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Chayama KL, Ng C, Fleming T, Small W, Sue KL, McNeil R. Housing-based syringe services programs to improve access to safer injecting equipment for people who inject drugs in Vancouver, Canada: a spatially oriented qualitative study. Harm Reduct J 2023; 20:126. [PMID: 37679789 PMCID: PMC10483728 DOI: 10.1186/s12954-023-00862-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 08/27/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Housing environments shape injection drug-related risks and harms and thus represent a critical implementation setting for syringe services programs (SSPs). As critical harm reduction measures, SSPs provide safe injecting equipment to people who inject drugs (PWID). Vancouver, Canada, has well-established syringe distribution programs through which PWID have low-threshold access to unlimited syringes and related injecting equipment, including through non-profit operated supportive housing and single-room occupancy hotels. This study examines the role of housing-based SSPs in distributing injecting equipment to PWID in Vancouver. METHODS Between January and March 2020, semi-structured, in-depth interviews were conducted in Vancouver with 26 PWID. Interviews were audio-recorded, transcribed, and coded. Salient themes were identified using inductive and deductive approaches. RESULTS Many participants accessed SSPs in housing facilities and expressed preference for these programs over those offered at other locations and through other health and social services. Three major themes emerged to explain this preference. First, most participants injected in the buildings where they resided, and housing-based SSPs made injecting equipment available when and where it was most needed. Second, many participants preferred to avoid carrying syringes outside of the places where they inject due to fears that syringe possession may lead to criminal charges or confiscation of syringes and/or illicit drugs by police. Third, for some participants, anti-drug user stigma and concerns over unwillingly disclosing their drug use hindered access to SSPs outside of housing settings. Programs operated within housing facilities often offered greater client anonymity along with more supportive and less stigmatizing environments, particularly in the presence of peer staff. CONCLUSION The current study advances understanding of access to injecting equipment in a setting with city-wide syringe distribution programs. Our findings underscore the benefits of housing-based SSPs and encourage the expansion of such services to maximize access to harm reduction supports for PWID.
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Affiliation(s)
- Koharu Loulou Chayama
- British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, Canada
- Interdisciplinary Studies Graduate Program, University of British Columbia, 6371 Crescent Road, Vancouver, Canada
| | - Cara Ng
- British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, Canada
| | - Taylor Fleming
- British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, Canada
- Interdisciplinary Studies Graduate Program, University of British Columbia, 6371 Crescent Road, Vancouver, Canada
| | - Will Small
- British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, Canada
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, Canada
| | - Kimberly L Sue
- Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, 06520, USA
- Department of Internal Medicine, Yale School of Medicine, 333 Cedar Street, New Haven, USA
| | - Ryan McNeil
- British Columbia Centre on Substance Use, 1045 Howe Street, Vancouver, Canada.
- Program in Addiction Medicine, Yale School of Medicine, New Haven, CT, 06520, USA.
- Department of Internal Medicine, Yale School of Medicine, 333 Cedar Street, New Haven, USA.
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Holeksa J. Dealing with low access to harm reduction: a qualitative study of the strategies and risk environments of people who use drugs in a small Swedish city. Harm Reduct J 2022; 19:23. [PMID: 35246162 PMCID: PMC8894830 DOI: 10.1186/s12954-022-00602-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 02/17/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The development of harm reduction has been limited in many areas of Sweden. This study aims to understand the implications that this has for the life circumstances and risk management of people who use drugs in areas of low access. METHODS Eleven qualitative, semi-structured interviews were undertaken with people who use drugs in a small urban centre with no needle and syringe exchange program (NSP) or Housing First policy. RESULTS Participants reported many solutions to lack of NSP, including travel to an external NSP, creating bridging distribution networks, stealing, borrowing, reusing, ordering online, and smuggling injection equipment. They were at risk of having their equipment confiscated by police. Participants were mostly homeless, and to address exclusion from housing services, were forced to frequently find new temporary solutions, sheltering themselves in public places, with friends, in cars, among others. Participants felt the lack of services reflected stigmatized notions of drug use and heightened their exclusion from general society. For example, they avoided accessing other health care services for fear of discrimination. These issues caused high levels of stress and anxiety, in addition to serious risk for many somatic and psychological health conditions, including HIV and HCV transmission. CONCLUSION Lack of harm reduction services placed a great burden on study participants to develop strategies due to gaps in official programming. It also contributes to a vicious cycle of exclusion from services. The implementation of such evidence-based programs will reduce this burden, as well as provide the indirect, symbolic effect of inclusion.
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Affiliation(s)
- Julie Holeksa
- Department of Social Work, Faculty of Health and Society, Malmö University, Citadellsvägen 7, 211 18, Malmö, Sweden.
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3
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Marotta PL, Stringer K, Beletsky L, West BS, Goddard-Eckrich D, Gilbert L, Hunt T, Wu E, El-Bassel N. Assessing the relationship between syringe exchange, pharmacy, and street sources of accessing syringes and injection drug use behavior in a pooled nationally representative sample of people who inject drugs in the United States from 2002 to 2019. Harm Reduct J 2021; 18:115. [PMID: 34789270 PMCID: PMC8600731 DOI: 10.1186/s12954-021-00565-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 11/03/2021] [Indexed: 11/10/2022] Open
Abstract
Provision of sterile syringes is an evidence-based strategy of reducing syringe sharing and reusing and yet, access to sterile syringes through pharmacies and syringe exchange programs (SEPs) in the United States remains inadequate. This nationally representative study examined associations between obtaining syringes from pharmacies, SEPs, and sterilizing syringes with bleach and risk of syringe borrowing, lending and reusing syringes in a pooled cross-sectional dataset of 1737 PWID from the 2002-2019 National Survey on Drug Use and Health. Logistic regression was used to produce odds ratios (OR) of the odds of injection drug behaviors after adjusting for obtaining syringes from SEPs, pharmacies, the street, and other sources and potential confounders of race, ethnicity, sex, education, and insurance coverage. Obtaining syringes through SEPs was associated with lower odds of borrowing (OR = .4, CI95% = .2, .9, p = .022) and reusing syringes (OR = .3, CI95% = .2, .6, < .001) compared to obtaining syringes on the street. Obtaining syringes from pharmacies was associated with lower odds of borrowing (OR = .5, CI95% = .3, .9, p = .037) and lending (OR = .5 CI95% = .3, .9, p = .020) syringes. Using bleach to clean syringes was associated with increased odds of borrowing (OR = 2.0, CI95% = 1.3, 3.0, p = .002), lending (OR = 2.0, CI95% = 1.3, 3.0, p = .002) and reusing syringes (OR = 2.4, CI95% = 1.6, 3.6, p < .001). Our findings support provision of syringes through pharmacies and SEPs as a gold-standard strategy of reducing sharing and reuse of syringes in the US.
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Affiliation(s)
- Phillip L Marotta
- Brown School, Washington University in St. Louis, St. Louis, MO, 63130, USA.
- School of Social Work, Columbia University, New York, NY, 10027, USA.
- Northeastern University, Boston, MA, 02115, USA.
| | - Kristi Stringer
- Brown School, Washington University in St. Louis, St. Louis, MO, 63130, USA
- School of Social Work, Columbia University, New York, NY, 10027, USA
- Northeastern University, Boston, MA, 02115, USA
| | - Leo Beletsky
- Brown School, Washington University in St. Louis, St. Louis, MO, 63130, USA
- School of Social Work, Columbia University, New York, NY, 10027, USA
- Northeastern University, Boston, MA, 02115, USA
| | - Brooke S West
- Brown School, Washington University in St. Louis, St. Louis, MO, 63130, USA
- School of Social Work, Columbia University, New York, NY, 10027, USA
- Northeastern University, Boston, MA, 02115, USA
| | - Dawn Goddard-Eckrich
- Brown School, Washington University in St. Louis, St. Louis, MO, 63130, USA
- School of Social Work, Columbia University, New York, NY, 10027, USA
- Northeastern University, Boston, MA, 02115, USA
| | - Louisa Gilbert
- Brown School, Washington University in St. Louis, St. Louis, MO, 63130, USA
- School of Social Work, Columbia University, New York, NY, 10027, USA
- Northeastern University, Boston, MA, 02115, USA
| | - Tim Hunt
- Brown School, Washington University in St. Louis, St. Louis, MO, 63130, USA
- School of Social Work, Columbia University, New York, NY, 10027, USA
- Northeastern University, Boston, MA, 02115, USA
| | - Elwin Wu
- Brown School, Washington University in St. Louis, St. Louis, MO, 63130, USA
- School of Social Work, Columbia University, New York, NY, 10027, USA
- Northeastern University, Boston, MA, 02115, USA
| | - Nabila El-Bassel
- Brown School, Washington University in St. Louis, St. Louis, MO, 63130, USA
- School of Social Work, Columbia University, New York, NY, 10027, USA
- Northeastern University, Boston, MA, 02115, USA
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4
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Høj SB, Jacka B, Minoyan N, Bussière P, Bruneau J. Deconstructing the 'cheque effect': short-term changes in injection drug use after receiving income assistance and associated factors. Addiction 2021; 116:571-582. [PMID: 32649010 DOI: 10.1111/add.15192] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 12/17/2019] [Accepted: 07/08/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND AND AIMS Disbursement of income assistance has been temporally associated with intensified drug use and related harms (coined the 'cheque effect'). However, relationships to injection drug use (IDU) remain understudied. We examined short-term 'cheque effects' and associated factors among people who inject drugs (PWID). DESIGN Cross-sectional analysis nested within a cohort study. SETTING Montreal, Quebec, Canada. PARTICIPANTS PWID receiving income assistance, with no employment income. A total of 613 PWID (median age 41, 83% male) contributed 3269 observations from 2011 to 2017. MEASUREMENTS AND METHODS At each cohort visit, an interviewer-administered questionnaire captured retrospective reports of injection-related behaviour during the 2-day periods (i) before and (ii) including/after receiving last month's income assistance payment (number of injections; drugs injected; any receptive syringe-sharing). The relative likelihood (odds) and magnitude (rate) of an increase in injection frequency ('cheque effect') were estimated in relation to social and behavioural factors using logistic and negative binomial regression in a covariate-adjusted two-part model. FINDINGS Prevalence of IDU and syringe-sharing were, respectively, 1.80 and 2.50 times higher in the days following versus preceding cheque receipt (P < 0.001). Among people with past-month IDU, most observations showed increased injection frequency (52%) or no change in injection frequency (44%). The likelihood of a 'cheque effect' was positively associated with cocaine injection [versus injection of other substances, odds ratio (OR) = 2.639, 95% confidence interval (CI) = 2.04-3.41], unstable housing (OR = 1.272, 95% CI = 1.03-1.57) and receiving opioid agonist therapy (OR =1.597, 95% CI = 1.27-2.00) during the same month. Magnitude of the 'cheque effect' was positively associated with cocaine injection [rate ratio (RR) = 1.795, 95% CI = 1.43-2.16], unstable housing (RR = 1.198, 95% CI = 1.02-1.38) and frequent injection (RR = 2.938, 95% CI = 2.43-3.44), but inversely associated with opioid agonist therapy (RR = 0.817, 95% CI = 0.68-0.95) and prescription opioid injection (RR = 0.794, 95% CI = 0.66-0.93). CONCLUSION Among people who inject drugs in Montreal, Canada, injection drug use and receptive syringe-sharing appear to be more prevalent in the 2 days after versus before receiving income assistance. The odds and rate of individual-level increases in injection frequency appear to be positively associated with cocaine injection (versus injection of other substances) and unstable housing.
