disparities: meta-analytic data indicate that WWID are nearly three times more likely to live with HIV than men who inject drugs, with a relative risk of 2.8 (95% CI: 1.8–4.4) ( 10 ). Despite this, few African countries systematically collect or publish gender-disaggregated data on PWID, effectively erasing women from policy visibility and resource allocation. Mozambique reflects this broader blind spot in global harm reduction ( 11 ). The country faces a concentrated HIV epidemic among key populations ( 12 ), yet surveillance systems remain largely blind to the realities of WWID. The National Strategic Plan for the Response to HIV and AIDS 2021–2025 recognizes the need for gender-responsive prevention but acknowledges the absence of data and tailored services for WWID ( 13 ). The underrepresentation of WWID in research is widely acknowledged. For instance, the 2013–2014 BBS among PWID in Mozambique included only 5% women, which may reflect either sampling limitations or their actual proportional size within the hidden PWID population. That survey reported HIV/HBV and HIV/HCV co-infection prevalences of 14.9% and 38.7% in Maputo, respectively ( 14 ). While this imbalance does not automatically confirm underrepresentation, it does align with the broader pattern of systemic exclusion of WWID from health research and programming, a pattern shaped by stigma, gender inequality, and intersecting forms of criminalization. Against this backdrop, Mozambique provides a critical lens through which to examine how gender, stigma, and structural inequities shape vulnerability among WWID in sub-Saharan Africa. This study aims to generate context-specific evidence on the socio-demographic characteristics, sexual behaviors, and experiences of stigma and discrimination among WWID in Mozambique providing critical insights to inform gender-responsive harm reduction and HIV prevention strategies. Methods Setting, participants, and procedures We conducted a cross-sectional study as part of the second round of the BBS among PWID in five urban areas of Mozambique, between July 2023 and March 2024. The selected sites included Maputo City in the southern region; Beira, Tete, and Quelimane in the central region; and Nampula in the northern region. Maputo City and Nampula/Nacala had also been included in the first round of BBS, allowing for comparative analyses of HIV prevalence and risk behaviors over time. Site selection was guided by national stakeholders to ensure representation of geographic, cultural, and programmatic diversity. The chosen areas were characterized by: (1) a known or suspected concentration of PWID; (2) an adult population size sufficient to meet sampling requirements; and (3) the presence of PWID-friendly HIV and sexually transmitted infection (STI) services for referrals. Socially connected contiguous neighborhoods were also included in the sampling frame to capture overlapping injection networks (15). The new sites for this round, namely Beira, Quelimane, and Tete were selected through a systematic process that considered HIV prevalence in the general population, the presence of PWID community-based prevention programs, and the availability of PWID-friendly services at health facilities. Eligible participants met the following criteria: (1) were aged ≥ 16 years old; (2) reporting injecting non-prescription drugs in the past 12 months before the survey; (3) presented a valid referral coupon; and (4) had resided in, worked in, or regularly socialized in the study area during the 12 months prior to the survey. We used respondent-driven sampling (RDS) to recruit participants, a method widely applied to reach hard-to-access populations, to generate population-based estimates of HIV prevalence and related behavioral indicators (16–18). The recruitment process of participants for this round of the survey was identical to the first round (15). All participants provided written informed consent prior to participation. Confidentiality was ensured through the use of unique participant codes and secure data storage systems. In total, 2,624 PWID were recruited across the five cities: 520 in Maputo (119 women), 517 in Beira (54 women), 524 in Tete (120 women), 531 in Quelimane (117 women), and 532 in Nampula (114 women). The present analysis focuses exclusively on the 524 women who inject drugs (WWID) included in the second-round BBS. Measures A structured quantitative questionnaire, adapted from the first round of the BBS among PWID in Mozambique, was used to collect data. The tool captured information across several domains, including socio-demographic characteristics, sexual behavior, substance use, biological and clinical history, symptoms of STIs, and HIV-related knowledge, attitudes, practices, stigma, discrimination, and perceptions. Biological samples were collected to determine the prevalence of HIV, active hepatitis B infection (HBsAg positivity), HCV, and HIV viral load. Before sample collection, all eligible participants received pre-test counseling on the importance of testing and the implications of positive results. Approximately 6 mL of venous blood was drawn using adult EDTA Vacutainer® tubes for rapid testing and dried blood spot (DBS) preparation. HIV testing followed the Mozambique’s sequential algorithm: an initial screening with Alere Determine® HIV-1/2 (Abbott Laboratories, UK), followed by a confirmatory test with Uni-Gold™ HIV (Trinity Biotech, Ireland). Indeterminate results were recorded if the confirmatory test was non-reactive. HBV testing was performed using Alere Determine® HBsAg rapid diagnostic test, which detects the presence of hepatitis B surface antigen (HBsAg) in blood samples. A reactive HBsAg result was considered indicative of current HBV infection, in line with WHO guidelines and standard epidemiological practices (19). It is important to note that HBsAg positivity reflects active infection but does not differentiate between acute and chronic stages. This marker was used to estimate the prevalence of ongoing HBV infection and to assess co-infections with HIV and/or HCV. HCV testing used the SD Bioline HCV rapid test, where all reactive results were also considered positive. All participants received post-test counseling with tailored messages according to their test results and risk profiles. Those testing positive for HIV, HBsAg, or HCV were referred to appropriate care services. Referral forms included both HBsAg and anti-HCV results to facilitate clinical linkage and confirmatory evaluation at designated health facilities Alcohol consumption was assessed using the Alcohol Use Disorders Identification Test – Consumption (AUDIT-C), a validated three-item screening tool derived from the full WHO AUDIT questionnaire. The AUDIT-C evaluates frequency of drinking, quantity per occasion, and frequency of heavy episodic drinking during the past 12 months (20). Scores range from 0 to 12, with higher values indicating greater risk of hazardous drinking. Following standard cut-offs used in previous studies, a score ≥3 for women was classified as “hazardous alcohol use”. Of the 524 participants in the study, 11 participants did not consent to rapid HIV testing, four participants did not consent to HCV testing, and five participants did not consent to HBV testing. For the cascade of care and treatment among WWID living with HIV, the study applied the The Joint United Nations Program on HIV/AIDS (UNAIDS) 95–95–95 framework (21): First 95: WWID living with HIV who had prior knowledge of their HIV-positive status at the time of the survey ; Second 95: WWID living with HIV who were already on antiretroviral therapy (ART) during the survey ; Third 95: WWID living with HIV with viral suppression, as determined by their viral load results during the survey. Statistical analysis Both bivariate and multivariable statistical analyses were conducted to assess associations between explanatory variables and outcomes of interest (HIV, HCV, and HBsAg seropositivity). Bivariate analyses were used to present the prevalence of each outcome across explanatory variable categories and to explore potential associations. The computed prevalence was derived using a meta-analytic approach, where we computed RDS-weighted estimates within each study site using the Gile’s Successive Sampling estimator and then derived one single pooled estimate using a fixed-effect meta-analysis approach. This approach was chosen to account for the clustered RDS design across multiple sites while generating an overall population estimate. Associations between explanatory and outcome variables were assessed using Pearson’s Chi-square test, and the Fisher’s exact test was applied whenever expected cell counts were fewer than five. Given the relatively high prevalence of HIV (>10%) in our sample, multivariate analysis was conducted for HIV using multivariable Poisson regression with robust standard errors, also known as modified Poisson regression, to identify independent predictors and estimate relative risks (22–24). This method is preferred over logistic regression for common outcomes to avoid overestimation of odds ratios. Variables included in the multivariable model were those that demonstrated statistical significance at the 0.20 significance level in the bivariate modified Poisson regression, allowing for the inclusion of potentially relevant covariates. Although the data were collected using RDS, the modified Poisson regression analysis was conducted without weighting. This methodological decision is supported by simulation studies indicating that unweighted regression often yields more stable and precise estimates in RDS analyses when the predictors of interest are not strongly correlated with network size or recruitment homophily (25–27). We acknowledge this as both a methodological choice and a limitation for comparability with other studies. The model was assessed for multicollinearity using variance inflation factor (VIF), and variables with VIF >5 were excluded. The final model was assessed for Goodness-of-fit using the Pearson Chi-square statistic. Statistical significance was set at a 0.05 level (28). All analyses were conducted using R statistical software version 4.2.2 (29), and the full R code is publicly available in our GitHub repository: https://github.com/RachidMuleia/HIV-prevalence-among-WWID.git. Results Characteristics of Study Participants The characteristics of the participants are described in Table 1. A total of 524 WWID were included in the analysis, with a median age of 22 years (interquartile range: 18–27). The majority (43.7%) were between 18 and 24 years old, while only 11.1% were aged 35 years or older. Participants were almost equally distributed across the five study sites, with approximately one-fifth recruited from Maputo City (22.7%), Tete (22.9%), Quelimane (22.3%), and Nampula (21.8%), and a smaller proportion from Beira (10.3%). In terms of education, 69.0% of the women had completed at least secondary education, while 31.0% had only primary education. The majority were single (74.6%), followed by married (13.5%) and separated or widowed (11.8%). A large proportion of participants (80.3%) reported unstable housing conditions, reflecting high social and economic vulnerability. Regarding sexual behavior, 68.6% initiated sexual activity at age 15 or older, whereas 31.4% reported sexual debut before age 15. Nearly all participants (97.4%) reported receiving money or goods in exchange for sex, and 27.3% reported having engaged in anal sex with male partners. Most identified as heterosexual (93.5%), while 6.5% identified as bisexual or homosexual. About 51.5% of participants met the criteria for hazardous alcohol use according to the AUDIT-C scale. Concerning injection practices, 67% reported sharing syringes at some point, while 71.2% used a new or sterilized syringe in the month preceding the survey. The majority (83%) reported injecting drugs within the last month, with 55.6% injecting 1–3 times per day. The main injectable drug was heroin (95%), followed by cocaine (4.4%). Almost half (54%) had been injecting drugs for 1–3 years, and 15.7% for seven years or more, indicating varying levels of exposure to long-term risk behaviors. Access to prevention and harm reduction services remained limited: only 18.9% reported receiving harm reduction services in the previous year, and just 10% had heard of naloxone. Similarly, 55.3% reported access to health services or peer educators in the past 12 months. Regarding reproductive and sexual health, 70.6% had already been pregnant, and 55.9% reported signs or symptoms of sexually transmitted infections (STIs) in the past year. Experiences of sexual violence were reported by 16.5% of participants in the previous six months, while 67.8% experienced discrimination in the past year. Prevalence of HIV and association with sociodemographic, behavioural characteristics and injecting drug use The analysis of sociodemographic, behavioral, and drug use-related variables identified multiple factors significantly associated with HIV prevalence among the study participants (p<0.05) (table 1). A progressive increase in HIV prevalence was observed with age, reaching the highest level in the group aged 35 years or older (72.9%; p<0.001). The geographic distribution revealed marked differences: prevalence was highest in Maputo (51.8%) and lowest in Quelimane (13.3%; p<0.001). Educational attainment was inversely associated with HIV prevalence. WWID with only primary education had significantly higher prevalence (36.5%) compared to those with secondary or higher education (19.6%; p<0.001). Marital status was also associated with HIV, with higher prevalence among married and separated/widowed women compared to single women (p<0.001). Structural vulnerabilities were strongly associated with HIV. Women without stable housing had higher prevalence than those with housing (42.3% vs. 23.8%; p<0.001). Among variables related to injecting practices, HIV prevalence was slightly lower among women who reported using a new or sterilized syringe in the past month (26.0%) compared to those who did not (29.4%), with a statistically significant difference observed (p=0.029). Age at first injection was also an associated factor: initiation before age 18 was associated with lower prevalence (9.2%) compared to initiation at 25 years or older (58.8%; p<0.001). Both duration of injecting drug use (p < 0.001) and injection frequency (p = 0.001) showed a dose–response relationship with HIV prevalence, increasing with longer duration and higher frequency of injection. Access to health services or a peer educator was positively associated with prevalence (32.2% vs. 12.6%; p<0.001). Additionally, those with a history of pregnancy had higher prevalence (29.7%) compared to those who never became pregnant (14.8%; p=0.002). No statistically significant associations were observed between HIV prevalence and the following variables: condom use, sexual orientation, anal sex practice, alcohol abuse, syringe sharing, easy access to needles, access to naloxone, participation in harm reduction treatments, presence of STI symptoms, history of sexual violence, and reports of discrimination. In the adjusted model (table 1), HIV infection among WWID remained significantly associated with older age, city of residence, educational level, duration of drug injection, and occurrence of STI symptoms. Compared with adolescents aged 16–17 years, the adjusted relative risk of HIV infection increased progressively with age: 18–24 years (aRR = 5.8; 95% CI: 2.1–15.7; p = 0.001), 24–34 years (aRR = 9.1; 95% CI: 3.2–26.4; p < 0.001), and ≥35 years (aRR = 13.8; 95% CI: 4.7–40.8; p < 0.001). Geographical variation persisted after adjustment, with women in Quelimane (aRR = 0.5; 95% CI: 0.3–0.9; p = 0.016) and Nampula (aRR = 0.4; 95% CI: 0.3–0.7; p = 0.001) exhibiting significantly lower HIV risk infection compared to Maputo City. Educational attainment remained significant, as women with only primary education had 1.4 times higher risk of HIV infection than those with secondary or higher education (aRR = 1.4; p = 0.010). Absence of STI symptoms in the past 12 months was associated with a lower risk of HIV infection (aRR = 0.8; p = 0.050). All other variables were not significantly associated with HIV prevalence in the adjusted model. HBsAg Positivity The proportion of participants with reactive HBsAg tests varied significantly by geographic location (p=0.001). Tete (10.0%) and Beira (9.3%) had the highest proportions, while no reactive cases were detected in Maputo City. Other cities showed lower reactivity, including Quelimane (2.6%) and Nampula (3.6%). Age at first sexual intercourse was significantly associated with HBsAg positivity: women who initiated sexual activity before age 15 had a prevalence of 8.8% compared to 2.9% among those who initiated at age 15 or older (p=0.008). A significant association was observed with age at first injection (p=0.050), with positivity rates of 7.2% among women who initiated injection before age 18, compared to 4.6% among those initiating at age 25 or older. HCV Positivity Significant geographic variation in HCV prevalence was observed across study sites (p<0.001). The highest prevalence was observed in Beira (48.1%) and Nampula (29.5%), while markedly lower rates were recorded in Maputo City (9.5%), Quelimane (4.3%), and Tete (13.3%). Injecting practices were significantly associated with prevalence. Women who initiated injection before age 18 had a higher prevalence (13.5%; p = 0.012) than those who initiated between ages 18–24 (8.8%). Women reporting heroin as their primary injectable drug had a prevalence of 7.6%, while no HCV cases were identified among those injecting cocaine, or other, although the number of women injecting these last two are very reduced (N = 23 and N = 3, respectively). Table 1. Prevalence of HIV, HBsAg and HCV among WWID in Mozambique, 2023, stratified by sociodemographic variables, behavioural characteristics and injecting drug use, with results from the association analyses (Chi-square χ 2 or Fisher exact test ‡). For HIV, simple and multivariable Poisson regression with robust standard errors are also reported (crude relative risk, cRR, and relative risk, aRR, respectively, and corresponding p-values). Significant values at 0.05 significance level are indicated in bold. Characteristics N (%) HIV HBsAg HCV N positives (%) χ 2 or Fisher P-value cRR (95%CI) cRR P-value aRR (95%CI) aRR P-Value N positives (%) χ 2 or Fisher P-value N positives (%) χ 2 or Fisher P-value Age group (years) The median age was 22 years (IQR: 18–27) 16-17 119 (22.7) 4 (6.1) <0.001 Ref Ref 10 (8.4) 0.117 20 (22.5) 0.887 18-24 229 (43.7) 53 (21.0) 7 (2.6-19.0) <0.001 5.8 (2.1-15.7) 0.001 7 (3.1) 43 (2.0) 25-34 118 (22.5) 47 (44.0) 12.4 (4.6-33.2) <0.001 9.1 (3.2-26.4) <0.001 6 (5.2) 18 (11.9) 35+ 58 (11.1) 36 (72.9) 18.8 (7.0-50.2) <0.001 13.8 (4.7-40.8) <0.001 1 (1.7) 10 (12.5) City Maputo City 119 (22.7) 59 (51.8) <0.001 Ref Ref 0 (0) 0.001 11 (9.5) <0.001 Beira 54 (10.3) 15 (27.8) 0.4 (0.2-0.7) 0.004 0.6 (0.4-1.0) 0.056 5 (9.3) 26 (48.1) Tete 120 (22.9) 29 (24.2) 0.3 (0.2-0.5) <0.001 0.7 (0.5-1.1) 0.168 12 (10.0) 16 (13.3) Quelimane 117 (22.3) 15 (13.3) 0.1 (0.1-0.3) <0.001 0.5 (0.3-0.9) 0.016 3 (2.6) 5 (4.3) Nampula 114 (21.8) 22 (19.6) 0.2 (0.1-0.4) <0.001 0.4 (0.3-0.7) 0.001 4 (3.6) 33 (29.5) Educational level Primary 162 (31.0) 63 (36.5) <0.001 1.8 (1.4-2.4) 1.4 (1.1-1.9) 0.010 10 (6.2) 0.353 27 (2.5) 0.845 Secondary/higher education 361 (69.0) 77 (19.6) Ref <0.001 Ref 14 (3.9) 64 (4.3) Marital status Single 391 (74.6) 83 (20.4) <0.001 Ref Ref 18 (4.6) 1.000 71 (3.0) 0.571 Married 71 (13.5) 32 (32.1) 2.1 (1.5-2.9) <0.001 1 (0.8-1.4) 0.861 3 (4.3) 9 (15.5) Separated/widowed 62 (11.8) 25 (31.6) 1.9 (1.3-2.6) 0.001 1 (0.7-1.4) 0.856 3 (4.8) 11 (5.1) Housing No stable housing 421 (80.3) 41 (42.3) <0.001 0.4 (0.3-0.7) <0.001 1 (0.7-1.4) 0.878 4 (4) 1.000 19 (19.2) 0.737 Stable housing 103 (19.7) 99 (23.8) Ref Ref 20 (4.8) 72 (17.1) Age at first sexual intercourse <15 160 (31.4) 37 (27.6) 0.186 Ref Ref 14 (8.8) 0.008 34 (1.4) 0.140 ≥15 349 (68.6) 102 (24.7) 1.3 (0.9-1.7) 0.161 1 (0.7-1.3) 0.929 10 (2.9) 54 (6.6) Received money or goods in exchange for sex ‡ Yes 486 (97.4) 129 (27) 0.197 Ref 23 (4.8) 1.000 80 (16.6) 0.130 No 13 (2.6) 1 (8.3) 0.2 (0-1.9) 0.181 --- --- 0 (0) 4 (33.3) Sexual orientation Heterosexual 490 (22.2) 133 (27.8) 0.479 Ref 24 (4.9) 0.392 87 (6.4) --- Bisexual/Homosexual 34 (14.3) 7 (20.6) 0.7 (0.4-1.5) 0.386 --- --- 0 (0) NA Have you ever had anal sex with a man Yes 143 (27.3) 36 (25.6) 0.648 Ref 5 (3.5) 0.603 27 (9.8) 0.688 No 380 (72.7) 104 (18.8) 1.1 (0.8-1.5) 0.574 --- --- 19 (5.1) 64 (2.6) Hazardous alcohol use (AUDIT-C) Abusive 270 (51.5) 76 (29.0) 0.493 Ref 10 (3.7) 0.412 49 (9.3) 0.758 Not abusive 254 (48.5) 64 (17.8) 0.9 (0.7-1.2) 0.434 --- --- 14 (5.6) 42 (0.7) Ever shared syringes for injecting drugs Yes 350 (25.3) 90 (25.9) 0.303 Ref 17 (4.9) 0.883 69 (7.6) 0.081 No 172 (22.8) 50 (30.7) 1.2 (0.9-1.6) 0.251 --- --- 7 (4.1) 22 (1.1) Used new/sterilized syringe last month before the survey Yes 369 (71.2) 109 (26.0) 0.029 Ref 18 (4.9) 0.660 72 (9.7) 0.090 No 55 (10.6) 15 (29.4) 0.9 (0.6-1.5) 0.79 --- --- 1 (1.9) 4 (3.8) Age of first drug injection <18 208 (39.8) 32 (9.2) <0.001 Ref Ref 15 (7.2) 0.050 28 (13.2) 0.012 18-24 226 (43.3) 68 (26.2) 1.9 (1.3-2.8) 0.001 0.9 (0.5-1.8) 0.788 5 (2.2) 52 (8.8) 25+ 88 (16.9) 40 (58.8) 3 (2-4.4) <0.001 0.7 (0.3-2.2) 0.575 4 (4.6) 11 (3.1) Primary injectable drug ** Heroin 496 (95.0) 133 (26.2) 0.300 Ref 22 (4.5) 0.370 91 (7.6) --- Cocaine 23 (4.4) 5 (11.5) 0.8 (0.4-1.8) 0.646 --- --- 2 (9.1) NA Other 3 (0.6) NA 2.4 (1.1-5.5) 0.031 --- --- 0 (0) NA Years injecting drugs <1 year 65 (12.6) 8 (11.3) <0.001 Ref Ref 3 (4.6) 0.954 11 (13.7) 0.984 1-3 years 278 (54) 58 (21.9) 1.7 (0.9-3.4) 0.122 1.7 (0.8-3.5) 0.173 14 (5.1) 50 (6.5) 4-6 years 91 (17.7) 30 (30.5) 2.8 (1.4-5.7) 0.004 1.6 (0.8-3.5) 0.193 3 (3.3) 15 (5.0) 7+ 81 (15.7) 43 (63.1) 4.5 (2.3-8.8) <0.001 2 (0.9-4.3) 0.085 4 (5) 15 (5.0) Injection frequency Not injections 94 (18) 15 (16.3) 0.001 Ref Ref 5 (5.4) 0.334 15 (16.1) 0.662 4 times a month 42 (8) 6 (14.6) 0.9 (0.4-2.1) 0.808 0.7 (0.2-2.4) 0.529 1 (2.4) 5 (12.2) 2-7 times a week 61 (11.7) 11 (18.3) 1.1 (0.6-2.3) 0.745 0.7 (0.2-1.9) 0.433 6 (9.8) 9 (14.8) 1-3 times a day 291 (55.6) 94 (33.1) 2 (1.2-3.3) 0.005 1.4 (0.6-3.2) 0.388 11 (3.8) 57 (19.7) ≥5 times a day 35 (6.7) 14 (40) 2.5 (1.3-4.5) 0.004 2.1 (0.7-6.8) 0.203 1 (2.9) 5 (14.7) Access to new syringe/needle Very easy/Easy 258 (60.1) 70 (19.1) 0.327 Ref 13 (5.1) 0.604 53 (9.4) 0.075 Difficult/Very difficult 171 (39.9) 55 (32.3) 1.2 (0.9-1.6) 0.274 --- --- 6 (3.5) 23 (5.9) Ever heard of naloxone? Yes 52 (10.0) 13 (14.1) 0.959 Ref 2 (3.8) 1 9 (16.8) 1 No 467 (90.0) 126 (26.7) 1.1 (0.6-1.7) 0.828 --- --- 22 (4.7) 80 (6.5) Received harm reduction services, past 12 months? ¥ Yes 99 (18.9) 26 (12.0) 1 Ref 4 (4.1) 1 13 (5.9) 0.299 No 424 (81.1) 114 (27.4) 1 (0.7-1.5) 0.905 --- --- 20 (4.7) 78 (5.6) Access to health services/peer educator, past 12 months Yes 290 (55.3) 95 (32.2) <0.001 Ref Ref 10 (3.5) 0.257 49 (9.5) 0.913 No 234 (44.7) 45 (12.6) 0.6 (0.4-0.8) <0.001 1 (0.7-1.4) 0.949 14 (6) 42 (2.5) Have you ever been pregnant Yes 367 (70.6) 113 (29.7) 0.002 Ref Ref 15 (4.1) 0.73 62 (7.6) 0.801 No 153 (29.4) 27 (14.8) 0.6 (0.4-0.8) 0.003 1.1 (0.7-1.6) 0.693 8 (5.3) 28 (2.6) Symptoms or signs of STI, past 12 months Yes 289 (55.9) 86 (30.6) 0.056 Ref Ref 15 (5.2) 0.672 58 (8.5) 0.112 No 228 (44.1) 50 (13.6) 0.7 (0.5-1) 0.047 0.8 (0.6-1) 0.050 9 (4) 32 (2.5) Experience sexual violence, past 6 months Yes 86 (16.5) 26 (30.1) 0.525 Ref 5 (5.8) 0.574 13 (17.6) 0.612 No 435 (83.5) 113 (22.6) 0.9 (0.6-1.2) 0.434 --- --- 19 (4.4) 78 (6.6) Experience of discrimination, past 12 months Yes 353 (67.8) 86 (23.7) 0.101 Ref Ref 18 (5.1) 0.566 65 (6.4) 0.475 No 168 (32.2) 54 (29.9) 1.3 (1-1.7) 0.078 1.1 (0.9-1.5) 0.315 6 (3.6) 26 (3.6) ‡ Exact Fisher test ¥ Abscess treatment, overdose treatment, opioid substitution therapy with methadone, detoxification programme, rehabilitation Overall prevalence of HIV, HBsAg, HCV, and co-infections Among the WWID, the weighted RDS results were used to estimate the prevalence of disease among the population, based on the sample of study participants. The estimate of HIV prevalence was 28.5% (140/513; 95% CI: 23.3–33.9). Hepatitis B surface antigen (HBsAg) positivity, indicating current HBV infection, was detected in 4.3% (24/520; 95% CI: 2.2–6.4), while hepatitis C virus (HCV) infection was identified in 17.9% (91/519; 95% CI: 13.9–22.0) of participants. Population-level estimates of co-infection showed that concurrent HIV and HBsAg positivity (HIV/HBV co-infection) was 0.9% (95% CI: 0.1–1.7; 5/520 participants), and HIV/HCV co-infection was 4.7% (95% CI: 2.4–7.0; 23/512 participants).Triple infection with HIV, HBV, and HCV was rare, with a population estimate of 0.2% (95% CI: 0.0–0.4; 1/512 participants). Table 2. Weighted prevalence of HIV, HBsAg positivity, HCV, and co-infections among women who inject drugs in Mozambique, 2023–2024 n/N Crude Prevalence (%) % (95% CI): Weighted HIV 140/513 27.3 28.5 (23.3–33.9) HBsAg positive (current HBV infection) 24/520 4.6 4.3 (2.2–6.4) HCV 91/519 17.5 17.9 (13.9–22.0) HIV + HBsAg 5/520 1.0 0.9 (0.1–1.7) HIV + HCV 23/512 4.5 4.7 (2.4–7.0) HIV + HBsAg + HCV 1/512 0.2 0.2 (0.0–0.4) HIV Care and Treatment Outcomes Compared to UNAIDS 95–95–95 Targets Among WWID living with HIV in the study sample, 85.0% were aware of their HIV-positive status (first 95). Among those who were aware of their status, 86.6% reported current use of antiretroviral therapy (ART) (second 95). Among those on ART, 75.7% had viral load suppression (third 95). When considered cumulatively, these steps correspond to an estimated ~56% of all WWID living with HIV being virally suppressed overall, compared with the UNAIDS benchmark of approximately 86%. Discussion This study revealed a high prevalence of HIV (28.5%), HCV (17.9%), and, to a lesser extent, HBsAg (4.3%) among WWID in the studied areas in Mozambique (524), with significant geographic and sociodemographic variations. These findings underscore the disproportionate vulnerability of this population and highlight the urgent need for gender-responsive, integrated interventions aligned with global public health goals. The observed patterns mirror global evidence identifying people who inject drugs (PWID) as a high-risk group for HIV and viral hepatitis infection( 4 ). The HIV prevalence of 28.5% among WWID in Mozambique is almost double that of women in the general adult population (15%) and five times higher than the global median among PWID (5%) ( 30 , 31 ). Maputo showed the highest rate (51.8%), which may reflect its longer-established injecting networks, higher urban mobility, and overlap between sex work and injection drug use dynamics also documented in Johannesburg and Nairobi ( 32 , 33 ). In contrast, Quelimane and Nampula had significantly lower prevalences (13.3% and 19.6%, respectively), suggesting differences in drug use patterns, less mature drug markets, access to harm reduction services, or transmission dynamics. HIV prevalence among participants was strongly correlated with age, educational attainment, and housing stability. The increasing prevalence with age reflects cumulative exposure and vulnerability over time, combining longer injecting trajectories, repeated sexual exposures, and interrupted access to care. This pattern mirrors findings across sub-Saharan Africa, where HIV prevalence among PWID rises sharply with duration of injection ( 34 ). Lower education and unstable housing emerged as key structural determinants: women with limited education and no fixed residence had substantially higher HIV prevalence. These results align with evidence showing that educational disadvantage and homelessness amplify vulnerability through reduced health literacy, economic precarity ( 35 ), amplify exposure within high-risk injection and sexual networks and limited access to prevention and treatment services ( 36 ). No significant associations were found with traditional behavioral indicators such as syringe sharing, likely reflecting social desirability bias, underreporting, or recent exposure to harm-reduction interventions whose coverage remains insufficient to produce population-level effects. The association between STI symptoms and HIV infection likely reflects health-seeking behavior among symptomatic women, suggesting that those who access STI care are also more likely to be tested for HIV. This underscores the potential of integrated sexual and reproductive health (SRH) services as a gateway to HIV prevention and treatment ( 37 ). The prevalence of HCV (17.9%) was lower than the African average among PWID (38%) ( 5 ), but remains concerning, especially in Beira (48.1%) and Nampula (29.5%), where intensive heroin injection networks have been previously reported ( 14 ). This geographic clustering suggests that HCV transmission in Mozambique may be at an earlier stage of diffusion compared with West and Central Africa, where endemic HCV infection among PWID often exceeds 40% ( 38 , 39 ). The concentration of cases in specific urban corridors likely reflects limited harm-reduction coverage, reuse of injecting equipment, and overlapping sex- and drug-related risk networks. The findings of HBsAg positivity varied by location (Tete and Beira with higher proportions, and absence in Maputo), highlighting regional differences in HBV circulation. This is consistent with the heterogeneity observed in other studies that identify subnational disparities in HBV among high-risk populations ( 14 , 40 , 41 ). The association between early sexual debut and HBV infection aligns with the known efficiency of sexual transmission of hepatitis B in high-risk populations. Despite the encouraging finding that 85% of HIV-positive WWID were aware of their status, only half were receiving ART and less than one in three achieved viral suppression. This steep attrition along the HIV care continuum exposes systemic barriers such as stigma, criminalization of drug use, gender-based violence, and fragmentation of services ( 36 , 42 ). These barriers restrict consistent engagement with care and undermine viral suppression efforts. Addressing these gaps requires integrating ART delivery with harm-reduction programs, HCV/HBV testing and treatment, and psychosocial support services tailored to women’s experiences of trauma, pregnancy, and caregiving responsibilities. Achieving the UNAIDS 95–95–95 targets among WWID will depend on shifting from purely biomedical interventions toward gender-sensitive, community-based, and trauma-informed models of care. Viral suppression, in this context, should be seen as a measure of health-system equity and resilience, not merely a clinical outcome. Limitations This study has several limitations that need to be acknowledged. First, its cross-sectional design precludes causal inference; observed associations between sociodemographic factors, behavioral indicators, and HIV, HBsAg, or HCV status should be interpreted as correlational rather than causal. Second, recruitment used RDS, which is appropriate for hidden and criminalized populations but may still under-represent subgroups of WWID who are less socially networked, more mobile, or more isolated by violence and stigma. As such, even the high prevalence estimates reported here may be conservative. Third, behavioral indicators (e.g., condom use, syringe sharing, number of partners) were based on self-report and therefore subject to recall bias and social desirability bias, particularly in a context of criminalization of drug use and sex work. Fourth, hepatitis B infection was defined using HBsAg rapid testing, which identifies current infection but does not distinguish acute from chronic infection, and HCV status was based on a rapid antibody test without confirmatory RNA testing; these constraints may lead to misclassification of infection stage and transmissibility. Finally, although we present weighted prevalence estimates to account for the RDS design, the multivariable analysis was conducted unweighted, consistent with evidence that unweighted regression often performs better in terms of bias and stability in RDS studies; however, this choice may limit direct comparability with other RDS-weighted analyses. Despite these limitations, this study provides rare, policy-relevant evidence on WWID in Mozambique, a population largely invisible in routine surveillance. Conclusions This study demonstrates a high burden of HIV, HCV, and HBsAg positivity among WWID in Mozambique, with clear geographic and sociodemographic disparities. The findings reveal how prolonged drug use, low educational attainment, housing instability, and limited access to healthcare converge to create multi-layered and cumulative vulnerability among WWID. These structural and social determinants of health compound biological risks, perpetuating gender and economic inequities that sustain the epidemics of HIV, HBV, and HCV. Addressing these overlapping challenges requires integrated, gender-responsive, and trauma-informed strategies. Priority actions should include expanding harm reduction interventions, and integrating diagnosis and treatment for HIV, HBV, and HCV within a unified continuum of care. Additionally, reducing stigma, criminalization, and gender-based violence remains fundamental to ensuring service uptake and retention in care. Without immediate, targeted, and sustained investment, these intertwined epidemics will continue to fuel health inequities and undermine Mozambique’s progress toward epidemic control. Conversely, implementing an inclusive, multisectoral public health response that prioritizes WWID will not only improve individual and population-level outcomes but also represent a tangible step toward achieving the Sustainable Development Goal of ending AIDS and viral hepatitis as public health threats by 2030. Abbreviations ART- Antiretroviral Therapy AUDIT-C - Alcohol consumption was assessed using the Alcohol Use Disorders Identification Test – Consumption HBsAg- Hepatitis B Surface Antigen HBV- Hepatitis B HCV- Hepatitis C HIV- Human Immunodeficiency Virus PWID- People Who Inject Drugs RDS- Respondent-Driven Sampling STI- Sexually Transmitted Infections UNAIDS - The Joint United Nations Program on HIV/AIDS WWID- Women Who Inject Drugs Declarations Ethics approval and consent to participate The study protocol was reviewed and approved by the Ethics Review Board of the Institutional Ethics Committee of the National Institute of Health (CIE-INS) under reference 097/CIBS-INS/2022, and by the National Bioethics Committee for Health in Mozambique (CNBS) under references 877/CNBS/22 and 690/CNBS/2023. The study was conducted in accordance with the Declaration of Helsinki and relevant national regulations. All participants provided written informed consent prior to participation. Participants aged 16–17 years were considered emancipated minors according to Mozambican regulations, and the CNBS exceptionally authorized the waiver of parental or guardian consent. These minors provided their consent using the same process applied to participants aged 18 years or older, with all necessary explanations to ensure understanding. No identifying information was collected, and measures were taken to protect participants’ privacy and safety Consent for publication Not applicable. No individual-level identifiable data are presented in this manuscript. Availability of data and materials All study datasets are accessible in the Mozambique National Institute of Health (INS) data repository for researchers who meet the criteria for access to confidential data. The data comes from the second round of the study on BBS among PWIDs, and the authors can be contacted at: https://ins.gov.mz/institucional/unidade-organicas/direccoes/direccao-de-inqueritos-e-observacao- de-saude/data-bases/Availability of data and materials. The analysis code used in this study is publicly available at: https://github.com/RachidMuleia/HIV-prevalence-among-WWID.git. Clinical trial number Not applicable. Competing interests The authors declare no competing interests. Funding This manuscript used data from research supported by the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund). The funder had no role in the study design, data collection, data analysis, data interpretation, or writing of the manuscript. Authors’ contributions ARB elaborated the manuscript, coordinated all survey activities from study design, implementation and dissemination, and supervised data collection in the field. 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Available from: https://www.scirp.org/reference/ReferencesPapers?ReferenceID=2342186 HIV and people who inject drugs — Thematic briefing note — 2024 global AIDS update The Urgency of Now: AIDS at a Crossroads | UNAIDS [Internet]. [cited 2025 Aug 11]. Available from: https://www.unaids.org/en/resources/documents/2024/2024-unaids-global-aids-update-people-who-inject-drugs INS. Divulgados Resultados do Inquérito sobre o Impacto do HIV e SIDA em Moçambique [Internet]. Instituto Nacional de Saúde. 2022 [cited 2025 Feb 16]. Available from: https://ins.gov.mz/divulgados-resultados-do-inquerito-sobre-o-impacto-do-hiv-e-sida-em-mocambique/ Needle R, Kroeger K, Belani H, Achrekar A, Parry CD, Dewing S. Sex, drugs, and HIV: rapid assessment of HIV risk behaviors among street-based drug using sex workers in Durban, South Africa. Soc Sci Med 1982. 2008 Nov;67(9):1447–55. Oguya FO, Kenya PR, Ongecha F, Mureithi P, Musyoka H, N M, et al. Rapid situational assessment of people who inject drugs (PWID) in Nairobi and coastal regions of Kenya: a respondent driven sampling survey. BMC Public Health [Internet]. 2021 Aug 14 [cited 2025 Nov 5];21(1). Available from: https://pubmed.ncbi.nlm.nih.gov/34391389/?utm_source=chatgpt.com Degenhardt L, Peacock A, Colledge S, Leung J, Grebely J, Vickerman P, et al. Global prevalence of injecting drug use and sociodemographic characteristics and prevalence of HIV, HBV, and HCV in people who inject drugs: a multistage systematic review. Lancet Glob Health. 2017 Dec;5(12):e1192–207. Briefing paper - Addressing gender-based violence against women and people of diverse gender identity and expression who use drugs [Internet]. [cited 2025 Mar 23]. Available from: https://www.unfpa.org/publications/briefing-paper-addressing-gender-based-violence-against-women-and-people-diverse Banze ÁR, Botão C, Muamine E, Condula M, Craveirinha S, Boothe M, et al. Understanding HIV vulnerability among women who inject drugs in Mozambique, 2023. Harm Reduct J. 2025 Apr 19;22(1):61. Global HIV, Hepatitis and STIs Programmes [Internet]. [cited 2025 Aug 11]. Available from: https://www.who.int/teams/global-hiv-hepatitis-and-stis-programmes/strategies/global-health-sector-strategies Fosu PK, Adjei CA, Atibila F, Aovare P, Ruiter RAC, Hoor GT. Prevalence of hepatitis C viral infection in Ghana: a systematic review and meta-analysis. BMC Infect Dis [Internet]. 2025 Oct 27 [cited 2025 Nov 9];25(1):1413. Available from: https://doi.org/10.1186/s12879-025-11655-2 Akiyama MJ, Cleland CM, Lizcano JA, Cherutich P, Kurth AE. Prevalence, estimated incidence, risk behaviours, and genotypic distribution of hepatitis C virus among people who inject drugs accessing harm-reduction services in Kenya: a retrospective cohort study. Lancet Infect Dis [Internet]. 2019 Nov [cited 2025 Nov 9];19(11):1255–63. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC7099605/ Mabunda N, Vieira L, Chelene I, Maueia C, Zicai AF, Duajá A, et al. Prevalence of hepatitis B virus and immunity status among healthcare workers in Beira City, Mozambique. PLoS ONE [Internet]. 2022 Oct 14 [cited 2026 Jan 13];17(10):e0276283. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC9565706/ ABDOOL KARIM SS, COOVADIA HM, WINDSOR IM, THEJPAL R, VAN DEN ENDE J, FOUCHE A. The Prevalence and Transmission of Hepatitis B Virus Infection in Urban, Rural and Institutionalized Black Children of Natal/KwaZulu, South Africa. Int J Epidemiol [Internet]. 1988 Mar 1 [cited 2026 Jan 13];17(1):168–73. Available from: https://doi.org/10.1093/ije/17.1.168 Viisainen K, Baumgart Dos Santos M, Sunderbrink U, Couto A. Gender and stigma in antiretroviral treatment adherence in Mozambique: A qualitative study. PLOS Glob Public Health. 2024;4(7):e0003166. Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8679000","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":595935870,"identity":"d054ce94-7ac2-4456-b25c-f24500d69e0d","order_by":0,"name":"Áuria Ribeiro Banze","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABC0lEQVRIiWNgGAWjYJCCAwwMFgwMzEDWhwobIMnYeIAILRJgLYwzzqSBtDQQ1MIA1gIEzLxth2GG4Ab8M3IfHvjBICFvzs788AHPmfN2a9sPA22psYnGafyNdIODPQwShjub2YwNJCpuJ287kwjUciwttwGXnhtpDAd4GCQYNxzmYZMwOHM72ewAUAtjw2GcWuSBWg7+YZCwB2ph/5HYdi7Z7PxD/FoMgFoOA21JBNnCcLDtgJ3ZDQK2GJ55xnBYxkAiecNhNmPJhjPJCWY3gLYk4PGL3PE05o9vKmxsN5w//PDznwo7e7Pz6Q8ffKixwe19iPMQzESwygS8ytGAPSmKR8EoGAWjYGQAAGtOY9kg8M3jAAAAAElFTkSuQmCC","orcid":"","institution":"Instituto Nacional de Saúde","correspondingAuthor":true,"prefix":"","firstName":"Áuria","middleName":"Ribeiro","lastName":"Banze","suffix":""},{"id":595935871,"identity":"5bc4179c-2336-45d4-a863-b7b7e23240a2","order_by":1,"name":"Rachid Muleia","email":"","orcid":"","institution":"Instituto Nacional de Saúde","correspondingAuthor":false,"prefix":"","firstName":"Rachid","middleName":"","lastName":"Muleia","suffix":""},{"id":595935876,"identity":"35e6f8b7-250c-4d17-b2fc-b265bb565365","order_by":2,"name":"Samuel Nuvunga","email":"","orcid":"","institution":"Instituto Nacional de Saúde","correspondingAuthor":false,"prefix":"","firstName":"Samuel","middleName":"","lastName":"Nuvunga","suffix":""},{"id":595935877,"identity":"fa1c59a7-72e2-4334-8160-443e480fc7b4","order_by":3,"name":"Isabel Craveiro","email":"","orcid":"","institution":"Universidade Nova de Lisboa","correspondingAuthor":false,"prefix":"","firstName":"Isabel","middleName":"","lastName":"Craveiro","suffix":""},{"id":595935882,"identity":"aec1776b-552f-4c1c-acc0-b7f8e967d520","order_by":4,"name":"Sofia Gonçalves Seabra","email":"","orcid":"","institution":"Universidade Nova de Lisboa","correspondingAuthor":false,"prefix":"","firstName":"Sofia","middleName":"Gonçalves","lastName":"Seabra","suffix":""},{"id":595935885,"identity":"15d04684-db5a-4251-a87f-953eaef0a05c","order_by":5,"name":"Cynthia Semá Baltazar","email":"","orcid":"","institution":"Instituto Nacional de Saúde","correspondingAuthor":false,"prefix":"","firstName":"Cynthia","middleName":"Semá","lastName":"Baltazar","suffix":""}],"badges":[],"createdAt":"2026-01-23 12:08:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8679000/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8679000/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":103397947,"identity":"afaba96a-3d59-4470-9025-8ffe06969ebd","added_by":"auto","created_at":"2026-02-25 08:58:30","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":265705,"visible":true,"origin":"","legend":"\u003cp\u003eProgress towards the UNAIDS 95–95–95 Targets AMONG WWID in Mozambique, 2023-2024\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-8679000/v1/59d8329df99babd7ae7584fa.jpeg"},{"id":103398141,"identity":"e1fc1829-bc6d-4ce0-8659-aedb341c43ea","added_by":"auto","created_at":"2026-02-25 08:58:55","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2071164,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8679000/v1/2e9e30f5-33de-44d9-afe4-9acc07e1c35a.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Prevalence and Risk Factors of HIV, HBV, and HCV Among Women Who Inject Drugs in Five Mozambican Cities: A Cross-Sectional Biological and Behavioral Survey, 2023–2024","fulltext":[{"header":"Background","content":"\u003cp\u003ePeople Who Inject Drugs (PWID) remain one of the populations most affected by HIV and viral hepatitis worldwide. Without access to harm reduction programs such as needle and syringe distribution or opioid substitution therapy, PWID are at elevated risk of acquiring Human Immunodeficiency Virus (HIV), Hepatitis B (HBV), and Hepatitis C (HCV) (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Yet, in many low- and middle-income countries, reliable data on the size and characteristics of this population remains scarce, limiting their visibility in national surveillance systems and hindering evidence-based policy and service delivery planning.\u003c/p\u003e \u003cp\u003eGlobally there were an estimated 14\u0026nbsp;million PWID in 2023 (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e), including approximately 2.8\u0026nbsp;million women (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). The global median HIV prevalence among PWID is 5%, nearly seven times higher than among adults aged 15\u0026ndash;49 years in the general population across 47 reporting countries (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). In addition, PWID experience high burdens of HBV and HCV, with global prevalence estimates of 6% and 60%, respectively (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Yet, Women Who Inject Drugs (WWID) are consistently reported to have higher HIV prevalence than men, reflecting compounded biological, social, and structural risks (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). These include exposure to gender-based violence, reliance on transactional sex, reduced negotiating power in relationships, and less access to prevention and treatment services (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). The intersection of these risks situates WWID at the confluence of the HIV, HBV, HCV, and gender inequality epidemics.\u003c/p\u003e \u003cp\u003eIn sub-Saharan Africa, the geography of HIV is changing. While heterosexual transmission remains dominant, emerging evidence points to injection drug use as a growing but under-recognized contributor to new infections (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Regional estimates suggest HIV prevalence of 24%, HBV prevalence of 5%, and HCV prevalence of 38% among PWID (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). However, these figures mask profound gender disparities: meta-analytic data indicate that WWID are nearly three times more likely to live with HIV than men who inject drugs, with a relative risk of 2.8 (95% CI: 1.8\u0026ndash;4.4) (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Despite this, few African countries systematically collect or publish gender-disaggregated data on PWID, effectively erasing women from policy visibility and resource allocation.