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Affiliation(s)
- Stine Bordier Høj
- Research Centre, Centre Hospitalier de l'Université de Montréal, Montréal, Canada
| | - Brendan Jacka
- Research Centre, Centre Hospitalier de l'Université de Montréal, Montréal, Canada
| | - Nanor Minoyan
- Research Centre, Centre Hospitalier de l'Université de Montréal, Montréal, Canada.,Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montréal, Canada
| | - Phélix Bussière
- Research Centre, Centre Hospitalier de l'Université de Montréal, Montréal, Canada
| | - Julie Bruneau
- Research Centre, Centre Hospitalier de l'Université de Montréal, Montréal, Canada.,Department of Family and Emergency Medicine, Université de Montréal, Montréal, Canada
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5
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Rezaei O, Ghiasvand H, Higgs P, Noroozi A, Noroozi M, Rezaei F, Armoon B, Bayani A. Factors associated with injecting-related risk behaviors among people who inject drugs: a systematic review and meta-analysis study. J Addict Dis 2020; 38:420-437. [DOI: 10.1080/10550887.2020.1781346] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Omid Rezaei
- Fellowship of Psychosomatic, Department of Psychiatry, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Hesam Ghiasvand
- Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
- Health Economics Group, Medical School, Saint Luke’s Campus, University of Exeter, Exeter, UK
| | - Peter Higgs
- Department of Public Health, La Trobe University, Melbourne, Australia
| | - Alireza Noroozi
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
- Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Noroozi
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Fatemeh Rezaei
- Department of Epidemiology and Biostatics, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Bahram Armoon
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Azadeh Bayani
- Student Research Committee, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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6
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Cheng T, Small W, Nosova E, Hogg R, Hayashi K, Kerr T, DeBeck K. Overdose Risk and Acquiring Opioids for Nonmedical Use Exclusively from Physicians in Vancouver, Canada. Subst Use Misuse 2020; 55:1912-1918. [PMID: 32589497 PMCID: PMC7480281 DOI: 10.1080/10826084.2020.1781176] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND A primary response to the alarming rise in overdose and mortality due to nonmedical prescription opioid (PO) use has been to restrict opioid prescribing; however, little is known about the relationship between obtaining opioids from a physician and overdose risk among people who use POs nonmedically and illicit street drugs. Objectives: Investigate the relationship between non-fatal overdose and acquiring POs exclusively from physicians for the purposes of engaging in nonmedical PO use. Methods: Data were collected between 2013 and 2016 among participants in two harmonized prospective cohort studies of people who use drugs in Vancouver: the At-Risk Youth Study (ARYS) and the Vancouver Injection Drug Users Study (VIDUS). Analyses were restricted to participants who engaged in nonmedical PO use and used generalized estimating equations. Results: Among 599 participants who used POs nonmedically, 82 (14%) individuals reported acquiring POs exclusively from a physician and 197 (33%) experienced a non-fatal overdose at some point over the study period. Acquiring POs exclusively from physicians was significantly and negatively associated with non-fatal overdose in the bivariate analysis (Odds Ratio = 0.60, 95% Confidence Interval (CI): 0.39-0.94) but not the final multivariate analysis (Adjusted Odds Ratio =0.87, 95% CI: 0.53-1.44). Conclusions: Compared to individuals who acquired POs from friends or the streets, participants who acquired POs exclusively from a physician were not at an increased risk of non-fatal overdose. Although responsible opioid prescribing is an important priority, additional strategies to address nonmedical PO use are urgently needed to reduce overdose and related morbidity and mortality.
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Affiliation(s)
- Tessa Cheng
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, BC, Canada, V5A 1S6
- British Columbia Centre on Substance Use, 400-1045 Howe St, Vancouver, BC Canada, V6Z 2A9
| | - Will Small
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, BC, Canada, V5A 1S6
- British Columbia Centre on Substance Use, 400-1045 Howe St, Vancouver, BC Canada, V6Z 2A9
- Centre for Applied Research in Mental Health and Addiction, SFU Faculty of Health Sciences, 515 W. Hastings Street, Vancouver, BC, Canada, V6B 5K3
| | - Ekaterina Nosova
- British Columbia Centre on Substance Use, 400-1045 Howe St, Vancouver, BC Canada, V6Z 2A9
- Faculty of Medicine, University of British Columbia, 317 – 2194 Health Sciences Mall, Vancouver, BC, Canada, V6T 1Z3
| | - Robert Hogg
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, BC, Canada, V5A 1S6
- BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, B.C., Canada, V6Z 1Y6
| | - Kanna Hayashi
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, BC, Canada, V5A 1S6
- British Columbia Centre on Substance Use, 400-1045 Howe St, Vancouver, BC Canada, V6Z 2A9
| | - Thomas Kerr
- British Columbia Centre on Substance Use, 400-1045 Howe St, Vancouver, BC Canada, V6Z 2A9
- Faculty of Medicine, University of British Columbia, 317 – 2194 Health Sciences Mall, Vancouver, BC, Canada, V6T 1Z3
| | - Kora DeBeck
- British Columbia Centre on Substance Use, 400-1045 Howe St, Vancouver, BC Canada, V6Z 2A9
- School of Public Policy, Simon Fraser University, 515 West Hastings Street, Suite 3271, Vancouver, BC, Canada, V6B 5K3
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7
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Ready E, Habecker P, Abadie R, Khan B, Dombrowski K. Competing forces of withdrawal and disease avoidance in the risk networks of people who inject drugs. PLoS One 2020; 15:e0235124. [PMID: 32569332 PMCID: PMC7307734 DOI: 10.1371/journal.pone.0235124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 06/09/2020] [Indexed: 11/19/2022] Open
Abstract
We analyze a network of needle-sharing ties among 117 people who inject drugs (PWID) in rural Puerto Rico, using exponential random graph modeling to examine whether network members engage in partner restriction to lower their risk of contracting HIV or hepatitis C (HCV), or in informed altruism to prevent others from contracting these infections. Although sharing of used syringes is a significant risk factor for transmission of these diseases among PWID, we find limited evidence for partner restriction or informed altruism in the network of reported needle-sharing ties. We find however that sharing of needles is strongly reciprocal, and individuals with higher injection frequency are more likely to have injected with a used needle. Drawing on our ethnographic work, we discuss how the network structures we observe may relate to a decision-making rationale focused on avoiding withdrawal sickness, which leads to risk-taking behaviors in this poor, rural context where economic considerations often lead PWID to cooperate in the acquisition and use of drugs.
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Affiliation(s)
- Elspeth Ready
- Department of Human Behavior, Ecology and Culture, Max Planck Institute for Evolutionary Anthropology, Leipzig, Germany
- Department of Anthropology, University of Florida, Gainesville, Florida, United States of America
- * E-mail:
| | - Patrick Habecker
- Department of Sociology, University of Nebraska-Lincoln, Lincoln, Nebraska, United States of America
| | - Roberto Abadie
- Department of Sociology, University of Nebraska-Lincoln, Lincoln, Nebraska, United States of America
| | - Bilal Khan
- Department of Sociology, University of Nebraska-Lincoln, Lincoln, Nebraska, United States of America
| | - Kirk Dombrowski
- VP Research Admin Office, University of Vermont, Burlington, Vermont, United States of America
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8
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Kåberg M, Karlsson N, Discacciati A, Widgren K, Weiland O, Ekström AM, Hammarberg A. Significant decrease in injection risk behaviours among participants in a needle exchange programme. Infect Dis (Lond) 2020; 52:336-346. [PMID: 32072841 DOI: 10.1080/23744235.2020.1727002] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background and aims: Sharing of unsterile injection equipment contributes to transmission of hepatitis C virus (HCV), HIV and hepatitis B virus (HBV) among people who inject drugs (PWID) but is largely preventable through needle exchange programmes (NEP). Sweden has been one of the last countries in Europe to scale up access to NEP for PWID, who consequently have high prevalence rates of HCV and HIV. The aim of the study was to investigate demographic and drug-related determinants of injection risk behaviours, sharing of needle/syringe and paraphernalia, and patterns of change over time in subgroups of PWID participating in the Stockholm NEP.Methods: The Stockholm NEP started in 2013 as the first formal NEP in the region. A total of 2860 PWID were included in this prospective open cohort study. The association between demographic and drug-related determinants and injection risk behaviours were analysed at baseline and followed up at 6, 12, 24, 36 and 48 months post-enrolment.Results: The following factors were associated with high levels of injection risk behaviours at inclusion: female gender, homelessness, low education level, younger age, amphetamine use, not in opioid substitution therapy (OST), being HIV negative and being HCV positive. We found an overall significant decrease in injection risk behaviours over time among participants. Not previously investigated in depth, we found that subgroups of participants varied in degrees of injection risk behaviour reduction over time and that women decreased injection risk behaviours faster than men. Enrolment in OST, HIV positive and age <25 years at inclusion were not associated with a decrease in injection risk behaviours over time.Conclusions: In this prospective cohort study over 4 years, we found that NEP participation was associated with a significant decrease in injection risk behaviours.
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Affiliation(s)
- Martin Kåberg
- Department of Medicine Huddinge, Division of Infection and Dermatology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden.,Stockholm Needle Exchange, Stockholm Centre for Dependency Disorders, Stockholm, Sweden
| | - Niklas Karlsson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.,Department of Monitoring and Evaluation, Public Health Agency of Sweden, Stockholm, Sweden
| | - Andrea Discacciati
- Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Katarina Widgren
- Department of Medicine Huddinge, Division of Infection and Dermatology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden.,Department of Monitoring and Evaluation, Public Health Agency of Sweden, Stockholm, Sweden
| | - Ola Weiland
- Department of Medicine Huddinge, Division of Infection and Dermatology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Anna Mia Ekström
- Department of Medicine Huddinge, Division of Infection and Dermatology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden.,Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Anders Hammarberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Stockholm Centre for Dependency Disorders, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
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9
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Employment Cessation, Long Term Labour Market Engagement and HIV Infection Risk Among People Who Inject Drugs in an Urban Canadian Setting. AIDS Behav 2019; 23:3267-3276. [PMID: 30924066 DOI: 10.1007/s10461-019-02472-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The potential for changes in socio-economic status, such as employment exits, to increase HIV infection risk are not well examined among people who inject illicit drugs (PWID). We used longstanding cohort data from Vancouver, Canada, to longitudinally assess associations between employment cessation and outcomes with documented linkages to HIV infection risk among PWID. From 2005 to 2015, 1222 participants reported 1154 employment exits. Employment exits were significantly associated with transitions into unstable housing; moving to the inner-city; initiating informal, prohibited or illegal income generation; high risk drug use practices; and exiting methadone maintenance therapy. HIV infection rates were higher among participants with lower long-term labour market engagement. These findings suggest that employment cessation coincides with initiating exposure to aspects of socioeconomic marginalization and drug use associated with HIV infection risk. Support for employment retention that prevents poverty entrenchment and harmful drug use could contribute to HIV prevention measures for PWID.
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10
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An Exploration of Factors Impacting Preexposure Prophylaxis Eligibility and Access Among Syringe Exchange Users. Sex Transm Dis 2019; 45:217-221. [PMID: 29465703 DOI: 10.1097/olq.0000000000000728] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND In 2015, approximately 50,000 new HIV infections occurred in the United States, 2,400 of which were attributable to injection drug use. Preexposure prophylaxis (PrEP) has the potential to curb HIV acquisition; however, uptake remains low among persons who inject drugs (PWID). The purpose of the study is to describe PrEP eligibility, willingness to use PrEP, and ability to access PrEP among PWID recruited from a pilot program that paired screening and treatment of sexually transmitted infections with mobile syringe exchange program (SEP) services. METHODS Between 2015 and 2016, 138 PWID 18 years or older were recruited from a mobile SEP in Camden, New Jersey. Participants completed a survey assessing sociodemographics and HIV risk and underwent chlamydia and gonorrhea screening. Centers for Disease Control clinical guidelines were used to calculate PrEP eligibility. Differences by sex were examined using inferential statistics. RESULTS Most women (95.4%) and men (84.5%) were considered PrEP eligible (P < 0.04). More women than men were willing to take PrEP (88.9% vs. 71.0%; P < 0.02). Participants reported substantial barriers to PrEP including feeling embarrassed (45.0%) or anxious (51.6%) about taking PrEP, nondisclosure to partners (51.4%), limited engagement with health care providers where PrEP might be provided (43.8%), and lacking health insurance (32.9%). CONCLUSIONS Despite reporting behavior that warrants the use of PrEP to prevent HIV and finding the concept acceptable, PWID face multiple barriers to PrEP access. Without tailored interventions to promote PrEP, uptake will likely remain suboptimal. Packaging PrEP with SEP services could provide a viable option for reaching eligible and interested PWID.