\u003c/p\u003e \u003cp\u003eMozambique reflects this broader blind spot in global harm reduction (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). The country faces a concentrated HIV epidemic among key populations (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e), yet surveillance systems remain largely blind to the realities of WWID. The \u003cem\u003eNational Strategic Plan for the Response to HIV and AIDS 2021\u0026ndash;2025\u003c/em\u003e recognizes the need for gender-responsive prevention but acknowledges the absence of data and tailored services for WWID (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). The underrepresentation of WWID in research is widely acknowledged. For instance, the 2013\u0026ndash;2014 BBS among PWID in Mozambique included only 5% women, which may reflect either sampling limitations or their actual proportional size within the hidden PWID population. That survey reported HIV/HBV and HIV/HCV co-infection prevalences of 14.9% and 38.7% in Maputo, respectively (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). While this imbalance does not automatically confirm underrepresentation, it does align with the broader pattern of systemic exclusion of WWID from health research and programming, a pattern shaped by stigma, gender inequality, and intersecting forms of criminalization.\u003c/p\u003e \u003cp\u003eAgainst this backdrop, Mozambique provides a critical lens through which to examine how gender, stigma, and structural inequities shape vulnerability among WWID in sub-Saharan Africa. This study aims to generate context-specific evidence on the socio-demographic characteristics, sexual behaviors, and experiences of stigma and discrimination among WWID in Mozambique providing critical insights to inform gender-responsive harm reduction and HIV prevention strategies.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eSetting, participants, and procedures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe conducted a cross-sectional study as part of the second round of the BBS among PWID in five urban areas of Mozambique, between July 2023 and March 2024. The selected sites included Maputo City in the southern region; Beira, Tete, and Quelimane in the central region; and Nampula in the northern region.\u003c/p\u003e\n\u003cp\u003eMaputo City and Nampula/Nacala had also been included in the first round of BBS, allowing for comparative analyses of HIV prevalence and risk behaviors over time. Site selection was guided by national stakeholders to ensure representation of geographic, cultural, and programmatic diversity. The chosen areas were characterized by: (1) a known or suspected concentration of PWID; (2) an adult population size sufficient to meet sampling requirements; and (3) the presence of PWID-friendly HIV and sexually transmitted infection (STI) services for referrals. Socially connected contiguous neighborhoods were also included in the sampling frame to capture overlapping injection networks (15).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The new sites for this round, namely Beira, Quelimane, and Tete were selected through a systematic process that considered HIV prevalence in the general population, the presence of PWID community-based prevention programs, and the availability of PWID-friendly services at health facilities.\u003c/p\u003e\n\u003cp\u003eEligible participants met the following criteria: (1) were aged \u0026ge; 16 years old; (2) reporting injecting non-prescription drugs in the past 12 months before the survey; (3) presented a valid referral coupon; and (4) had resided in, worked in, or regularly socialized in the study area during the 12 months prior to the survey.\u003c/p\u003e\n\u003cp\u003eWe used respondent-driven sampling (RDS) to recruit participants, a method widely applied to reach hard-to-access populations, \u0026nbsp;to generate population-based estimates of HIV prevalence and related behavioral indicators (16\u0026ndash;18). The recruitment process of participants for this round of the survey was identical to the first round (15). All participants provided written informed consent prior to participation. Confidentiality was ensured through the use of unique participant codes and secure data storage systems.\u003c/p\u003e\n\u003cp\u003eIn total, 2,624 PWID were recruited across the five cities: 520 in Maputo (119 women), 517 in Beira (54 women), 524 in Tete (120 women), 531 in Quelimane (117 women), and 532 in Nampula (114 women). The present analysis focuses exclusively on the 524 women who inject drugs (WWID) included in the second-round BBS.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMeasures\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA structured quantitative questionnaire, adapted from the first round of the BBS among PWID in Mozambique, was used to collect data. The tool captured information across several domains, including socio-demographic characteristics, sexual behavior, substance use, biological and clinical history, symptoms of STIs, and HIV-related knowledge, attitudes, practices, stigma, discrimination, and perceptions.\u003c/p\u003e\n\u003cp\u003eBiological samples were collected to determine the prevalence of HIV, active hepatitis B infection (HBsAg positivity), HCV, and HIV viral load. Before sample collection, all eligible participants received pre-test counseling on the importance of testing and the implications of positive results. Approximately 6 mL of venous blood was drawn using adult EDTA Vacutainer\u0026reg; tubes for rapid testing and dried blood spot (DBS) preparation.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHIV testing followed the\u0026nbsp;Mozambique\u0026rsquo;s sequential algorithm: an initial screening with\u0026nbsp;\u003cem\u003eAlere Determine\u0026reg; HIV-1/2\u003c/em\u003e (Abbott Laboratories, UK), followed by a confirmatory test with\u0026nbsp;\u003cem\u003eUni-Gold\u0026trade; HIV\u003c/em\u003e (Trinity Biotech, Ireland). Indeterminate results were recorded if the confirmatory test was non-reactive. HBV testing was performed using\u0026nbsp;\u003cem\u003eAlere Determine\u0026reg; HBsAg\u003c/em\u003e rapid diagnostic test, which detects the presence of hepatitis B surface antigen (HBsAg) in blood samples. A reactive HBsAg result was considered indicative of current HBV infection, in line with WHO guidelines and standard epidemiological practices (19). It is important to note that HBsAg positivity reflects active infection but does not differentiate between acute and chronic stages. This marker was used to estimate the prevalence of ongoing HBV infection and to assess co-infections with HIV and/or HCV. HCV testing used the\u0026nbsp;\u003cem\u003eSD Bioline HCV\u003c/em\u003e rapid test, where all reactive results were also considered positive.\u003c/p\u003e\n\u003cp\u003eAll participants received post-test counseling with tailored messages according to their test results and risk profiles. Those testing positive for HIV, HBsAg, or HCV were referred to appropriate care services. Referral forms included both HBsAg and anti-HCV results to facilitate clinical linkage and confirmatory evaluation at designated health facilities\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAlcohol consumption was assessed using the Alcohol Use Disorders Identification Test \u0026ndash; Consumption (AUDIT-C), a validated three-item screening tool derived from the full WHO AUDIT questionnaire. The AUDIT-C evaluates frequency of drinking, quantity per occasion, and frequency of heavy episodic drinking during the past 12 months (20). Scores range from 0 to 12, with higher values indicating greater risk of hazardous drinking. Following standard cut-offs used in previous studies, a score \u0026ge;3 for women was classified as \u0026ldquo;hazardous alcohol use\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003eOf the 524 participants in the study, 11 participants did not consent to rapid HIV testing, four participants did not consent to HCV testing, and five participants did not consent to HBV testing.\u003c/p\u003e\n\u003cp\u003eFor the cascade of care and treatment among WWID living with HIV, the study applied the \u0026nbsp;The Joint United Nations Program on HIV/AIDS (UNAIDS) 95\u0026ndash;95\u0026ndash;95 framework (21): \u003cstrong\u003eFirst 95:\u003c/strong\u003e WWID living with HIV who had prior knowledge of their HIV-positive status at the time of the survey\u003cstrong\u003e; Second 95:\u003c/strong\u003e WWID living with HIV who were already on antiretroviral therapy (ART) during the survey\u003cstrong\u003e; Third 95:\u003c/strong\u003e WWID living with HIV with viral suppression, as determined by their viral load results during the survey.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBoth bivariate and multivariable statistical analyses were conducted to assess associations between explanatory variables and outcomes of interest (HIV, HCV, and HBsAg seropositivity). Bivariate analyses were used to present the prevalence of each outcome across explanatory variable categories and to explore potential associations. The computed prevalence was derived using a meta-analytic approach, where we computed RDS-weighted estimates within each study site using the Gile\u0026rsquo;s Successive Sampling estimator and then derived one single pooled estimate using a fixed-effect meta-analysis approach. \u0026nbsp;This approach was chosen to account for the clustered RDS design across multiple sites while generating an overall population estimate. Associations between explanatory and outcome variables were assessed using Pearson\u0026rsquo;s Chi-square test, and the Fisher\u0026rsquo;s exact test was applied whenever expected cell counts were fewer than five.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Given the relatively high prevalence of HIV (\u0026gt;10%) in our sample, multivariate analysis was conducted for HIV using multivariable Poisson regression with robust standard errors, also known as modified Poisson regression, to identify independent predictors and estimate relative risks (22\u0026ndash;24). This method is preferred over logistic regression for common outcomes to avoid overestimation of odds ratios. Variables included in the multivariable model were those that demonstrated statistical significance at the 0.20 significance level in the bivariate modified Poisson regression, allowing for the inclusion of potentially relevant covariates. Although the data were collected using RDS, the modified Poisson regression analysis was conducted without weighting. This methodological decision is supported by simulation studies indicating that unweighted regression often yields more stable and precise estimates in RDS analyses when the predictors of interest are not strongly correlated with network size or recruitment homophily (25\u0026ndash;27). We acknowledge this as both a methodological choice and a limitation for comparability with other studies. The model was assessed for multicollinearity using variance inflation factor (VIF), and variables with VIF \u0026gt;5 were excluded.\u003c/p\u003e\n\u003cp\u003eThe final model was assessed for Goodness-of-fit using the Pearson Chi-square statistic. Statistical significance was set at a 0.05 level (28). All analyses were conducted using R statistical software version 4.2.2 (29), and the full R code is publicly available in our GitHub repository: \u0026nbsp;https://github.com/RachidMuleia/HIV-prevalence-among-WWID.git.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eCharacteristics of Study Participants\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe characteristics of the participants are described in Table 1. A total of 524 WWID were included in the analysis, with a median age of 22 years (interquartile range: 18\u0026ndash;27). The majority (43.7%) were between 18 and 24 years old, while only 11.1% were aged 35 years or older.\u003c/p\u003e\n\u003cp\u003eParticipants were almost equally distributed across the five study sites, with approximately one-fifth recruited from Maputo City (22.7%), Tete (22.9%), Quelimane (22.3%), and Nampula (21.8%), and a smaller proportion from Beira (10.3%).\u003c/p\u003e\n\u003cp\u003eIn terms of education, 69.0% of the women had completed at least secondary education, while 31.0% had only primary education. The majority were single (74.6%), followed by married (13.5%) and separated or widowed (11.8%). A large proportion of participants (80.3%) reported unstable housing conditions, reflecting high social and economic vulnerability.\u003c/p\u003e\n\u003cp\u003eRegarding sexual behavior, 68.6% initiated sexual activity at age 15 or older, whereas 31.4% reported sexual debut before age 15. Nearly all participants (97.4%) reported receiving money or goods in exchange for sex, and 27.3% reported having engaged in anal sex with male partners. Most identified as heterosexual (93.5%), while 6.5% identified as bisexual or homosexual.\u003c/p\u003e\n\u003cp\u003eAbout 51.5% of participants met the criteria for hazardous alcohol use according to the AUDIT-C scale. Concerning injection practices, 67% reported sharing syringes at some point, while 71.2% used a new or sterilized syringe in the month preceding the survey. The majority (83%) reported injecting drugs within the last month, with 55.6% injecting 1\u0026ndash;3 times per day.\u003c/p\u003e\n\u003cp\u003eThe main injectable drug was heroin (95%), followed by cocaine (4.4%). Almost half (54%) had been injecting drugs for 1\u0026ndash;3 years, and 15.7% for seven years or more, indicating varying levels of exposure to long-term risk behaviors.\u003c/p\u003e\n\u003cp\u003eAccess to prevention and harm reduction services remained limited: only 18.9% reported receiving harm reduction services in the previous year, and just 10% had heard of naloxone. Similarly, 55.3% reported access to health services or peer educators in the past 12 months.\u003c/p\u003e\n\u003cp\u003eRegarding reproductive and sexual health, 70.6% had already been pregnant, and 55.9% reported signs or symptoms of sexually transmitted infections (STIs) in the past year. Experiences of sexual violence were reported by 16.5% of participants in the previous six months, while 67.8% experienced discrimination in the past year.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePrevalence of HIV and association with sociodemographic, behavioural characteristics and injecting drug use\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe analysis of sociodemographic, behavioral, and drug use-related variables identified multiple factors significantly associated with HIV prevalence among the study participants (p\u0026lt;0.05) (table 1). A progressive increase in HIV prevalence was observed with age, reaching the highest level in the group aged 35 years or older (72.9%; p\u0026lt;0.001). The geographic distribution revealed marked differences: prevalence was highest in Maputo (51.8%) and lowest in Quelimane (13.3%; p\u0026lt;0.001).\u003c/p\u003e\n\u003cp\u003eEducational attainment was inversely associated with HIV prevalence. WWID with only primary education had significantly higher prevalence (36.5%) compared to those with secondary or higher education (19.6%; p\u0026lt;0.001). Marital status was also associated with HIV, with higher prevalence among married and separated/widowed women compared to single women (p\u0026lt;0.001).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eStructural vulnerabilities were strongly associated with HIV. Women without stable housing had higher prevalence than those with housing (42.3% vs. 23.8%; p\u0026lt;0.001).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAmong variables related to injecting practices, HIV prevalence was slightly lower among women who reported using a new or sterilized syringe in the past month (26.0%) compared to those who did not (29.4%), with a statistically significant difference observed (p=0.029).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Age at first injection was also an associated factor: initiation before age 18 was associated with lower prevalence (9.2%) compared to initiation at 25 years or older (58.8%; p\u0026lt;0.001).\u003c/p\u003e\n\u003cp\u003eBoth duration of injecting drug use (p \u0026lt; 0.001) and injection frequency (p = 0.001) showed a dose\u0026ndash;response relationship with HIV prevalence, increasing with longer duration and higher frequency of injection.\u003c/p\u003e\n\u003cp\u003eAccess to health services or a peer educator was positively associated with prevalence (32.2% vs. 12.6%; p\u0026lt;0.001). Additionally, those with a history of pregnancy had higher prevalence (29.7%) compared to those who never became pregnant (14.8%; p=0.002).\u003c/p\u003e\n\u003cp\u003eNo statistically significant associations were observed between HIV prevalence and the following variables: condom use, sexual orientation, anal sex practice, alcohol abuse, syringe sharing, easy access to needles, access to naloxone, participation in harm reduction treatments, presence of STI symptoms, history of sexual violence, and reports of discrimination.\u003c/p\u003e\n\u003cp\u003eIn the adjusted model (table 1), HIV infection among WWID remained significantly associated with older age, city of residence, educational level, duration of drug injection, and occurrence of STI symptoms. Compared with adolescents aged 16\u0026ndash;17 years, the adjusted relative risk of HIV infection increased progressively with age: 18\u0026ndash;24 years (aRR = 5.8; 95% CI: 2.1\u0026ndash;15.7; p = 0.001), 24\u0026ndash;34 years (aRR = 9.1; 95% CI: 3.2\u0026ndash;26.4; p \u0026lt; 0.001), and \u0026ge;35 years (aRR = 13.8; 95% CI: 4.7\u0026ndash;40.8; p \u0026lt; 0.001). Geographical variation persisted after adjustment, with women in Quelimane (aRR = 0.5; 95% CI: 0.3\u0026ndash;0.9; p = 0.016) and Nampula (aRR = 0.4; 95% CI: 0.3\u0026ndash;0.7; p = 0.001) exhibiting significantly lower HIV risk infection compared to Maputo City. Educational attainment remained significant, as women with only primary education had 1.4 times higher risk of HIV infection than those with secondary or higher education (aRR = 1.4; p = 0.010).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Absence of STI symptoms in the past 12 months was associated with a lower risk of HIV infection (aRR = 0.8; \u003cem\u003ep\u003c/em\u003e = 0.050). All other variables were not significantly associated with HIV prevalence in the adjusted model.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eHBsAg Positivity\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe proportion of participants with reactive HBsAg tests varied significantly by geographic location (p=0.001). Tete (10.0%) and Beira (9.3%) had the highest proportions, while no reactive cases were detected in Maputo City. Other cities showed lower reactivity, including Quelimane (2.6%) and Nampula (3.6%).\u003c/p\u003e\n\u003cp\u003eAge at first sexual intercourse was significantly associated with HBsAg positivity: women who initiated sexual activity before age 15 had a prevalence of 8.8% compared to 2.9% among those who initiated at age 15 or older (p=0.008). \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA significant association was observed with age at first injection (p=0.050), with positivity rates of 7.2% among women who initiated injection before age 18, compared to 4.6% among those initiating at age 25 or older.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eHCV Positivity\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSignificant geographic variation in HCV prevalence was observed across study sites (p\u0026lt;0.001). The highest prevalence was observed in Beira (48.1%) and Nampula (29.5%), while markedly lower rates were recorded in Maputo City (9.5%), Quelimane (4.3%), and Tete (13.3%).\u003c/p\u003e\n\u003cp\u003eInjecting practices were significantly associated with prevalence. Women who initiated injection before age 18 had a higher prevalence (13.5%; p = 0.012) than those who initiated between ages 18\u0026ndash;24 (8.8%).\u003c/p\u003e\n\u003cp\u003eWomen reporting heroin as their primary injectable drug had a prevalence of 7.6%, while no HCV cases were identified among those injecting cocaine, or other, although the number of women injecting these last two are very reduced (N = 23 and N = 3, respectively).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1.\u0026nbsp;\u003c/strong\u003ePrevalence of HIV, HBsAg and HCV\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eamong WWID in Mozambique, 2023,\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003estratified by sociodemographic variables, behavioural characteristics and injecting drug use, with results from the\u0026nbsp;association analyses (Chi-square\u0026nbsp;\u0026chi;\u003csup\u003e2\u003c/sup\u003e or Fisher exact test \u0026Dagger;). For HIV, simple and multivariable Poisson regression with robust standard errors are also reported (crude relative risk, cRR, and relative risk, aRR, respectively, and corresponding p-values). Significant values at 0.05 significance level are indicated in bold.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"913\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 119px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"6\" style=\"width: 450px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHIV\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 127px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHBsAg\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHCV\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;N positives (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e or Fisher P-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ecRR (95%CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ecRR P-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eaRR (95%CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eaRR P-Value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;N positives (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e or Fisher P-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN positives (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026chi;\u003csup\u003e2\u003c/sup\u003e or Fisher P-value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"12\" style=\"width: 913px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge group (years) The median age was 22 years (IQR: 18\u0026ndash;27)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e16-17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e119 (22.7)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4 (6.1)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003eRef\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRef\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e10 (8.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.117\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e20 (22.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.887\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e18-24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e229 (43.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e53 (21.0)\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e7 (2.6-19.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5.8 (2.1-15.7)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e7 (3.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e43 (2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e25-34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e118 (22.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e47 (44.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e12.4 (4.6-33.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e9.1 (3.2-26.4)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e6 (5.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e18 (11.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e35+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e58 (11.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e36 (72.9)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e18.8 (7.0-50.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e13.8 (4.7-40.8)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e1 (1.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e10 (12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"12\" style=\"width: 913px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eMaputo City\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e119 (22.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e59 (51.8)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRef\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0 (0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e11 (9.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eBeira\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e54 (10.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e15 (27.8)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e0.4 (0.2-0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.6 (0.4-1.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.056\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5 (9.3)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e26 (48.1)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eTete\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e120 (22.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e29 (24.2)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e0.3 (0.2-0.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e0.7 (0.5-1.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e0.168\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e12 (10.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e16 (13.3)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eQuelimane\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e117 (22.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e15 (13.3)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e0.1 (0.1-0.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.5 (0.3-0.9)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.016\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e3 (2.6)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5 (4.3)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eNampula\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e114 (21.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e22 (19.6)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e0.2 (0.1-0.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.4 (0.3-0.7)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4 (3.6)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e33 (29.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"12\" style=\"width: 913px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducational level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e162 (31.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e63 (36.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e1.8 (1.4-2.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.4 (1.1-1.9)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.010\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e10 (6.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.353\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e27 (2.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.845\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eSecondary/higher education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e361 (69.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e77 (19.6)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRef\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e14 (3.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e64 (4.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"12\" style=\"width: 913px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e391 (74.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e83 (20.4)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e18 (4.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 55px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e71 (3.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.571\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e71 (13.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e32 (32.1)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e2.1 (1.5-2.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e1 (0.8-1.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e0.861\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e3 (4.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e9 (15.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eSeparated/widowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e62 (11.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e25 (31.6)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e1.9 (1.3-2.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e1 (0.7-1.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e0.856\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e3 (4.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e11 (5.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"12\" style=\"width: 913px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHousing\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eNo stable housing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e421 (80.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e41 (42.3)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e0.4 (0.3-0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e1 (0.7-1.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e0.878\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e4 (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 55px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e19 (19.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.737\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eStable housing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e103 (19.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e99 (23.8)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e20 (4.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e72 (17.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"12\" style=\"width: 913px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge at first sexual intercourse\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e\u0026lt;15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e160 (31.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e37 (27.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.186\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e14 (8.8)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.008\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e34 (1.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.140\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e\u0026ge;15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e349 (68.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e102 (24.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e1.3 (0.9-1.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e1 (0.7-1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e0.929\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e10 (2.9)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e54 (6.