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11
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Scheim AI, Bardwell G, Rachlis B, Mitra S, Kerr T. Syringe sharing among people who inject drugs in London, Canada. Canadian Journal of Public Health 2018; 109:174-182. [PMID: 29981046 DOI: 10.17269/s41997-018-0058-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 01/20/2018] [Indexed: 01/20/2023]
Abstract
OBJECTIVES London, Ontario, is facing an outbreak of HIV among people who inject drugs (PWID), as well as persistently high levels of hepatitis C virus (HCV). Syringe sharing is the primary driver of HIV and HCV transmission risks among PWID, however, little is known about factors contributing to syringe sharing in this setting. Therefore, we sought to characterize syringe sharing and its correlates among London PWID. METHODS Between March and April, 2016, PWID participated in a survey administered by peer research associates as part of the Ontario Integrated Supervised Injection Services Feasibility Study. Bivariable and multivariable logistic regression models examined associations with syringe sharing (borrowing or lending previously used syringes) over the previous 6 months. A sub-analysis described patterns of borrowing and lending by self-reported HIV and HCV statuses. RESULTS Of 198 PWID, 44 (22%) reported syringe sharing in the past 6 months. In the multivariable analysis, selling drugs (adjusted odds ratio; AOR = 1.92, 95% CI = 1.20-3.08), daily crystal methamphetamine injection (AOR = 1.66, 95% CI = 1.07-2.59), and identifying as HIV-positive (AOR = 3.11, 95% CI = 1.61-6.01) were independently associated with increased syringe sharing. While not independently associated with syringe sharing, problems accessing syringes were common (13-50%). Self-reported HIV-positive respondents were more likely to report syringe borrowing (p < 0.001), but not lending (p = 0.26). CONCLUSION We observed a high rate of syringe sharing among London PWID, with sharing being associated with high-intensity injection of crystal methamphetamine, as well as with involvement in drug sales. Considering the current HIV outbreak in London, multi-level prevention efforts are urgently needed.
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Affiliation(s)
- Ayden I Scheim
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, N6A 5C1, Canada.,Division of Infectious Diseases and Global Public Health, University of California San Diego School of Medicine, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Geoff Bardwell
- British Columbia Centre on Substance Use, 400-1045 Howe St, Vancouver, BC, V6Z 2A9, Canada.,Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Beth Rachlis
- Ontario HIV Treatment Network, 1300 Yonge Street, Suite 600, Toronto, ON, M4T 1X3, Canada.,Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, 155 College Street West, 6th floor, Toronto, ON, M5T 3M7, Canada
| | - Sanjana Mitra
- British Columbia Centre on Substance Use, 400-1045 Howe St, Vancouver, BC, V6Z 2A9, Canada.,Interdisciplinary Studies, University of British Columbia, 270-2357 Main Mall, Vancouver, British Columbia, V6T 1Z4, Canada
| | - Thomas Kerr
- British Columbia Centre on Substance Use, 400-1045 Howe St, Vancouver, BC, V6Z 2A9, Canada. .,Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
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12
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Olding M, Enns B, Panagiotoglou D, Shoveller J, Harrigan PR, Barrios R, Kerr T, Montaner JSG, Nosyk B. A historical review of HIV prevention and care initiatives in British Columbia, Canada: 1996-2015. J Int AIDS Soc 2017; 20:21941. [PMID: 28953322 PMCID: PMC5640311 DOI: 10.7448/ias.20.1.21941] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 08/22/2017] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION British Columbia has made significant progress in the treatment and prevention of HIV since 1996, when Highly Active Antiretroviral Therapy (HAART) became available. However, we currently lack a historical summary of HIV prevention and care interventions implemented in the province since the introduction of HAART and how they have shaped the HIV epidemic. Guided by a socio-ecological framework, we present a historical review of biomedical and health services, community and structural interventions implemented in British Columbia from 1996-2015 to prevent HIV transmission or otherwise enhance the cascade of HIV care. METHODS We constructed a historical timeline of HIV interventions implemented in BC between 1996 and 2015 by reviewing publicly available reports, guidelines and other documents from provincial health agencies, community organizations and AIDS service organizations, and by conducting searches of peer-reviewed literature through PubMed and Ovid MEDLINE. We collected further programmatic information by administering a data collection form to representatives from BC's regional health authorities and an umbrella agency representing 45 AIDS Service organizations. Using linked population-level health administrative data, we identified key phases of the HIV epidemic in British Columbia, as characterized by distinct changes in HIV incidence, HAART uptake and the provincial HIV response. RESULTS AND DISCUSSION In total, we identified 175 HIV prevention and care interventions implemented in BC from 1996 to 2015. We identify and describe four phases in BC's response to HIV/AIDS: the early HAART phase (1996-1999); the harm reduction and health service scale-up phase (2000-2005); the early Treatment as Prevention phase (2006-2009); and the STOP HIV/AIDS phase (2010-present). In doing so, we provide an overview of British Columbia's universal and centralized HIV treatment system and detail the role of community-based and provincial stakeholders in advancing innovative prevention and harm reduction approaches, as well as "seek, test, treat and retain" strategies. CONCLUSIONS The review provides valuable insight into British Columbia's HIV response, highlights emerging priorities, and may inform future efforts to evaluate the causal impact of interventions.
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Affiliation(s)
- Michelle Olding
- BC Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC, Canada
| | - Ben Enns
- BC Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC, Canada
| | | | - Jean Shoveller
- BC Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - P Richard Harrigan
- BC Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC, Canada
- Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Rolando Barrios
- BC Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC, Canada
- Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Thomas Kerr
- BC Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC, Canada
- Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Julio S. G. Montaner
- BC Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC, Canada
- Division of AIDS, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Bohdan Nosyk
- BC Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
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13
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Pilarinos A, Kennedy MC, McNeil R, Dong H, Kerr T, DeBeck K. The association between residential eviction and syringe sharing among a prospective cohort of street-involved youth. Harm Reduct J 2017; 14:24. [PMID: 28499382 PMCID: PMC5429556 DOI: 10.1186/s12954-017-0150-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 05/01/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Syringe sharing is a high-risk practice associated with the transmission of infectious diseases, such as HIV and HCV. While youth who contend with housing instability are known to be more likely to engage in high-risk substance use, the potential relationship between being evicted from housing and syringe sharing has not been examined. This study assessed whether residential eviction was associated with syringe sharing among street-involved youth in Vancouver, Canada. METHODS Data were derived from the At-Risk Youth Study (ARYS), a prospective cohort of street-involved youth who use drugs age 14-26 in Vancouver, Canada. The study period was June 2007 to May 2014, and the potential relationship between residential eviction and syringe sharing was analyzed using multivariable generalized estimating equations (GEE) logistic regression. RESULTS Among 405 street-involved youth who injected drugs, 149 (36.8%) reported syringe sharing, defined as borrowing or lending a syringe, at some point during the study period. In a multivariable GEE analysis, recent residential eviction remained independently associated with syringe sharing (adjusted odds ratio (AOR) = 1.72, 95% confidence interval (CI): 1.16-2.57), after adjusting for potential confounders. CONCLUSIONS Syringe sharing was significantly elevated among youth who had recently been evicted from housing. These findings indicate that policy and programmatic interventions that increase housing stability may help mitigate high-risk substance use practices among vulnerable youth.
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Affiliation(s)
- Andreas Pilarinos
- BC Centre on Substance Use, British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Interdisciplinary Studies Graduate Program, University of British Columbia, 270-2357 Main Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Mary Clare Kennedy
- BC Centre on Substance Use, British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada
| | - Ryan McNeil
- BC Centre on Substance Use, British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Division of AIDS, Department of Medicine, University of British Columbia, 667-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Huiru Dong
- BC Centre on Substance Use, British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Thomas Kerr
- BC Centre on Substance Use, British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.,Division of AIDS, Department of Medicine, University of British Columbia, 667-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
| | - Kora DeBeck
- BC Centre on Substance Use, British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. .,School of Public Policy, Simon Fraser University, 3277-515 Hastings W Street, Vancouver, BC, V6B 5K3, Canada.
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14
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Roy É, Arruda N, Jutras-Aswad D, Berbiche D, Perreault M, Bertrand K, Dufour M, Bruneau J. Examining the link between cocaine binging and individual, social and behavioral factors among street-based cocaine users. Addict Behav 2017; 68:66-72. [PMID: 28103534 DOI: 10.1016/j.addbeh.2017.01.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 12/22/2016] [Accepted: 01/04/2017] [Indexed: 01/27/2023]
Abstract
AIMS To estimate the prevalence of cocaine binging and examine associated factors, to characterize binge episodes and to study the relationship between cocaine binging and HIV and HCV risk behaviors among street-based cocaine users. METHODS A prospective cohort study was conducted in Montréal, Canada. Interviewer-administered questionnaire were carried out at 3-month intervals. Cocaine binging was defined as using large quantities of cocaine, without stopping, over a limited period of time, until resources run out or until being physically incapable of consuming. Generalized Estimation Equations (GEE) analyses were used. Covariates considered included demographic, behavioral, mental health and social risk factors. FINDINGS In total, 605 participants were recruited. Prevalence of cocaine binging over the month prior to recruitment was 24.5%. Correlates of cocaine binging were older age (AOR 1.46), homelessness (AOR 1.44), criminal/marginal income strategies (AOR 1.61), high psychological distress (AOR 1.31), high cocaine dependence (AOR 3.71), drug overdoses (AOR 1.56) and smoking as the main route of cocaine administration (AOR 1.38). Additional GEE analyses showed that cocaine binging was significantly associated with the sharing of drug paraphernalia (AOR 1.35) and sexual relations under the influence of cocaine (AOR 1.21). CONCLUSION Cocaine binging is frequent among street-based cocaine users and is associated with markers of vulnerability. It is also associated with increased odds of both sexual and drug use risk behaviors. Interventions need to be tailored in order to help cocaine bingers develop personal strategies that could prevent binging. Harm reduction programs should help cocaine bingers adequately assess their drug equipment needs.
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15
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Kerr T, Wood E, Palepu A, Wilson D, Schechter MT, Tyndall MW. Responding to an Explosive HIV Epidemic Driven by Frequent Cocaine Injection: Is There a Role for Safe Injecting Facilities? JOURNAL OF DRUG ISSUES 2016. [DOI: 10.1177/002204260303300303] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Although there have been repeated calls for the establishment of safe injection facilities (SIFs) in Vancouver since the early 1990s, questions remain concerning the feasibility of SIFs due to the high prevalence of injection cocaine and the concomitant problems cocaine use presents. Therefore, we determined the prevalence of willingness to attend SIFs among cocaine injectors in Vancouver and explored the factors associated with this willingness, using data from the Vancouver Injection Drug Users Study. After considering the results derived from this analysis, additional qualitative methods were employed to explore further willingness to use SIFs, barriers and facilitators of SIF utilization, and methods of maximizing use among selected subpopulations of cocaine injectors. The results suggest that a high proportion of cocaine injectors, including some of those most at risk, would attend an SIF if one were available. However, in order to better accommodate cocaine injectors, several modifications could be made to conventional SIF service design and delivery. The vast majority of these modifications relate to ensuring effective responses to cocaine toxicity. Given the acceptability of SIFs among cocaine injectors, it appears that an SIF pilot could result in significant and immediate benefits in terms of public health and community safety.
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Affiliation(s)
- Thomas Kerr
- Canadian HIV/AIDS Legal Network and Research Associate at the BC Centre for Excellence in HIV/AIDS
| | - Evan Wood
- BC Centre for Excellence in HIV/AIDS and coprincipal investigator of the Vancouver Injection Drug Users Study (VIDUS)
| | - Anita Palepu
- Internal medicine specialist and an assistant professor on the Faculty of Medicine at the University of British Columbia
| | - Dean Wilson
- Healthcare advocate and past president of the Vancouver Area Network of Drug Users (VANDU)
| | - Martin T. Schechter
- Department of Healthcare and Epidemiology at the University of British Columbia
| | - Mark W. Tyndall
- Faculty of Medicine at the University of British Columbia, and a research associate at the BC Centre for Excellence in HIV/AIDS
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16
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Brothers S. Merchants, samaritans, and public health workers: Secondary syringe exchanger discursive practices. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2016; 37:1-8. [PMID: 27449813 DOI: 10.1016/j.drugpo.2016.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 02/07/2016] [Accepted: 06/01/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Secondary syringe exchangers (SSEs) are a vital component of harm reduction efforts among persons who inject drugs (PWIDs). However, little research has explored how secondary exchange occurs, nor why SSEs do their work. This study looks at secondary exchange as an act of resilience within the PWID risk environment. It asks how secondary syringe exchangers utilize syringes to improve their mental and material well-being. METHODS This article draws on findings from semi-structured in-depth interviews of 30 SSEs. It is also informed by 4 years of participant observation as a volunteer and site supervisor at the San Francisco Aids Foundation syringe exchange sites, and 1 year of participant observation with SSEs and their clients. RESULTS This study finds that SSEs use syringes as a resource to support three discursive practices - those of merchants, public health workers, and samaritans. These discursive practices correlate to their work and educational backgrounds, and to their accounts of charging for syringes, disseminating public health information, and helping their clients in various ways. CONCLUSION SSEs hold heterogeneous motivations and operate in multiple contexts. Many SSEs see themselves as, and behave as, informal health care workers or helpers in their community. They could be utilized, with minimal training and encouragement, to disseminate additional harm reduction information and materials.