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"12\" style=\"width: 913px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReceived money or goods in exchange for sex\u003c/strong\u003e\u003cstrong\u003e\u0026Dagger;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e486 (97.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e129 (27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.197\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e23 (4.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 55px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e80 (16.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.130\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e13 (2.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e1 (8.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e0.2 (0-1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e0.181\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e---\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e---\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e4 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"12\" style=\"width: 913px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSexual orientation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eHeterosexual\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e490 (22.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e133 (27.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.479\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e24 (4.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.392\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e87 (6.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 55px;\"\u003e\n \u003cp\u003e---\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eBisexual/Homosexual\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e34 (14.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e7 (20.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e0.7 (0.4-1.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.386\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e---\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e---\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"12\" style=\"width: 913px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHave you ever had anal sex with a man\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e143 (27.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e36 (25.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.648\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e5 (3.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.603\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e27 (9.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.688\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e380 (72.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e104 (18.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e1.1 (0.8-1.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.574\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e---\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e---\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e19 (5.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e64 (2.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"12\" style=\"width: 913px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHazardous alcohol use (AUDIT-C)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eAbusive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e270 (51.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e76 (29.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.493\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e10 (3.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.412\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e49 (9.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.758\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eNot abusive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e254 (48.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e64 (17.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e0.9 (0.7-1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.434\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e---\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e---\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e14 (5.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e42 (0.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"12\" style=\"width: 913px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;Ever shared syringes for injecting drugs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e350 (25.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e90 (25.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.303\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e17 (4.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.883\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e69 (7.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.081\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e172 (22.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e50 (30.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e1.2 (0.9-1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.251\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e---\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e---\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e7 (4.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e22 (1.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"12\" style=\"width: 913px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUsed new/sterilized syringe last month before the survey\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e369 (71.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e109 (26.0)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.029\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e18 (4.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.660\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e72 (9.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.090\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e55 (10.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e15 (29.4)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e0.9 (0.6-1.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e---\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e---\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e1 (1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e4 (3.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"12\" style=\"width: 913px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge of first drug injection\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u0026lt;18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e208 (39.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e32 (9.2)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e15 (7.2)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.050\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e28 (13.2)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.012\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e\u0026nbsp;18-24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e226 (43.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e68 (26.2)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e1.9 (1.3-2.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e0.9 (0.5-1.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e0.788\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e5 (2.2)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e52 (8.8)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e\u0026nbsp;25+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e88 (16.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e40 (58.8)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e3 (2-4.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e0.7 (0.3-2.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e0.575\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e4 (4.6)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e11 (3.1)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"12\" style=\"width: 913px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePrimary injectable drug **\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eHeroin\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e496 (95.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e133 (26.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e22 (4.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.370\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e91 (7.6)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 55px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e---\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eCocaine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e23 (4.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e5 (11.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e0.8 (0.4-1.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.646\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e---\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e---\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e2 (9.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e3 (0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e2.4 (1.1-5.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.031\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e---\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e---\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"12\" style=\"width: 913px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYears injecting drugs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e\u0026lt;1 year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e65 (12.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e8 (11.3)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e3 (4.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.954\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e11 (13.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.984\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e1-3 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e278 (54)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e58 (21.9)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e1.7 (0.9-3.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.122\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e1.7 (0.8-3.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e0.173\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e14 (5.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e50 (6.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e4-6 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e91 (17.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e30 (30.5)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e2.8 (1.4-5.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e1.6 (0.8-3.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e0.193\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e3 (3.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e15 (5.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e\u0026nbsp;7+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e81 (15.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e43 (63.1)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e4.5 (2.3-8.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e2 (0.9-4.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e0.085\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e4 (5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e15 (5.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"12\" style=\"width: 913px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eInjection frequency\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eNot injections\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e94 (18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e15 (16.3)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e5 (5.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.334\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e15 (16.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.662\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e\u0026nbsp;4 times a month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e42 (8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e6 (14.6)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e0.9 (0.4-2.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.808\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e0.7 (0.2-2.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e0.529\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e1 (2.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e5 (12.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e\u0026nbsp;2-7 times a week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e61 (11.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e11 (18.3)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e1.1 (0.6-2.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.745\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e0.7 (0.2-1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e0.433\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e6 (9.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e9 (14.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e\u0026nbsp;1-3 times a day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e291 (55.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e94 (33.1)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e2 (1.2-3.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e1.4 (0.6-3.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e0.388\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e11 (3.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e57 (19.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003e\u0026ge;5 times a day\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e35 (6.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e14 (40)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e2.5 (1.3-4.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e2.1 (0.7-6.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e0.203\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e1 (2.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e5 (14.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"12\" style=\"width: 913px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAccess to new syringe/needle\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eVery easy/Easy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e258 (60.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e70 (19.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.327\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 173px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e13 (5.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e0.604\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e53 (9.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\n \u003cp\u003e0.075\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eDifficult/Very difficult\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e171 (39.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e55 (32.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e1.2 (0.9-1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.274\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e---\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e---\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e6 (3.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e23 (5.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"12\" style=\"width: 913px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEver heard of naloxone?\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e52 (10.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e13 (14.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.959\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e2 (3.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 55px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e9 (16.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 55px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e467 (90.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e126 (26.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e1.1 (0.6-1.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.828\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e---\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e---\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e22 (4.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e80 (6.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"12\" style=\"width: 913px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReceived harm reduction services, past 12 months? \u0026yen;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e99 (18.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e26 (12.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 54px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e4 (4.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 55px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e13 (5.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.299\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e424 (81.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e114 (27.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e1 (0.7-1.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.905\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e---\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e---\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e20 (4.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e78 (5.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"12\" style=\"width: 913px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAccess to health services/peer educator, past 12 months\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e290 (55.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e95 (32.2)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e10 (3.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.257\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e49 (9.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.913\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e234 (44.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e45 (12.6)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e0.6 (0.4-0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e1 (0.7-1.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e0.949\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e14 (6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e42 (2.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"12\" style=\"width: 913px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHave you ever been pregnant\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e367 (70.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e113 (29.7)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.002\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e15 (4.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e62 (7.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.801\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e153 (29.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e27 (14.8)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e0.6 (0.4-0.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e1.1 (0.7-1.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e0.693\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e8 (5.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e28 (2.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"12\" style=\"width: 913px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSymptoms or signs of STI, past 12 months\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e289 (55.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e86 (30.6)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 54px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.056\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRef\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e15 (5.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.672\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e58 (8.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.112\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e228 (44.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e50 (13.6)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e0.7 (0.5-1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.047\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.8 (0.6-1)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.050\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e9 (4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e32 (2.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"12\" style=\"width: 913px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eExperience sexual violence, past 6 months\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e86 (16.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e26 (30.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.525\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e5 (5.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.574\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e13 (17.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.612\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e435 (83.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e113 (22.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e0.9 (0.6-1.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.434\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e---\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e---\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e19 (4.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e78 (6.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"12\" style=\"width: 913px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eExperience of discrimination, past 12 months\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e353 (67.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e86 (23.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 54px;\"\u003e\n \u003cp\u003e0.101\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003eRef\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 67px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e18 (5.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.566\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e65 (6.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 55px;\"\u003e\n \u003cp\u003e0.475\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 119px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e168 (32.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e54 (29.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e1.3 (1-1.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e0.078\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 89px;\"\u003e\n \u003cp\u003e1.1 (0.9-1.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 67px;\"\u003e\n \u003cp\u003e0.315\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 72px;\"\u003e\n \u003cp\u003e6 (3.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 89px;\"\u003e\n \u003cp\u003e26 (3.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u0026Dagger;\u003c/em\u003e\u003c/strong\u003e\u003cem\u003eExact Fisher test\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003e\u003csup\u003e\u0026yen;\u003c/sup\u003e\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e\u003cem\u003eAbscess treatment, overdose treatment, opioid substitution therapy with methadone, detoxification programme, rehabilitation\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOverall prevalence of HIV, HBsAg, HCV, and co-infections\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong the WWID, the weighted RDS results were used to estimate the prevalence of disease among the population, based on the sample of study participants. The estimate of HIV prevalence was 28.5% (140/513; 95% CI: 23.3\u0026ndash;33.9). Hepatitis B surface antigen (HBsAg) positivity, indicating current HBV infection, was detected in 4.3% (24/520; 95% CI: 2.2\u0026ndash;6.4), while hepatitis C virus (HCV) infection was identified in 17.9% (91/519; 95% CI: 13.9\u0026ndash;22.0) of participants.\u003c/p\u003e\n\u003cp\u003ePopulation-level estimates of co-infection showed that concurrent HIV and HBsAg positivity (HIV/HBV co-infection) was 0.9% (95% CI: 0.1\u0026ndash;1.7; 5/520 participants), and HIV/HCV co-infection was 4.7% (95% CI: 2.4\u0026ndash;7.0; 23/512 participants).Triple infection with HIV, HBV, and HCV was rare, with a population estimate of 0.2% (95% CI: 0.0\u0026ndash;0.4; 1/512 participants).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u0026nbsp;\u003c/strong\u003eWeighted prevalence of HIV, HBsAg positivity, HCV, and co-infections among women who inject drugs in Mozambique, 2023\u0026ndash;2024\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"573\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e\u003cstrong\u003en/N\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 139px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCrude Prevalence (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 157px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e% (95% CI): Weighted\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003eHIV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e140/513\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 139px;\"\u003e\n \u003cp\u003e27.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 157px;\"\u003e\n \u003cp\u003e28.5 (23.3\u0026ndash;33.9)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003eHBsAg positive (current HBV infection)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e24/520\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 139px;\"\u003e\n \u003cp\u003e4.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 157px;\"\u003e\n \u003cp\u003e\u0026nbsp;4.3 (2.2\u0026ndash;6.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003eHCV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e91/519\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 139px;\"\u003e\n \u003cp\u003e17.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 157px;\"\u003e\n \u003cp\u003e17.9 (13.9\u0026ndash;22.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003eHIV + HBsAg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e5/520\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 139px;\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 157px;\"\u003e\n \u003cp\u003e0.9 (0.1\u0026ndash;1.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003eHIV + HCV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e23/512\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 139px;\"\u003e\n \u003cp\u003e4.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 157px;\"\u003e\n \u003cp\u003e4.7 (2.4\u0026ndash;7.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003eHIV + HBsAg + HCV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 49px;\"\u003e\n \u003cp\u003e1/512\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 139px;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 157px;\"\u003e\n \u003cp\u003e0.2 (0.0\u0026ndash;0.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eHIV Care and Treatment Outcomes Compared to UNAIDS 95\u0026ndash;95\u0026ndash;95 Targets\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAmong WWID living with HIV in the study sample, 85.0% were aware of their HIV-positive status (first 95). Among those who were aware of their status, 86.6% reported current use of antiretroviral therapy (ART) (second 95). Among those on ART, 75.7% had viral load suppression (third 95). When considered cumulatively, these steps correspond to an estimated ~56% of all WWID living with HIV being virally suppressed overall, compared with the UNAIDS benchmark of approximately 86%.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study revealed a high prevalence of HIV (28.5%), HCV (17.9%), and, to a lesser extent, HBsAg (4.3%) among WWID in the studied areas in Mozambique (524), with significant geographic and sociodemographic variations. These findings underscore the disproportionate vulnerability of this population and highlight the urgent need for gender-responsive, integrated interventions aligned with global public health goals. The observed patterns mirror global evidence identifying people who inject drugs (PWID) as a high-risk group for HIV and viral hepatitis infection(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe HIV prevalence of 28.5% among WWID in Mozambique is almost double that of women in the general adult population (15%) and five times higher than the global median among PWID (5%) (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). Maputo showed the highest rate (51.8%), which may reflect its longer-established injecting networks, higher urban mobility, and overlap between sex work and injection drug use dynamics also documented in Johannesburg and Nairobi (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). In contrast, Quelimane and Nampula had significantly lower prevalences (13.3% and 19.6%, respectively), suggesting differences in drug use patterns, less mature drug markets, access to harm reduction services, or transmission dynamics.\u003c/p\u003e \u003cp\u003eHIV prevalence among participants was strongly correlated with age, educational attainment, and housing stability. The increasing prevalence with age reflects cumulative exposure and vulnerability over time, combining longer injecting trajectories, repeated sexual exposures, and interrupted access to care. This pattern mirrors findings across sub-Saharan Africa, where HIV prevalence among PWID rises sharply with duration of injection (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e). Lower education and unstable housing emerged as key structural determinants: women with limited education and no fixed residence had substantially higher HIV prevalence. These results align with evidence showing that educational disadvantage and homelessness amplify vulnerability through reduced health literacy, economic precarity (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e), amplify exposure within high-risk injection and sexual networks and limited access to prevention and treatment services (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eNo significant associations were found with traditional behavioral indicators such as syringe sharing, likely reflecting social desirability bias, underreporting, or recent exposure to harm-reduction interventions whose coverage remains insufficient to produce population-level effects. The association between STI symptoms and HIV infection likely reflects health-seeking behavior among symptomatic women, suggesting that those who access STI care are also more likely to be tested for HIV. This underscores the potential of integrated sexual and reproductive health (SRH) services as a gateway to HIV prevention and treatment (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe prevalence of HCV (17.9%) was lower than the African average among PWID (38%) (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e), but remains concerning, especially in Beira (48.1%) and Nampula (29.5%), where intensive heroin injection networks have been previously reported (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). This geographic clustering suggests that HCV transmission in Mozambique may be at an earlier stage of diffusion compared with West and Central Africa, where endemic HCV infection among PWID often exceeds 40% (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e, \u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). The concentration of cases in specific urban corridors likely reflects limited harm-reduction coverage, reuse of injecting equipment, and overlapping sex- and drug-related risk networks.