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Affiliation(s)
- Sarah Brothers
- Department of Sociology, Yale University, 493 College Street, New Haven, CT 06511, United States.
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17
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Strike C, Cavalieri W, Bright R, Myers T, Calzavara L, Millson M. Syringe Acquisition, Peer Exchange and HIV Risk. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/009145090503200207] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
To explore syringe access patterns and implications for HIV prevention programming, data from qualitative interviews (n=120) with injection drug users (IDU) and an evaluation of a satellite syringe-exchange program (SEP) were used. Three patterns were identified: IDUs who stockpile supplies to meet their own needs and to provide secondary distribution to friends and drug-using associates; IDUs who keep a several-days supply of syringes available, primarily for their own use; and IDUs who usually obtain equipment at the time of obtaining drugs, in some cases unsterile equipment from other injectors. The first two types of injectors are typically in stable housing, while the last group are generally in unstable housing. This analysis highlights the very direct link between adequate housing and safer injection practices for HIV prevention, and points to the need to advocate more broadly on behalf of IDUs for appropriate housing, harm-reduction and social services.
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Abstract
OBJECTIVE Although the global burden of HIV infection among sex workers (SW) has been well recognized, HIV-related risks among sex workers who inject drugs (SW-IDU) have received less attention. We investigated the relationship between sex work and HIV incidence among people who inject drugs (IDU) in a Canadian setting. DESIGN Prospective cohort study. METHODS Using Kaplan-Meier methods and the extended Cox regression, we compared HIV incidence among SW-IDU and non-SW-IDU in Vancouver, Canada, after adjusting for potential confounders. RESULTS Between 1996 and 2012, 1647 participants were included in the study, including 512 (31.1%) IDU engaged in sex work. At 5 years the HIV cumulative incidence was higher among SW-IDU in comparison to other IDU (12 vs. 7%, P = 0.001). In unadjusted Cox regression analyses, HIV incidence among SW-IDU was also elevated [relative hazard: 1.69; 95% confidence interval (CI): 1.13-2.53]. However, in a multivariable analysis, sex work did not remain associated with HIV infection (adjusted relative hazard: 0.74; 95% CI: 0.45-1.20), with cocaine injection appearing to account for the elevated risk for HIV infection among SW-IDU. CONCLUSION These data suggest that local SW-IDU have elevated rates of HIV infection. However, our exploration of risk factors among SW-IDU demonstrated that drug use patterns and environmental factors, rather than sexual risks, may explain the elevated HIV incidence among SW-IDU locally. Our findings highlight the need for social and structural interventions, including increased access to harm reduction programs and addiction treatment.
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19
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Fischer B, Murphy Y, Rudzinski K, MacPherson D. Illicit drug use and harms, and related interventions and policy in Canada: A narrative review of select key indicators and developments since 2000. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2015; 27:23-35. [PMID: 26359046 DOI: 10.1016/j.drugpo.2015.08.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 08/04/2015] [Accepted: 08/05/2015] [Indexed: 01/04/2023]
Abstract
BACKGROUND By the year 2000, Canada faced high levels of illicit drug use and related harms. Simultaneously, a fundamental tension had raisen between continuing a mainly repression-based versus shifting to a more health-oriented drug policy approach. Despite a wealth of new data and numerous individual studies that have emerged since then, no comprehensive review of key indicators and developments of illicit drug use/harm epidemiology, interventions and law/policy exist; this paper seeks to fill this gap. METHODS We searched and reviewed journal publications, as well as key reports, government publications, surveys, etc. reporting on data and information since 2000. Relevant data were selected and extracted for review inclusion, and subsequently grouped and narratively summarized in major topical sub-theme categories. RESULTS Cannabis use has remained the principal form of illicit drug use; prescription opioid misuse has arisen as a new and extensive phenomenon. While new drug-related blood-borne-virus transmissions declined, overdose deaths increased in recent years. Acceptance and proliferation of - mainly local/community-based - health measures (e.g., needle exchange, crack paraphernalia or naloxone distribution) aiming at high-risk drug users has evolved, though reach and access limitations have persisted; Vancouver's 'supervised injection site' has attracted continued attention yet remains un-replicated elsewhere in Canada. While opioid maintenance treatment utilization increased, access to treatment for key (e.g., infectious disease, psychiatric) co-morbidities among drug users remained limited. Law enforcement continued to principally focus on cannabis and specifically cannabis users. 'Drug treatment courts' were introduced but have shown limited effectiveness; several attempts cannabis control law reform have failed, except for the recent establishment of 'medical cannabis' access provisions. CONCLUSIONS While recent federal governments introduced several law and policy measures reinforcing a repression approach to illicit drug use, lower-level jurisdictions (e.g., provincial/municipal levels) and non-governmental organizations increasingly promoted social- and health-oriented intervention frameworks and interventions, therefore creating an increasingly bifurcated - and inherently contradictory - drug policy landscape and reality in Canada.
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Affiliation(s)
- Benedikt Fischer
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada.
| | - Yoko Murphy
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, Canada
| | - Katherine Rudzinski
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, Canada
| | - Donald MacPherson
- Canadian Drug Policy Coalition, Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada
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20
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Rafful C, Wagner KD, Werb D, González-Zúñiga PE, Verdugo S, Rangel G, Strathdee SA. Prevalence and correlates of neck injection among people who inject drugs in Tijuana, Mexico. Drug Alcohol Rev 2015; 34:630-6. [PMID: 25867795 DOI: 10.1111/dar.12264] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 02/08/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION AND AIMS Injecting drugs in the neck has been related to adverse health conditions such as jugular vein thrombosis, deep neck infections, aneurysm, haematomas, airway obstruction, vocal cord paralysis and wound botulism, among others. We identified prevalence and correlates of neck injection among people who inject drugs (PWID) in Tijuana, Mexico. DESIGN AND METHODS Beginning in 2011, PWID aged ≥18 years who injected drugs within the last month were recruited into a prospective cohort. At baseline and semi-annually, PWID completed interviewer-administered surveys soliciting data on drug-injecting practices. Logistic regression was used to identify predictors of injecting in the neck as the most frequent injection site at a single visit. RESULTS Of 380 PWID, 35.3% injected in the neck at least once in the past 6 months, among whom 71.6% reported it as their most common injection site, the most common injecting site after the arms (47%). Controlling for age, years injecting and injecting frequency, injecting heroin and methamphetamine two or more times per day and having sought injection assistance were associated with injecting in the neck [adjusted odds ratios (AOR): 2.12; 95% confidence intervals (CI): 1.27-3.53 and AOR: 2.65; 95% CI: 1.52-4.53 respectively]. DISCUSSION AND CONCLUSIONS Injecting in the neck was very common among PWID in Tijuana and was associated with polydrug use and seeking injection assistance. Tailoring harm reduction education interventions for individuals who provide injection assistance ('hit doctors') may allow for the dissemination of safe injecting knowledge to reduce injection-related morbidity and mortality.
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Affiliation(s)
- Claudia Rafful
- Division of Global Public Health, University of California, La Jolla, USA.,Graduate School of Public Health, San Diego State University, San Diego, USA
| | - Karla D Wagner
- School of Community Health Sciences, University of Nevada, Reno, USA
| | - Dan Werb
- Division of Global Public Health, University of California, La Jolla, USA
| | | | - Silvia Verdugo
- Division of Global Public Health, University of California, La Jolla, USA.,Instituto de Servicios de Salud Pública de Baja California, Tijuana, Mexico
| | - Gudelia Rangel
- Secretariat of Health, Mexico.,Mexico-United States Border Health Commission, Mexico
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21
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Ahmed T, Long TN, Huong PT, Stewart DE. Drug injecting and HIV risk among injecting drug users in Hai Phong, Vietnam: a qualitative analysis. BMC Public Health 2015; 15:32. [PMID: 25631330 PMCID: PMC4324409 DOI: 10.1186/s12889-015-1404-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 01/12/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hai Phong, located in northern Vietnam, has become a high HIV prevalence province among Injecting Drug Users (IDUs) since the infection shifted from the southern to the northern region of the country. Previous research indicates high levels of drug and sex related risk behaviour especially among younger IDUs. Our recent qualitative research provides a deeper understanding of HIV risk behaviour and highlights views and experiences of IDUs relating to drug injecting and sharing practices. METHODS Fifteen IDUs participated in semi-structured interviews conducted in September-October, 2012. Eligible participants were selected from those recruited in a larger scale behavioural research project and identified through screening questions. Interviews were conducted by two local interviewers in Vietnamese and were audiotaped. Ethical procedures, including informed consent and participants' understanding of their right to skip and withdraw, were applied. Transcripts were translated and double checked. The data were categorised and coded according to themes. Thematic analysis was conducted and a qualitative data analysis thematic framework was used. RESULTS Qualitative analysis highlighted situational circumstances associated with HIV risks among IDUs in Hai Phong and revealed three primary themes: (i) places for injecting, (ii) injecting drugs in small groups, and (iii) sharing practices. Our results showed that shared use of jointly purchased drugs and group injecting were widespread among IDUs without adequate recognition of these as HIV risk behaviours. Frequent police raids generated a constant fear of arrest. As a consequence, the majority preferred either rail lines or isolated public places for injection, while some injected in their own or a friend's home. Price, a heroin crisis, and strong group norms encouraged collective preparation and group injecting. Risk practices were enhanced by a number of factors: the difficulty in getting new syringes, quick withdrawal management, punitive attitudes, fear of arrest/imprisonment, lack of resources, incorrect self-assessment, and risk denial. Some of the IDU participants emphasised self-care attitudes which should be encouraged to minimise HIV transmission risk. CONCLUSION The IDUs' experiences in Hai Phong identified through our data broaden our qualitative understanding about the HIV transmission risk among IDUs and emphasize the need to strengthen harm reduction services in Vietnam.
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Affiliation(s)
- Tanvir Ahmed
- School of Medicine, Griffith University, Griffith Graduate Centre, South Bank Campus, 226 Grey Street, South Brisbane, QLD 4101, Australia.
| | - Thanh Nguyen Long
- Vietnam Authority of HIV/AIDS Control, Lane 135/3 Nui Truc Street, Ba Đinh District, Hanoi, Vietnam.
| | - Phan Thi Huong
- Vietnam Authority of HIV/AIDS Control, Lane 135/3 Nui Truc Street, Ba Đinh District, Hanoi, Vietnam.
| | - Donald Edwin Stewart
- School of Medicine, Griffith University, Griffith Graduate Centre, South Bank Campus, 226 Grey Street, South Brisbane, QLD 4101, Australia.