\u003c/p\u003e \u003cp\u003eThe findings of HBsAg positivity varied by location (Tete and Beira with higher proportions, and absence in Maputo), highlighting regional differences in HBV circulation. This is consistent with the heterogeneity observed in other studies that identify subnational disparities in HBV among high-risk populations (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e). The association between early sexual debut and HBV infection aligns with the known efficiency of sexual transmission of hepatitis B in high-risk populations.\u003c/p\u003e \u003cp\u003eDespite the encouraging finding that 85% of HIV-positive WWID were aware of their status, only half were receiving ART and less than one in three achieved viral suppression. This steep attrition along the HIV care continuum exposes systemic barriers such as stigma, criminalization of drug use, gender-based violence, and fragmentation of services (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e, \u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e). These barriers restrict consistent engagement with care and undermine viral suppression efforts. Addressing these gaps requires integrating ART delivery with harm-reduction programs, HCV/HBV testing and treatment, and psychosocial support services tailored to women\u0026rsquo;s experiences of trauma, pregnancy, and caregiving responsibilities. Achieving the UNAIDS 95\u0026ndash;95\u0026ndash;95 targets among WWID will depend on shifting from purely biomedical interventions toward gender-sensitive, community-based, and trauma-informed models of care. Viral suppression, in this context, should be seen as a measure of health-system equity and resilience, not merely a clinical outcome.\u003c/p\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eLimitations\u003c/h2\u003e \u003cp\u003eThis study has several limitations that need to be acknowledged. First, its cross-sectional design precludes causal inference; observed associations between sociodemographic factors, behavioral indicators, and HIV, HBsAg, or HCV status should be interpreted as correlational rather than causal. Second, recruitment used RDS, which is appropriate for hidden and criminalized populations but may still under-represent subgroups of WWID who are less socially networked, more mobile, or more isolated by violence and stigma. As such, even the high prevalence estimates reported here may be conservative. Third, behavioral indicators (e.g., condom use, syringe sharing, number of partners) were based on self-report and therefore subject to recall bias and social desirability bias, particularly in a context of criminalization of drug use and sex work. Fourth, hepatitis B infection was defined using HBsAg rapid testing, which identifies current infection but does not distinguish acute from chronic infection, and HCV status was based on a rapid antibody test without confirmatory RNA testing; these constraints may lead to misclassification of infection stage and transmissibility. Finally, although we present weighted prevalence estimates to account for the RDS design, the multivariable analysis was conducted unweighted, consistent with evidence that unweighted regression often performs better in terms of bias and stability in RDS studies; however, this choice may limit direct comparability with other RDS-weighted analyses. Despite these limitations, this study provides rare, policy-relevant evidence on WWID in Mozambique, a population largely invisible in routine surveillance.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study demonstrates a high burden of HIV, HCV, and HBsAg positivity among WWID in Mozambique, with clear geographic and sociodemographic disparities. The findings reveal how prolonged drug use, low educational attainment, housing instability, and limited access to healthcare converge to create multi-layered and cumulative vulnerability among WWID. These structural and social determinants of health compound biological risks, perpetuating gender and economic inequities that sustain the epidemics of HIV, HBV, and HCV. Addressing these overlapping challenges requires integrated, gender-responsive, and trauma-informed strategies. Priority actions should include expanding harm reduction interventions, and integrating diagnosis and treatment for HIV, HBV, and HCV within a unified continuum of care. Additionally, reducing stigma, criminalization, and gender-based violence remains fundamental to ensuring service uptake and retention in care. Without immediate, targeted, and sustained investment, these intertwined epidemics will continue to fuel health inequities and undermine Mozambique\u0026rsquo;s progress toward epidemic control. Conversely, implementing an inclusive, multisectoral public health response that prioritizes WWID will not only improve individual and population-level outcomes but also represent a tangible step toward achieving the Sustainable Development Goal of ending AIDS and viral hepatitis as public health threats by 2030.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eART- Antiretroviral Therapy\u003c/p\u003e\n\u003cp\u003eAUDIT-C - Alcohol consumption was assessed using the Alcohol Use Disorders Identification Test \u0026ndash; Consumption\u003c/p\u003e\n\u003cp\u003eHBsAg- Hepatitis B Surface Antigen\u003c/p\u003e\n\u003cp\u003eHBV- Hepatitis B\u003c/p\u003e\n\u003cp\u003eHCV- Hepatitis C\u003c/p\u003e\n\u003cp\u003eHIV- Human Immunodeficiency Virus\u003c/p\u003e\n\u003cp\u003ePWID- People Who Inject Drugs\u003c/p\u003e\n\u003cp\u003eRDS- Respondent-Driven Sampling\u003c/p\u003e\n\u003cp\u003eSTI- Sexually Transmitted Infections\u003c/p\u003e\n\u003cp\u003eUNAIDS - The Joint United Nations Program on HIV/AIDS\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWWID- Women Who Inject Drugs\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study protocol was reviewed and approved by the Ethics Review Board of the Institutional Ethics Committee of the National Institute of Health (CIE-INS) under reference 097/CIBS-INS/2022, and by the National Bioethics Committee for Health in Mozambique (CNBS) under references 877/CNBS/22 and 690/CNBS/2023. The study was conducted in accordance with the Declaration of Helsinki and relevant national regulations. All participants provided written informed consent prior to participation. Participants aged 16\u0026ndash;17 years were considered emancipated minors according to Mozambican regulations, and the CNBS exceptionally authorized the waiver of parental or guardian consent. These minors provided their consent using the same process applied to participants aged 18 years or older, with all necessary explanations to ensure understanding. No identifying information was collected, and measures were taken to protect participants\u0026rsquo; privacy and safety\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable. No individual-level identifiable data are presented in this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll study datasets are accessible in the Mozambique National Institute of Health (INS) data repository for researchers who meet the criteria for access to confidential data. The data comes from the second round of the study on BBS among PWIDs, and the authors can be contacted at: https://ins.gov.mz/institucional/unidade-organicas/direccoes/direccao-de-inqueritos-e-observacao- de-saude/data-bases/Availability of data and materials. The analysis code used in this study is publicly available at: https://github.com/RachidMuleia/HIV-prevalence-among-WWID.git.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis manuscript used data from research supported by the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund). The funder had no role in the study design, data collection, data analysis, data interpretation, or writing of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eARB elaborated the manuscript, coordinated all survey activities from study design, implementation and dissemination, and supervised data collection in the field. RM supervised data collection and performed quantitative analyses. SN, SGS, IC and CSB reviewed and approved all drafts and the final manuscript. \u0026nbsp;All authors reviewed and approved all drafts and the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors extend their gratitude to all individuals who contributed to the planning, execution, analysis, and dissemination of the results, including investigators, study teams, Technical Working Groups, Non-Governmental Organizations, members of civil society, and the National HIV/STD program.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eHIV and people who inject drugs \u0026mdash; Thematic briefing note \u0026mdash; 2024 global AIDS update The Urgency of Now: AIDS at a Crossroads | UNAIDS [Internet]. [cited 2025 Mar 15]. 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Available from: https://doi.org/10.1186/s12879-025-11655-2\u003c/li\u003e\n\u003cli\u003eAkiyama MJ, Cleland CM, Lizcano JA, Cherutich P, Kurth AE. Prevalence, estimated incidence, risk behaviours, and genotypic distribution of hepatitis C virus among people who inject drugs accessing harm-reduction services in Kenya: a retrospective cohort study. Lancet Infect Dis [Internet]. 2019 Nov [cited 2025 Nov 9];19(11):1255\u0026ndash;63. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC7099605/\u003c/li\u003e\n\u003cli\u003eMabunda N, Vieira L, Chelene I, Maueia C, Zicai AF, Duaj\u0026aacute; A, et al. Prevalence of hepatitis B virus and immunity status among healthcare workers in Beira City, Mozambique. PLoS ONE [Internet]. 2022 Oct 14 [cited 2026 Jan 13];17(10):e0276283. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC9565706/\u003c/li\u003e\n\u003cli\u003eABDOOL KARIM SS, COOVADIA HM, WINDSOR IM, THEJPAL R, VAN DEN ENDE J, FOUCHE A. The Prevalence and Transmission of Hepatitis B Virus Infection in Urban, Rural and Institutionalized Black Children of Natal/KwaZulu, South Africa. Int J Epidemiol [Internet]. 1988 Mar 1 [cited 2026 Jan 13];17(1):168\u0026ndash;73. Available from: https://doi.org/10.1093/ije/17.1.168\u003c/li\u003e\n\u003cli\u003eViisainen K, Baumgart Dos Santos M, Sunderbrink U, Couto A. Gender and stigma in antiretroviral treatment adherence in Mozambique: A qualitative study. PLOS Glob Public Health. 2024;4(7):e0003166. \u003cstrong\u003e\u003c/strong\u003e\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"HIV, hepatitis, injecting drug use, harm reduction, women's health, Mozambique","lastPublishedDoi":"10.21203/rs.3.rs-8679000/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8679000/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eWomen who inject drugs (WWID) are disproportionately affected by HIV and viral hepatitis, yet data on prevalence and risk factors in Mozambique remain scarce. This study aimed to estimate the prevalence of Human Immunodeficiency Virus (HIV), Hepatitis B surface antigen (HBsAg), and Hepatitis C (HCV) among WWID and to identify associated sociodemographic and behavioral risk factors.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA cross-sectional biological and behavioral survey was conducted among 524 WWID in five Mozambican cities (Maputo, Beira, Tete, Quelimane, Nampula) between July 2023 and March 2024, using respondent-driven sampling (RDS). Participants completed structured questionnaires and underwent rapid testing for HIV, HBV, and HCV. RDS-weighted prevalence estimates were calculated for all outcomes. Modified Poisson regression with robust standard errors was used to identify factors associated with HIV infection.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe weighted prevalence was 28.5% (95% CI: 23.3\u0026ndash;33.9) for HIV, 4.3% (95% CI: 2.2\u0026ndash;6.4) for HBsAg positivity, and 17.9% (95% CI: 13.9\u0026ndash;22.0) for HCV. HIV prevalence increased markedly with age and duration of injection and was highest in Maputo City. In adjusted analyses, compared to those aged 16\u0026ndash;17, older age (\u0026ge;\u0026thinsp;35 years; aRR\u0026thinsp;=\u0026thinsp;13.8; 95% CI: 4.7\u0026ndash;40.8), longer injecting duration (\u0026ge;\u0026thinsp;7 years), and residence in Maputo were independently associated with HIV infection, while secondary or higher education and absence of recent STI symptoms were protective. Among WWID living with HIV, 85.0% were aware of their status, 86.6% of those aware were on antiretroviral therapy, and 75.7% of those on treatment were virally suppressed.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eWWID in Mozambique face a high burden of HIV and HCV, with significant geographic disparities. Losses along with the HIV care continuum, particularly gaps in retention and viral suppression, highlight critical issues in sustained treatment and adherence access rather than initial diagnosis. Urgent interventions integrating harm reduction, gender-sensitive HIV/HCV services, and targeted prevention in high-burden areas are needed.\u003c/p\u003e","manuscriptTitle":"Prevalence and Risk Factors of HIV, HBV, and HCV Among Women Who Inject Drugs in Five Mozambican Cities: A Cross-Sectional Biological and Behavioral Survey, 2023–2024","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-25 08:56:11","doi":"10.21203/rs.3.rs-8679000/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-13T03:26:43+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-12T01:25:14+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-07T23:07:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"118746615043915403525159158463188565720","date":"2026-02-24T00:11:15+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-23T05:07:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"96724871058298103279176860120182692948","date":"2026-02-23T01:15:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"301555867977540428546399752187598528404","date":"2026-02-22T16:16:14+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"151152977697817009361978811514277256634","date":"2026-02-20T06:14:35+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"146974301415037141009052505098728454690","date":"2026-02-19T15:14:37+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-19T14:42:34+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-11T15:46:21+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-09T08:09:30+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-08T15:55:29+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2026-02-08T15:48:08+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e9f2d1e8-fd65-472d-8778-2d348b90c78f","owner":[],"postedDate":"February 25th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-03-13T03:38:59+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-25 08:56:11","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8679000","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8679000","identity":"rs-8679000","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}