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22
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Voon P, Callon C, Nguyen P, Dobrer S, Montaner JSG, Wood E, Kerr T. Denial of prescription analgesia among people who inject drugs in a Canadian setting. Drug Alcohol Rev 2014; 34:221-8. [PMID: 25521168 DOI: 10.1111/dar.12226] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 10/05/2014] [Indexed: 01/18/2023]
Abstract
INTRODUCTION AND AIMS Despite the high prevalence of pain among people who inject drugs (PWIDs), clinicians may be reluctant to prescribe opioid-based analgesia to those with a history of drug use or addiction. We sought to examine the prevalence and correlates of PWIDs reporting being denied of prescription analgesia (PA). We also explored reported reasons for and actions taken after being denied PA. DESIGN AND METHODS Using data from two prospective cohort studies of PWIDs, multivariate logistic regression was used to identify the prevalence and correlates of reporting being denied PA. Descriptive statistics were used to characterise reasons for denials and subsequent actions. RESULTS Approximately two-thirds (66.5%) of our sample of 462 active PWIDs reported having ever been denied PA. We found that reporting being denied PA was significantly and positively associated with having ever been enrolled in methadone maintenance treatment (adjusted odds ratio 1.76, 95% confidence interval 1.11-2.80) and daily cocaine injection (adjusted odds ratio 2.38, 95% confidence interval 1.00-5.66). The most commonly reported reason for being denied PA was being accused of drug seeking (44.0%). Commonly reported actions taken after being denied PA included buying the requested medication off the street (40.1%) or obtaining heroin to treat pain (32.9%). DISCUSSION AND CONCLUSIONS These findings highlight the challenges of addressing perceived pain and the need for strategies to prevent high-risk methods of self-managing pain, such as obtaining diverted medications or illicit substances for pain. Such strategies may include integrated pain management guidelines within methadone maintenance treatment and other substance use treatment programs.
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Affiliation(s)
- Pauline Voon
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada
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Wilson DP, Donald B, Shattock AJ, Wilson D, Fraser-Hurt N. The cost-effectiveness of harm reduction. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2014; 26 Suppl 1:S5-11. [PMID: 25727260 DOI: 10.1016/j.drugpo.2014.11.007] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 11/11/2014] [Accepted: 11/11/2014] [Indexed: 10/24/2022]
Abstract
HIV prevalence worldwide among people who inject drugs (PWID) is around 19%. Harm reduction for PWID includes needle-syringe programs (NSPs) and opioid substitution therapy (OST) but often coupled with antiretroviral therapy (ART) for people living with HIV. Numerous studies have examined the effectiveness of each harm reduction strategy. This commentary discusses the evidence of effectiveness of the packages of harm reduction services and their cost-effectiveness with respect to HIV-related outcomes as well as estimate resources required to meet global and regional coverage targets. NSPs have been shown to be safe and very effective in reducing HIV transmission in diverse settings; there are many historical and very recent examples in diverse settings where the absence of, or reduction in, NSPs have resulted in exploding HIV epidemics compared to controlled epidemics with NSP implementation. NSPs are relatively inexpensive to implement and highly cost-effective according to commonly used willingness-to-pay thresholds. There is strong evidence that substitution therapy is effective, reducing the risk of HIV acquisition by 54% on average among PWID. OST is relatively expensive to implement when only HIV outcomes are considered; other societal benefits substantially improve the cost-effectiveness ratios to be highly favourable. Many studies have shown that ART is cost-effective for keeping people alive but there is only weak supportive, but growing evidence, of the additional effectiveness and cost-effectiveness of ART as prevention among PWID. Packages of combined harm reduction approaches are highly likely to be more effective and cost-effective than partial approaches. The coverage of harm reduction programs remains extremely low across the world. The total annual costs of scaling up each of the harm reduction strategies from current coverage levels, by region, to meet WHO guideline coverage targets are high with ART greatest, followed by OST and then NSPs. But scale-up of all three approaches is essential. These interventions can be cost-effective by most thresholds in the short-term and cost-saving in the long-term.
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Affiliation(s)
| | | | | | - David Wilson
- Global HIV/AIDS Program, World Bank, United States
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Voon P, Callon C, Nguyen P, Dobrer S, Montaner J, Wood E, Kerr T. Self-management of pain among people who inject drugs in Vancouver. Pain Manag 2014; 4:27-35. [PMID: 24641341 DOI: 10.2217/pmt.13.62] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
AIMS To evaluate factors and methods associated with self-management of pain among people who inject drugs (IDUs) in Vancouver (Canada). PATIENTS & METHODS This cross-sectional study used bivariate statistics and multivariate logistic regression to analyze self-reported responses among 483 IDUs reporting moderate-to-extreme pain in two prospective cohort studies from 1 December 2012 to 31 May 2013. RESULTS Median age was 49.6 years (interquartile range: 43.9-54.6 years), 33.1% of IDUs were female and 97.5% reported self-management of pain. Variables independently and positively associated with self-managed pain included having been refused a prescription for pain medication (adjusted odds ratio: 7.83; 95% CI: 1.64-37.3) and having ever been homeless (adjusted odds ratio: 3.70; 95% CI: 1.00-13.7). Common methods of self-management of pain included injecting heroin (52.7%) and obtaining diverted prescription pain medication from the street (65.0%). CONCLUSION Self-management of pain was common among IDUs who reported moderate-to-extreme pain in this setting, particularly among those who had been refused a prescription for pain medication and those who had ever been homeless. These data highlight the challenges of adequate pain management among IDUs.
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Affiliation(s)
- Pauline Voon
- British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
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Ngemu EK, Khayeka-Wandabwa C, Kweka EJ, Choge JK, Anino E, Oyoo-Okoth E. Effectiveness of option B highly active antiretroviral therapy (HAART) prevention of mother-to-child transmission (PMTCT) in pregnant HIV women. BMC Res Notes 2014; 7:52. [PMID: 24447387 PMCID: PMC3898637 DOI: 10.1186/1756-0500-7-52] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 01/15/2014] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Ensuring that no baby is born with HIV is an essential step towards achieving an AIDS-free generation. To achieve this, strategies that decouple links between childbirth and HIV transmission are necessary. Traditional forms of prevention of mother-to-child transmission of HIV (PMTCT), has been recommended. Recognizing the importance and challenges of combination of methods to achieve rapid PMTCT, the World Health Organization (WHO) recommended option B Highly Active Antiretroviral Therapy (HAART) for all HIV-positive pregnant women. This study aimed to evaluate the effectiveness of the HAART in PMTCT. A cohort of HIV-infected pregnant women in Kenya were obtained from the DREAM Center, Nairobi. The study participants underwent adherence counselling and Option B of HAART [Nevirapine(NVP) + Lamivudine + Zidovudine] at the fourth week of gestation followed by an intravenous NVP administration intrapartum and postpartum NVP syrup to the respective infants for six weeks. Absolute pre-HAART and post-HAART CD4 counts and viral loads counts were determined. Comparison of the CD4 counts and viral loads before and after administration of HAART were done using Wilcoxon's Matched Pairs Signed-Ranks Test. FINDINGS The mean absolute CD4 cell counts in mothers after administration of HAART was significantly higher (Z = 15.664, p < 0.001) than before the administration of HAART). Also the viral load of the mothers significantly (Z = 11.324, p < 0.001) reduced following HAART treatment. Following the HAART administration in mothers, up to 90% of children were confirmed to be HIV negative. CONCLUSION Administration of HAART to mothers and children demonstrated an effective mechanism of PMTCT. However, other aspects of HAART such as adherence, costs, mothers behaviour during HAART, and the child feeding programme during the therapy should further be evaluated and ascertained how they can affect the overall efficacy of option B HAART in PMTCT.
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Affiliation(s)
- Erastus K Ngemu
- School of Science, Department of Biochemistry, University of Eldoret, PO Box 1125, Eldoret, Kenya
| | - Christopher Khayeka-Wandabwa
- Institute of Tropical Medicine and Infectious Diseases (ITROMID), Jomo Kenyatta University of Agriculture and Technology (JKUAT), Nairobi, Kenya
| | - Eliningaya J Kweka
- Tropical Pesticides Research Institute, Division of Livestock and Human Diseases Vector Control, Mosquito Section, Ngaramtoni, Off Nairobi road, PO Box 3024, Arusha, Tanzania
| | - Joseph K Choge
- School of Health Sciences, University of Eastern Africa, Baraton, PO Box 2500-30100, Eldoret, Kenya
| | - Edward Anino
- School of Science, Department of Biochemistry, University of Eldoret, PO Box 1125, Eldoret, Kenya
| | - Elijah Oyoo-Okoth
- School Natural Resources and Environmental Studies, Karatina University, PO Box 1957-10101, Karatina, Kenya
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Tyndall MW. Impact of supervised injection facilities on community HIV levels: a public health perspective. Expert Rev Anti Infect Ther 2014; 1:543-9. [PMID: 15482151 DOI: 10.1586/14787210.1.4.543] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The health and social consequences of intravenous drug use pose major challenges to cities across North America. Preventable drug-related harms including accidental overdose, serious bacterial infections, injuries of violence and more recently, the emergence of HIV and hepatitis C, have major impacts on community health. Among the various interventions designed to reduce the harms associated with injection drug use, the establishment of a supervised injection facility is perhaps the most controversial. This review will focus on the potential impact of supervised injection facilities on HIV transmission in conjunction with current HIV prevention initiatives. This will include a review of the health and social consequences associated with illicit drugs use, the limitations of drug enforcement, and the potential impact of supervised injection facilities on reducing the harms associated with injection drug use.
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Affiliation(s)
- Mark W Tyndall
- Centre for Excellence in HIV/AIDS, University of British Columbia, Vancouver, Canada.
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Nolan S, DeBeck K, Nguyen P, Kerr T, Wood E. Binge Drug Use among Street-Involved Youth in a Canadian Setting. ADDICTION RESEARCH & THEORY 2014; 22:535-540. [PMID: 26109928 PMCID: PMC4476542 DOI: 10.3109/16066359.2014.926896] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Binge drug use has been associated with increased risk of HIV infection and other serious health-related harms among adult drug user populations. This study sought to determine the prevalence and correlates of binge drug use among street-involved youth in a Canadian setting. METHODS From Sept 2005 to May 2012, data were collected from the At-Risk Youth Study (ARYS), a prospective cohort of street-involved youth aged 14 - 26 who use illicit drugs. Multivariate generalized estimating equations (GEE) was used to identify factors associated with binge drug use. RESULTS Of the 987 participants included in this analysis, 41.5% reported binge drug use at baseline, and another 59.1% reported binge drug use at some point during the study. In multivariate GEE analysis, older age (adjusted odds ratio [AOR] = 1.11), homelessness (AOR = 1.67), drug injecting (AOR = 1.63), non-fatal overdose (AOR = 1.98), public injecting (AOR 1.42), being a victim of violence (AOR = 1.38), sex work (AOR = 2.51) and participation in drug dealing (AOR = 2.04) were independently associated with binge drug use in the previous 6 months (all p<0.05). DISCUSSION The prevalence of reporting binge drug use among the youth was high in this setting and was independently associated with a range of high-risk activities and markers of vulnerability. Querying high-risk youth about binge drug use may help prioritize those in greatest need of addiction treatment strategies and public health interventions.
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Affiliation(s)
- Seonaid Nolan
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, Canada
| | - Kora DeBeck
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, Canada
- School of Public Policy, Simon Fraser University
| | - Paul Nguyen
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, Canada
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, Canada
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, Canada
- Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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Lee WK, Ti L, Hayashi K, Kaplan K, Suwannawong P, Wood E, Kerr T. Assisted injection among people who inject drugs in Thailand. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2013; 8:32. [PMID: 24020370 PMCID: PMC3849853 DOI: 10.1186/1747-597x-8-32] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 09/06/2013] [Indexed: 11/17/2022]
Abstract
Background Assisted injection is common among people who inject drugs (IDU), and has been associated with elevated risk for HIV infection and overdose. However, this practice has not been explored in the Asian context, including in Thailand, where HIV prevalence among IDU remains high. Methods Using multivariate logistic regression, we examined the prevalence and correlates of assisted injecting among IDU participating in the Mitsampan Community Research Project in Bangkok. We also sought to identify reasons for engaging in assisted injecting and those who provide this form of assistance. Results In total, 430 IDU participated in this study, including 376 (87.5%) who reported having ever required assistance injecting, and 81 (18.8%) who reported assisted injecting in the previous six months. In multivariate analyses, assisted injecting in the previous six months was independently and positively associated with being female (adjusted odds ratio [AOR] = 2.42; 95% confidence interval [CI]: 1.40 – 4.18), being a weekly heroin injector (AOR = 1.78; 95% CI: 0.99 – 3.20), syringe sharing (AOR = 2.08; 95% CI: 1.18 – 3.68) and soft-tissue infection (AOR = 3.51; 95% CI: 1.43 – 2.53). Having a longer injecting career (AOR = 0.96; 95% CI: 0.94 – 0.99) was negatively associated with assisted injecting. Primary reasons given for engaging in assisted injecting included being new to injecting and lacking knowledge on how to inject. The most common providers of assistance with injecting were close friends. Conclusion We found a high prevalence of assisted injecting among IDU in Bangkok, with females, frequent heroin injectors, those with shorter injecting careers being more likely to engage in this practice. Those who require help with the injecting process are more likely to share syringes, and have skin infections. These findings indicate the need for interventions focused on promoting safer and self-administered injections.
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Affiliation(s)
- William K Lee
- British Columbia Centre for Excellence in HIV/AIDS, St, Paul's Hospital, 608-1081 Burrard Street, V6Z 1Y6, Vancouver, BC, Canada.
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MacArthur GJ, van Velzen E, Palmateer N, Kimber J, Pharris A, Hope V, Taylor A, Roy K, Aspinall E, Goldberg D, Rhodes T, Hedrich D, Salminen M, Hickman M, Hutchinson SJ. Interventions to prevent HIV and Hepatitis C in people who inject drugs: a review of reviews to assess evidence of effectiveness. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2013; 25:34-52. [PMID: 23973009 DOI: 10.1016/j.drugpo.2013.07.001] [Citation(s) in RCA: 208] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2012] [Revised: 06/25/2013] [Accepted: 07/03/2013] [Indexed: 01/23/2023]
Abstract
BACKGROUND Injecting drug use is a major risk factor for the acquisition and transmission of HIV and Hepatitis C virus (HCV). Prevention of these infections among people who inject drugs (PWID) is critical to reduce ongoing transmission, morbidity and mortality. METHODS A review of reviews was undertaken involving systematic literature searches of Medline, Embase, CINAHL, PsychINFO, IBSS and the Cochrane Library (2000-2011) to identify English language reviews regarding the effectiveness of harm reduction interventions in relation to HIV transmission, HCV transmission and injecting risk behaviour (IRB). Interventions included needle and syringe programmes (NSP); the provision of injection paraphernalia; opiate substitution treatment (OST); information, education and counselling (IEC); and supervised injecting facilities (SIFs). Reviews were classified into 'core' or 'supplementary' using critical appraisal criteria, and the strength of review-level evidence was assessed. RESULTS Twelve core and thirteen supplementary reviews were included. From these reviews we identified: (i) for NSP: tentative review-level evidence to support effectiveness in reducing HIV transmission, insufficient review-level evidence relating to HCV transmission, but sufficient review-level evidence in relation to IRB; (ii) for OST: sufficient review-level evidence of effectiveness in relation to HIV transmission and IRB, but tentative review-level evidence in relation to HCV transmission; (iii) for IEC, the provision of injection paraphernalia and SIFs: tentative review-level evidence of effectiveness in reducing IRB; and either insufficient or no review-level evidence for these interventions in relation to HIV or HCV transmission. CONCLUSION Review-level evidence indicates that harm reduction interventions can reduce IRB, with evidence strongest for OST and NSP. However, there is comparatively little review-level evidence regarding the effectiveness of these interventions in preventing HCV transmission among PWID. Further studies are needed to assess the effectiveness and impact of scaling up comprehensive packages of harm reduction interventions to minimise HIV and HCV transmission among PWID.
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Affiliation(s)
- Georgina J MacArthur
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK.
| | - Eva van Velzen
- NHS Sutton and Merton/London KSS Specialty School of Public Health, UK
| | | | - Jo Kimber
- University of New South Wales, Sydney, Australia
| | | | - Vivian Hope
- Centre for Research on Drugs and Health Behaviour, London School of Hygiene and Tropical Medicine, London, UK; Health Protection Services, Health Protection Agency, London, UK
| | - Avril Taylor
- University of the West of Scotland, Paisley, Scotland, UK
| | | | - Esther Aspinall
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | | | - Tim Rhodes
- Centre for Research on Drugs and Health Behaviour, London School of Hygiene and Tropical Medicine, London, UK
| | - Dagmar Hedrich
- European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal
| | - Mika Salminen
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - Matthew Hickman
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol BS8 2PS, UK
| | - Sharon J Hutchinson
- Health Protection Scotland, Glasgow, UK; University of the West of Scotland, Paisley, Scotland, UK
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Kidorf M, King VL, Peirce J, Kolodner K, Brooner RK. An Observation of Lower Rates of Drug Use over Time in Community Syringe Exchangers. Am J Addict 2013; 22:271-6. [DOI: 10.1111/j.1521-0391.2012.12002.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Revised: 02/28/2012] [Accepted: 08/20/2012] [Indexed: 11/29/2022] Open
Affiliation(s)
- Michael Kidorf
- Department of Psychiatry and Behavioral Sciences; Johns Hopkins University School of Medicine; Baltimore, Maryland
| | - Van L. King
- Department of Psychiatry and Behavioral Sciences; Johns Hopkins University School of Medicine; Baltimore, Maryland
| | - Jessica Peirce
- Department of Psychiatry and Behavioral Sciences; Johns Hopkins University School of Medicine; Baltimore, Maryland
| | - Ken Kolodner
- Department of Psychiatry and Behavioral Sciences; Johns Hopkins University School of Medicine; Baltimore, Maryland
| | - Robert K. Brooner
- Department of Psychiatry and Behavioral Sciences; Johns Hopkins University School of Medicine; Baltimore, Maryland
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Schwartz RP, Stitzer ML, Feaster DJ, Korthuis PT, Alvanzo AAH, Winhusen TM, Donnard L, Snead N, Metsch LR. HIV rapid testing in drug treatment: comparison across treatment modalities. J Subst Abuse Treat 2013; 44:369-74. [PMID: 23021496 PMCID: PMC3577980 DOI: 10.1016/j.jsat.2012.08.219] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Revised: 08/21/2012] [Accepted: 08/24/2012] [Indexed: 11/30/2022]
Abstract
Despite high rates of risky behavior among patients, many drug abuse treatment programs do not provide on-site HIV testing. This secondary analysis examined differences in outcome by program modality from a multi-site trial in which 1281 HIV-negative patients in three methadone programs, seven non-methadone outpatient programs, and three residential programs were randomly assigned to: (1) off-site referral for HIV risk reduction counseling and testing; or on-site rapid testing (2) with or (3) without risk reduction counseling. The parent study using generalized estimating equations with site as a cluster variable found significantly higher rates of HIV testing and feedback of results by 1 month post-enrollment for the combined on-site conditions compared to the offsite condition [RR=4.52, 97.5% CI (3.57, 5.72)]. Utilizing the same statistical approach, we found neither significant treatment modality nor significant treatment modality by testing condition interaction effects either for receipt of HIV test results at 1 month or for sexual or drug use HIV-risk behaviors at 6-month follow-up. On-site HIV testing is effective across treatment modalities for achieving high rates of testing and results feedback. All programs should be encouraged to adopt or expand this service.
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Richardson L, Wood E, Kerr T. The impact of social, structural and physical environmental factors on transitions into employment among people who inject drugs. Soc Sci Med 2012; 76:126-33. [PMID: 23157930 DOI: 10.1016/j.socscimed.2012.10.015] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Revised: 05/24/2012] [Accepted: 10/25/2012] [Indexed: 10/27/2022]
Abstract
Despite growing awareness of the importance of context for the health of people who use drugs, studies examining labour market outcomes have rarely considered the role that physical, social and structural factors play in shaping labour market participation among drug users. Using discrete time event history analyses, we assessed associations between high-intensity substance use, individual drug use-related risk and features of inner-city drug use scenes with transitions into regular employment. Data were derived from a community-recruited cohort of people who inject drugs in Vancouver, Canada (n = 1579) spanning the period of May 1996-May 2005. Results demonstrate that systematic socio-demographic differences in labour market outcomes in this context generally correspond to dimensions of demographic disadvantage. Additionally, in initial analyses, high-intensity substance use is negatively associated with transitions into employment. However, this negative association loses significance when indicators measuring exposure to physical, social and structural features of the broader risk environment are considered. These findings indicate that interventions designed to improve employment outcomes among drug users should address these social, structural and physical components of the risk environment as well as promote the cessation of drug use.
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Hyshka E, Strathdee S, Wood E, Kerr T. Needle exchange and the HIV epidemic in Vancouver: lessons learned from 15 years of research. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2012; 23:261-70. [PMID: 22579215 PMCID: PMC3392518 DOI: 10.1016/j.drugpo.2012.03.006] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Revised: 03/23/2012] [Accepted: 03/26/2012] [Indexed: 11/29/2022]
Abstract
During the mid-1990s, Vancouver experienced a well characterized HIV outbreak among injection drug users (IDU) and many questioned how this could occur in the presence of a high volume needle exchange program (NEP). Specific concerns were fuelled by early research demonstrating that frequent needle exchange program attendees were more likely to be HIV positive than those who attended the NEP less frequently. Since then, some have misinterpreted this finding as evidence that NEPs are ineffective or potentially harmful. In light of continuing questions about the Vancouver HIV epidemic, we review 15 years of peer-reviewed research on Vancouver's NEP to describe what has been learned through this work. Our review demonstrates that: (1) NEP attendance is not causally associated with HIV infection, (2) frequent attendees of Vancouver's NEP have higher risk profiles which explain their increased risk of HIV seroconversion, and (3) a number of policy concerns, as well as the high prevalence of cocaine injecting contributed to the failure of the NEP to prevent the outbreak. Additionally, we highlight several improvements to Vancouver's NEP that contributed to declines in syringe sharing and HIV incidence. Vancouver's experience provides a number of important lessons regarding NEP. Keys to success include refocusing the NEP away from an emphasis on public order objectives by separating distribution and collection functions, removing syringe distribution limits and decentralizing and diversifying NEP services. Additionally, our review highlights the importance of context when implementing NEPs, as well as ongoing evaluation to identify factors that constrain or improve access to sterile syringes.
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Affiliation(s)
- Elaine Hyshka
- Addiction and Mental Health Research Lab, School of Public Health, University of Alberta
- British Columbia Centre for Excellence in HIV/AIDS, University of British Columbia
| | | | - Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, University of British Columbia
- Department of Medicine, University of British Columbia
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, University of British Columbia
- Department of Medicine, University of British Columbia
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Kidorf M, King VL, Gandotra N, Kolodner K, Brooner RK. Improving treatment enrollment and re-enrollment rates of syringe exchangers: 12-month outcomes. Drug Alcohol Depend 2012; 124:162-6. [PMID: 22209388 PMCID: PMC3341500 DOI: 10.1016/j.drugalcdep.2011.12.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Revised: 12/06/2011] [Accepted: 12/07/2011] [Indexed: 10/14/2022]
Abstract
BACKGROUND Developing bridges between community syringe exchange programs (SEPs) and substance abuse treatment could benefit syringe exchangers and the public health. Kidorf et al. (2009) showed that motivational approaches employed at an SEP site improved rates of treatment enrollment and reduced drug use over a 4-month observation window. The present study extends this report by evaluating rates of treatment enrollment and re-enrollment over a 12-month period. METHODS Opioid dependent individuals (n = 281) newly registered at an SEP were randomly assigned to one of three referral interventions: (1) 8 individual motivational enhancement sessions and 16 treatment readiness group sessions designed to improve treatment interest and readiness (motivated referral condition; MRC-only); (2) MRC-only with monetary incentives for attending sessions and enrolling in treatment (MRC+I); or (3) standard referral (SRC). MRC-only and MRC+I participants discharged from treatment could attend a treatment re-engagement group designed to facilitate return to treatment (MRC+I participants received incentives for attending sessions and re-enrolling in treatment). RESULTS The 4-month outcomes generally extended over 12 months. MRC+I participants were more likely to enroll in methadone maintenance than MRC-only or SRC participants, and to re-enroll in treatment following discharge. MRC+I participants also reported more days of treatment and less heroin and injection use. CONCLUSIONS The good harm reduction outcomes for many SEP participants can be enhanced through strategies designed to facilitate treatment enrollment and re-enrollment.
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Affiliation(s)
- Michael Kidorf
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Addiction Treatment Services - BBRC, Johns Hopkins Bayview Medical Center, 5510 Nathan Shock Drive, Suite 1500, Baltimore, MD 21224, United States.
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Small W, Wood E, Tobin D, Rikley J, Lapushinsky D, Kerr T. The Injection Support Team: a peer-driven program to address unsafe injecting in a Canadian setting. Subst Use Misuse 2012; 47:491-501. [PMID: 22428817 DOI: 10.3109/10826084.2012.644107] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In 2005, members of the Vancouver Area Network of Drug Users (VANDU) formed the Injection Support Team (IST). A community-based research project examined this drug-user-led intervention through observation of team activities, over 30 interviews with team members, and 9 interviews with people reached by the team. The IST is composed of recognized "hit doctors," who perform outreach in the open drug scene to provide safer injecting education and instruction regarding safer assisted-injection. The IST represents a unique drug-user-led response to the gaps in local harm reduction efforts including programmatic barriers to attending the local supervised injection facility.
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Affiliation(s)
- Will Small
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada
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Ti L, Buxton J, Wood E, Shannon K, Zhang R, Montaner J, Kerr T. Factors associated with difficulty accessing crack cocaine pipes in a Canadian setting. Drug Alcohol Rev 2012; 31:890-6. [PMID: 22462808 DOI: 10.1111/j.1465-3362.2012.00446.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND AIMS Crack cocaine pipe sharing is associated with various health-related harms, including hepatitis C transmission. Although difficulty accessing crack pipes has been found to predict pipe sharing, little is known about the factors that limit pipe access in settings where pipes are provided at no cost, albeit in limited capacity. Therefore, we investigated crack pipe access among people who use drugs in Vancouver, Canada. DESIGN AND METHODS Data were collected through two Canadian prospective cohort studies. Generalised estimating equations with logit link for binary outcomes were used to identify factors associated with difficulty accessing crack pipes. RESULTS Among 914 participants who reported using crack cocaine, 33% reported difficulty accessing crack pipes. In multivariate analyses, factors independently associated with difficulty accessing crack pipes included: sex work involvement [adjusted odds ratio (AOR) = 1.57; 95% confidence interval (CI): 1.03-2.39], having shared a crack pipe (AOR = 1.69; 95% CI: 1.32-2.16), police presence where one buys/uses drugs (AOR = 1.47; 95% CI: 1.10-1.95), difficulty accessing services (AOR = 1.74; 95% CI: 1.31-2.32) and health problems associated with crack use (AOR = 1.37; 95% CI: 1.04-1.79). Reasons given for difficulty accessing pipes included sources being closed (48.2%) and no one around selling pipes (18.1%). DISCUSSION AND CONCLUSIONS A substantial proportion of people who smoke crack cocaine report difficulty accessing crack pipes in a setting where pipes are available at no cost but in limited quantity. These findings indicate the need for enhanced efforts to distribute crack pipes and address barriers to pipe access.
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Affiliation(s)
- Lianping Ti
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
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Werb D, Bouchard M, Kerr T, Shoveller J, Qi J, Montaner J, Wood E. Drug dealing cessation among a cohort of drug users in Vancouver, Canada. Drug Alcohol Depend 2011; 118:459-63. [PMID: 21664770 PMCID: PMC3182286 DOI: 10.1016/j.drugalcdep.2011.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2010] [Revised: 05/05/2011] [Accepted: 05/07/2011] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Drug dealing among drug users has been associated with elevated risk-taking and negative health outcomes. However, little is known about the cessation of drug dealing among this population. METHODS We assessed time to cessation of drug dealing using Cox regression. We also used generalized estimating equation (GEE) analysis and chi-square analysis to examine factors associated with willingness to cease drug dealing. RESULTS In total, 868 participants reported drug dealing between November 2005 and March 2009. Among 381 participants dealing drugs at baseline, 194 (51%) ceased dealing. Incidence of dealing cessation was positively associated with spending less than $50 per day on drugs (Adjusted Hazard Ratio [AHR]=1.88, 95% confidence interval [CI]: 1.14-3.10) and negatively associated with buying drugs from the same source (AHR=0.60, 95% CI: 0.37-0.98). In a GEE analysis, willingness to cease dealing was positively associated with older age (Adjusted Odds Ratio [AOR]=1.02, 95% CI: 1.01-1.03), crack use (AOR=2.00, 95% CI: 1.44-2.79), public injecting (AOR=1.95, 95% CI: 1.55-2.43), and reporting that police presence affects drug purchases (AOR=1.53, 95% CI: 1.22-1.91), and negatively associated with crystal methamphetamine injection (AOR=0.62, 95% CI: 0.47-0.83). DISCUSSION Intensity of drug use and acquisition method were predictive of dealing cessation. Willingness to cease dealing was associated with a range of risky drug-related activities. Interventions to reduce drug dealing should be conceived in tandem with addiction treatment strategies.
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Affiliation(s)
- Dan Werb
- British Columbia Centre for Excellence in HIV/AIDS, 608 – 1081, Burrard Avenue, Vancouver, BC, Canada V6Z 1Y6
,School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, Canada V6T 1Z3
| | - Martin Bouchard
- School of Criminology, Simon Fraser University, 8888 University Drive, Burnaby, BC, Canada V5A 1S6
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, 608 – 1081, Burrard Avenue, Vancouver, BC, Canada V6Z 1Y6
| | - Jean Shoveller
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, Canada V6T 1Z3
| | - Jiezhi Qi
- British Columbia Centre for Excellence in HIV/AIDS, 608 – 1081, Burrard Avenue, Vancouver, BC, Canada V6Z 1Y6
| | - Julio Montaner
- British Columbia Centre for Excellence in HIV/AIDS, 608 – 1081, Burrard Avenue, Vancouver, BC, Canada V6Z 1Y6
,Division of AIDS, Department of Medicine, University of British Columbia, 10203 - 2775 Laurel Street, Vancouver, BC, Canada, V5Z 1M9
| | - Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, 608 – 1081, Burrard Avenue, Vancouver, BC, Canada V6Z 1Y6
,Division of AIDS, Department of Medicine, University of British Columbia, 10203 - 2775 Laurel Street, Vancouver, BC, Canada, V5Z 1M9
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Marshall BDL, Shoveller JA, Wood E, Patterson TL, Kerr T. Difficulty accessing syringes mediates the relationship between methamphetamine use and syringe sharing among young injection drug users. AIDS Behav 2011; 15:1546-53. [PMID: 21197598 PMCID: PMC3180618 DOI: 10.1007/s10461-010-9876-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Injection drug users (IDU) who use methamphetamine (MA) are at an increased risk of HIV infection due to engagement in injection-related risk behavior including syringe sharing. In this cohort study of young IDU aged 18-30, we investigated the relationship between injection MA use and syringe sharing, and whether difficulty accessing sterile syringes mediated this association. Behavioral questionnaires were completed by 384 IDU in Vancouver, Canada between October 2005 and May 2008. Generalized estimating equations were used to estimate direct and indirect effects. The median age of participants was 24 (IQR: 22–27) and 214 (55.7%) were male. Injecting MA was independently associated with syringe sharing. Mediation analyses revealed that difficulty accessing sterile syringes partially mediated the association between injecting MA and syringe sharing. Interventions to reduce syringe sharing among young methamphetamine injectors must address social and structural barriers to accessing HIV prevention programs.
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Affiliation(s)
- Brandon D. L. Marshall
- Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3 Canada
| | - Jean A. Shoveller
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3 Canada
| | - Evan Wood
- Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada
- Department of Medicine, University of British Columbia, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada
| | - Thomas L. Patterson
- Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada
- Department of Psychiatry, University of California, 9500 Gilman Drive, La Jolla, CA 92093-0680 USA
| | - Thomas Kerr
- Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada
- Department of Medicine, University of British Columbia, St. Paul’s Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada
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Do crack smoking practices change with the introduction of safer crack kits? Canadian Journal of Public Health 2011. [PMID: 21714316 DOI: 10.1007/bf03404893] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES Crack smoking has increased in Vancouver despite the harms associated with its use. Many people who smoke crack share their equipment, thereby increasing their risk for infectious disease. This project explored the effects of outreach distribution of "safer crack kits" on smoking practices. METHODS Two cross-sectional surveys were conducted, the first prior to kit distribution and the second a year later. Participants were individuals who smoked crack and lived in Vancouver's inner city. Crack smoking practices and use of items in the crack kit were documented. RESULTS The results of the second survey (i.e., following 12 months of kit distribution) showed an increase in availability and use of safer use items; mouthpieces and condoms provided in the kit were used by 79% and 59% of recipients, respectively. Unsafe practices were reported post distribution: although 42% used brass screens, the majority reported that they usually used Brillo; over 40% of respondents reported using syringe plungers to scrape crack resin; and participants reported sharing crack-use paraphernalia. CONCLUSION While kit distribution made safer use items more accessible, its impact on safer use practice was limited. Our findings highlight the need for targeted distribution of safer use items. Future research should explore the dynamics of unsafe crack smoking practices and ways to leverage safer use messaging.
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Debeck K, Wood E, Zhang R, Buxton J, Montaner J, Kerr T. A dose-dependent relationship between exposure to a street-based drug scene and health-related harms among people who use injection drugs. J Urban Health 2011; 88:724-35. [PMID: 21533961 PMCID: PMC3157498 DOI: 10.1007/s11524-011-9575-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
While the community impacts of drug-related street disorder have been well described, lesser attention has been given to the potential health and social implications of drug scene exposure on street-involved people who use illicit drugs. Therefore, we sought to assess the impacts of exposure to a street-based drug scene among injection drug users (IDU) in a Canadian setting. Data were derived from a prospective cohort study known as the Vancouver Injection Drug Users Study. Four categories of drug scene exposure were defined based on the numbers of hours spent on the street each day. Three generalized estimating equation (GEE) logistic regression models were constructed to identify factors associated with varying levels of drug scene exposure (2-6, 6-15, over 15 hours) during the period of December 2005 to March 2009. Among our sample of 1,486 IDU, at baseline, a total of 314 (21%) fit the criteria for high drug scene exposure (>15 hours per day). In multivariate GEE analysis, factors significantly and independently associated with high exposure included: unstable housing (adjusted odds ratio [AOR] = 9.50; 95% confidence interval [CI], 6.36-14.20); daily crack use (AOR = 2.70; 95% CI, 2.07-3.52); encounters with police (AOR = 2.11; 95% CI, 1.62-2.75); and being a victim of violence (AOR = 1.49; 95 % CI, 1.14-1.95). Regular employment (AOR = 0.50; 95% CI, 0.38-0.65), and engagement with addiction treatment (AOR = 0.58; 95% CI, 0.45-0.75) were negatively associated with high exposure. Our findings indicate that drug scene exposure is associated with markers of vulnerability and higher intensity addiction. Intensity of drug scene exposure was associated with indicators of vulnerability to harm in a dose-dependent fashion. These findings highlight opportunities for policy interventions to address exposure to street disorder in the areas of employment, housing, and addiction treatment.
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Affiliation(s)
- Kora Debeck
- British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada
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Debeck K, Wood E, Qi J, Fu E, McArthur D, Montaner J, Kerr T. Interest in low-threshold employment among people who inject illicit drugs: implications for street disorder. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2011; 22:376-84. [PMID: 21684142 DOI: 10.1016/j.drugpo.2011.05.012] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Revised: 05/11/2011] [Accepted: 05/20/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Income generation opportunities available to people who use illicit drugs have been associated with street disorder. Among a cohort of injection drug users (IDU) we sought to examine street-based income generation practices and willingness to forgo these sources of income if other low-threshold work opportunities were made available. METHODS Data were derived from a prospective community recruited cohort of IDU. We assessed the prevalence of engaging in disorderly street-based income generation activities, including sex work, drug dealing, panhandling, and recycling/salvaging/vending. Using multivariate logistic regressions based on Akaike information criterion and the best subset selection procedure, we identified factors associated with disorderly income generation activities, and assessed willingness to forgo these sources of income during the period of November 2008 to July 2009. RESULTS Among our sample of 874 IDU, 418 (48%) reported engaging in a disorderly income generation activity in the previous six months. In multivariate analyses, engaging in disorderly income generation activities was independently associated with high intensity stimulant use, as well as binge drug use, having encounters with police, being a victim of violence, sharing used syringes, and injecting in public areas. Among those engaged in disorderly income generation, 198 (47%) reported a willingness to forgo these income sources if given opportunities for low-threshold employment, with sex workers being most willing to engage in alternative employment. CONCLUSION Engagement in disorderly street-based income generation activities was associated with high intensity stimulant drug use and various markers of risk. We found that a high proportion of illicit drug users were willing to cease engagement in these activities if they had options for causal low-threshold employment. These findings indicate that there is a high demand for low-threshold employment that may offer important opportunities to reduce drug-related street disorder and associated harms.
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Affiliation(s)
- Kora Debeck
- BC Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6
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Kidorf M, King VL, Peirce J, Pierce J, Kolodner K, Brooner RK. Benefits of concurrent syringe exchange and substance abuse treatment participation. J Subst Abuse Treat 2011; 40:265-71. [PMID: 21255959 PMCID: PMC3056913 DOI: 10.1016/j.jsat.2010.11.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Revised: 11/11/2010] [Accepted: 11/22/2010] [Indexed: 11/16/2022]
Abstract
Participation in syringe exchange programs (SEPs) is associated with many individual and public health benefits but may have little impact on reducing drug use without concurrent treatment engagement. This study evaluated rates of drug use, other risk behaviors, and illegal activities in newly registered SEP participants (N = 240) enrolled versus not enrolled in substance abuse treatment over a 4-month observation window and examined the effect of days in treatment on these outcomes. After controlling for baseline differences, SEP registrants enrolled in treatment (n = 113) reported less days of opioid and cocaine use, injection drug use, illegal activities, and incarceration than those not enrolled in treatment (n = 127). For those enrolled in treatment, days of treatment was strongly correlated with each of these outcomes. These findings provide good evidence for a dose-response effect of treatment in syringe exchangers and suggest that substance abuse treatment significantly expands the harm reduction benefits of SEP participation.
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Affiliation(s)
- Michael Kidorf
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, MD, USA.
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Developing Canada's research base for harm reduction and health equity approaches to HIV prevention and treatment. Canadian Journal of Public Health 2011. [PMID: 21370777 DOI: 10.1007/bf03403960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
In the area of infectious disease control, Canadian research efforts to address the HIV epidemic in Vancouver's Downtown East Side neighbourhood have fueled the development of harm reduction and health equity perspectives worldwide. These research efforts have, in turn, reshaped the field of public health approaches to HIV prevention and control. As a result of the intensive and sustained research initiatives led by Canadian scientists Drs. Thomas Kerr and Evan Wood, the 'HIV problem' and public health responses to it have been radically reconceptualized - shifting from an exclusive focus on individual choice towards asking fundamental questions about our society and the structural features that put people at risk for contracting HIV. Their research on harm reduction and health equity related to HIV vulnerability and outcomes has informed and shaped: (1) the establishment of North America's first supervised injection facility, Insite, located in Vancouver's Downtown East Side neighbourhood; (2) dramatic changes to Vancouver's needle exchange policies; (3) HIV treatment approaches among injection drug using populations (IDU). By drawing attention to the ways in which Canadian health care policies and programs can be restructured to better support the health of vulnerable populations, the work of Drs. Kerr and Wood represents a uniquely Canadian public health milestone.
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Johnstone-Robertson SP, Hargrove J, Williams BG. Antiretroviral therapy initiated soon after HIV diagnosis as standard care: potential to save lives? HIV AIDS-RESEARCH AND PALLIATIVE CARE 2011; 3:9-17. [PMID: 22096403 PMCID: PMC3218708 DOI: 10.2147/hiv.s7278] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
In 2008, an estimated 33.4 million people were infected with human immunodeficiency virus (HIV) and ~4 million people were receiving antiretroviral therapy (ART). However, in 2007, an estimated 6.7 million people were in need of ART under the current World Health Organization guidelines, and 2.7 million more people became infected with HIV. Most of those not currently eligible for ART will become eligible within the next decade, making the current treatment strategy unsustainable. The development of cheaper, less toxic, and more potent antiretrovirals over the past decade has made it possible to consider novel strategies of arresting the HIV/AIDS epidemic. Evidence is growing that ART can be used to prevent HIV transmission and that earlier initiation of treatment is beneficial for those infected with HIV. A mathematical model predicts that by testing whole communities annually and treating all who are infected immediately, up to 7.2 million AIDS-related deaths could be prevented in the next 40 years, long-term funding required to fight the HIV epidemic could be reduced, and, most importantly, control of the HIV/ AIDS epidemic could be regained within 1–2 years of full-scale implementation of the strategy. We discuss the development of the concept of ART for the prevention of HIV transmission and the modeled impact that a test-and-treat strategy could have on the HIV epidemic, and consequently argue that a field trial should be carried out to confirm model parameters, highlight any practical problems, and test the model’s predictions.
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Affiliation(s)
- Simon P Johnstone-Robertson
- South African Centre for Epidemiological Modelling and Analysis, DST/NRF Centre of Excellence in Epidemiological Modelling and Analysis, Stellenbosch, South Africa
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Jenkins LM, Banta-Green CJ, Maynard C, Kingston S, Hanrahan M, Merrill JO, Coffin PO. Risk factors for nonfatal overdose at Seattle-area syringe exchanges. J Urban Health 2011; 88:118-28. [PMID: 21246299 PMCID: PMC3042084 DOI: 10.1007/s11524-010-9525-6] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Opioid-involved overdose deaths are on the rise, both nationwide and in the state of Washington. In a survey of 443 participants at syringe exchanges in Seattle, Washington, 16% had overdosed in the last year. Several factors were significantly associated in bivariate analysis: lack of permanent housing; incarceration of five or more days in the past year; gender of sex partners; sharing of syringes and other injection paraphernalia; use of speedballs (cocaine and heroin together), goofballs (methamphetamine and heroin together), buprenorphine; injection use of crack cocaine and sedatives; and use of opioids with sedatives. Adjusting for other variables in multivariate logistic regression analyses, only recent incarceration and sharing of injection materials were still significantly associated with overdose. Correctional facilities, syringe exchange programs, and other agencies serving opioid injectors should include overdose prevention components in release planning and services.
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Affiliation(s)
- Lindsay M Jenkins
- Alcohol and Drug Abuse Institute, University of Washington, Seattle, WA, USA.
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Small W, Ainsworth L, Wood E, Kerr T. IDU perspectives on the design and operation of North America's first medically supervised injection facility. Subst Use Misuse 2011; 46:561-8. [PMID: 20874006 DOI: 10.3109/10826084.2010.517714] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
While the public health benefits of supervised injection facilities (SIFs) have been well documented, there is a lack of research examining the views of injection drug users (IDU) regarding the operation of these facilities. This study used 50 semistructured qualitative interviews to explore IDU perspectives on the design and operation of an SIF in Vancouver, Canada. Although the environment and operation of the SIF are well accepted, long wait times and limited operating hours, as well as regulations that prohibit sharing drugs and assisted injections, pose barriers to using the SIF. Modifying operating procedures and expanding the capacity of the current facility could address these barriers.
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Affiliation(s)
- Will Small
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada
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Fairbairn N, Small W, Van Borek N, Wood E, Kerr T. Social structural factors that shape assisted injecting practices among injection drug users in Vancouver, Canada: a qualitative study. Harm Reduct J 2010; 7:20. [PMID: 20807442 PMCID: PMC2939605 DOI: 10.1186/1477-7517-7-20] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2009] [Accepted: 08/31/2010] [Indexed: 11/23/2022] Open
Abstract
Background Injection drug users (IDU) commonly seek manual assistance with illicit drug injections, a practice known to be associated with various health-related harms. We investigated the social structural factors that shape risks related to assisted injection and the harms that may result. Methods Twenty semi-structured qualitative interviews were conducted with IDU enrolled in the ACCESS or Vancouver Injection Drug Users Study (VIDUS) who reported requiring assistance injecting in the past six months. Audio-recorded interviews were transcribed verbatim and a thematic analysis was conducted. Results Barriers to self-injecting included a lack of knowledge of proper injecting technique, a loss of accessible veins, and drug withdrawal. The exchange of money or drugs for assistance with injecting was common. Harms experienced by IDU requiring assistance injecting included theft of the drug, missed injections, overdose, and risk of blood-borne disease transmission. Increased vulnerability to HIV/HCV infection within the context of intimate relationships was represented in participant narratives. IDU identified a lack of services available for those who require assistance injecting, with notable mention of restricted use of Vancouver's supervised injection facility. Conclusions This study documents numerous severe harms that arise from assisted injecting. Social structural factors that shape the risks related to assisted injection in the Vancouver context included intimate partner relations and social conventions requiring an exchange of goods for provision of injecting assistance. Health services for IDU who need help injecting should include targeted interventions, and supervised injection facilities should attempt to accommodate individuals who require assistance with injecting.
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Affiliation(s)
- Nadia Fairbairn
- British Columbia Centre for Excellence in HIV/AIDS, St, Paul's Hospital, University of British Columbia, 608-1081 Burrard Street, Vancouver, B,C,, V6Z 1Y6, Canada.
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Rachlis BS, Wood E, Li K, Hogg RS, Kerr T. Drug and HIV-related risk behaviors after geographic migration among a cohort of injection drug users. AIDS Behav 2010; 14:854-61. [PMID: 18427970 DOI: 10.1007/s10461-008-9397-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2007] [Accepted: 04/04/2008] [Indexed: 11/26/2022]
Abstract
To determine whether migration impacted on drug use and HIV-related risk behaviors among injection drug users (IDU), we identified participants in a prospective cohort of IDU (Vancouver Injection Drug User Study) who had reported migrating out of Greater Vancouver between May 1996 and November 2005. We compared risk behaviors before and after a move for individuals who migrated (movers) and for a similar period for non-movers using linear growth curve analyses. In total, 1,122 individuals were included, including 430 (38.3%) women and 331 (29.5%) Aboriginal participants. Among these, 192 (17.1%) individuals reported migrating out of Greater Vancouver between 1996 and 2005 while 930 (82.9%) did not. Movers were significantly younger than non-movers: 32.0 (Interquartile Range [IQR]: 24.3-39.2) and 34.6 (IQR: 26.9-40.8) respectively. A significant decrease in those reporting unstable housing, frequent heroin and cocaine injection occurred only in movers. Our findings suggest that, in this setting, risk-taking among IDU declines following periods of migration out of Greater Vancouver.
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Affiliation(s)
- Beth S Rachlis
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada, V6Z 1Y6
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GIBSON ERINK, EXNER HEIDI, STONE RYAN, LINDQUIST JENNIFER, COWEN LAURA, ROTH ERICA. A mixed methods approach to delineating and understanding injection practices among clientele of a Victoria, British Columbia needle exchange program. Drug Alcohol Rev 2010; 30:360-5. [DOI: 10.1111/j.1465-3362.2010.00219.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kerr T, Small W, Buchner C, Zhang R, Li K, Montaner J, Wood E. Syringe sharing and HIV incidence among injection drug users and increased access to sterile syringes. Am J Public Health 2010; 100:1449-53. [PMID: 20558797 DOI: 10.2105/ajph.2009.178467] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We assessed the effects of syringe exchange program (SEP) policy on rates of HIV risk behavior and HIV incidence among injection drug users. METHODS Using a multivariate generalized estimating equation and Cox regression methods, we examined syringe borrowing, syringe lending, and HIV incidence among a prospective cohort of 1228 injection drug users in Vancouver, British Columbia. RESULTS We observed substantial declines in rates of syringe borrowing (from 20.1% in 1998 to 9.2% in 2003) and syringe lending (from 19.1% in 1998 to 6.8% in 2003) following SEP policy change. These declines coincided with a statistically significant increase in the proportion of participants accessing sterile syringes from nontraditional SEP sources (P < .001). In multivariate analyses, the period following the change in SEP policy was independently associated with a greater than 40% reduction in syringe borrowing (adjusted odds ratio [AOR] = 0.57; 95% confidence interval [CI] = 0.49, 0.65) and lending (AOR = 0.52; 95% CI = 0.45, 0.60), as well as declining HIV incidence (adjusted hazard ratio = 0.13; 95% CI = 0.06, 0.31). CONCLUSIONS Widespread syringe distribution appears to be a more effective SEP policy than do more restrictive SEP policies that limit syringe access. Efforts should be made to ensure that SEP policies and program design serve to maximize rather than hinder syringe access.
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Affiliation(s)
- Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, Department of Medicine, University of British Columbia, Vancouver, Canada.
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