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Mitra S, Kolla G, Bardwell G, Wang R, Sniderman R, Mason K, Werb D, Scheim A. Requiring help injecting among people who inject drugs in Toronto, Canada: Characterising the need to address sociodemographic disparities and substance-use specific patterns. Drug Alcohol Rev 2022; 41:1062-1070. [PMID: 35577755 DOI: 10.1111/dar.13473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 03/09/2022] [Accepted: 03/26/2022] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Those requiring help injecting are at an elevated risk of injection-related injury and blood-borne infections and are thus a priority group for harm reduction programs. As supervised consumption services (SCS) are scaled-up across Canada, information on those who require help injecting is necessary to inform equitable service uptake. We characterised the sociodemographic, structural and drug use correlates of needing help injecting among a cohort of people who inject drugs in Toronto, Canada. METHODS A cross-sectional baseline survey was administered between November 2018 and March 2020. Unadjusted and multivariable logistic regression models examined associations with requiring help injecting in the past 6 months. A gender-stratified sub-analysis described characteristics of receiving help among those requiring it. RESULTS Of 701 participants (31.0% cisgender women), 294 (41.9%) needed recent help injecting. In unadjusted analyses, being a racialised, non-Indigenous person (odds ratio [OR] 1.79, 95% confidence interval [CI] 1.13-2.86) or a cisgender woman (OR 1.72, 95% CI 1.24-2.39) were associated with needing help. In multivariable analyses, requiring assistance was associated with needing frequent help preparing drugs (adjusted OR [AOR] 9.52, 95% CI 4.78-21.28), fewer years since first injection (AOR for 1 year increase: 0.97, 95% CI 0.95-0.99) and injecting stimulants. Among those who required help, cisgender women reported needing assistance more often than cisgender men (P = 0.009). DISCUSSION AND CONCLUSIONS Over two-fifths of the sample required help injecting; requiring assistance was associated with sociodemographic indicators and substance use-specific patterns. Findings highlight the need to scale-up educational resources for those who receive or provide help injecting, as well as SCS that accommodate onsite injection assistance.
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Affiliation(s)
- Sanjana Mitra
- Interdisciplinary Graduate Studies Program, University of British Columbia, Vancouver, Canada.,British Columbia Centre on Substance Use, Vancouver, Canada
| | - Gillian Kolla
- Canadian Institute for Substance Use Research, University of Victoria, Victoria, Canada
| | - Geoff Bardwell
- British Columbia Centre on Substance Use, Vancouver, Canada.,Department of Medicine, University of British Columbia, St. Paul's Hospital, Vancouver, Canada
| | - Rick Wang
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
| | - Ruby Sniderman
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Canada
| | - Kate Mason
- South Riverdale Community Health Centre, Toronto, Canada
| | - Dan Werb
- Centre on Drug Policy Evaluation, Unity Health Toronto, Toronto, Canada.,University of California San Diego School of Medicine, La Jolla, USA
| | - Ayden Scheim
- Dornsife School of Public Health, Drexel University, Philadelphia, USA.,Centre on Drug Policy Evaluation, Unity Health Toronto, Toronto, Canada
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Lavalley J, Collins AB, Mayer S, Gaudette L, Krüsi A, McNeil R, Boyd J. Negotiating sex work and client interactions in the context of a fentanyl-related overdose epidemic. CULTURE, HEALTH & SEXUALITY 2021; 23:1390-1405. [PMID: 32895026 PMCID: PMC8609966 DOI: 10.1080/13691058.2020.1785550] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 06/17/2020] [Indexed: 06/11/2023]
Abstract
Despite awareness of the role of drug use in shaping sex worker/client interactions, these dynamics remain poorly understood in the context of illicit fentanyl-driven overdose epidemics. This study examined sex workers' experiences negotiating client interactions amidst a toxic drug supply in Vancouver, Canada. Findings draw from two ethnographic studies. The first, conducted between December 2016 and May 2017, examined the rapid implementation of several low-threshold supervised consumption sites. The second investigated experiences of women accessing a women-only site from May 2017 to June 2018. Data included 200 hours of fieldwork and in-depth semi-structured interviews with 34 street-based sex workers who use illicit drugs. Data were analysed thematically with attention to the risk environment. Participants described providing harm reduction services to clients as a means to reduce overdose-related risks, thus increasing sex workers' hidden labour. Participants, comments regarding criminalisation and stigma surrounding drug use and sex work indicated a reticence to report overdoses, thereby potentially increasing the risks of overdose-related harms, including death. There is an urgent need for sex worker-led overdose prevention strategies that prioritise health and safety of sex workers and their clients with specific attention to how the criminalisation of particular drugs, practices and people contributes to overdose-related risks.
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Affiliation(s)
- Jennifer Lavalley
- British Columbia Centre on Substance Use, Vancouver, BC,
Canada
- Interdisciplinary Studies Graduate Program, University of
British Columbia, Vancouver, BC, Canada
| | - Alex B. Collins
- British Columbia Centre on Substance Use, Vancouver, BC,
Canada
- Faculty of Health Sciences, Simon Fraser University,
Burnaby, BC, Canada
| | - Samara Mayer
- British Columbia Centre on Substance Use, Vancouver, BC,
Canada
- Interdisciplinary Studies Graduate Program, University of
British Columbia, Vancouver, BC, Canada
| | - Laurel Gaudette
- British Columbia Centre on Substance Use, Vancouver, BC,
Canada
| | - Andrea Krüsi
- Department of Medicine, University of British Columbia,
Vancouver, BC, Canada
- Centre for Gender and Sexual Health Equity, Vancouver, BC,
Canada
| | - Ryan McNeil
- British Columbia Centre on Substance Use, Vancouver, BC,
Canada
- Department of Medicine, University of British Columbia,
Vancouver, BC, Canada
- Program in Addiction Medicine, Yale School of Medicine, New
Haven, CT, USA
- General Internal Medicine, Yale School of Medicine, New
Haven, CT, USA
| | - Jade Boyd
- British Columbia Centre on Substance Use, Vancouver, BC,
Canada
- Department of Medicine, University of British Columbia,
Vancouver, BC, Canada
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Brothers S, Kral AH, Wenger L, Simpson K, Bluthenthal RN. Assisted injection provider practices and motivations in Los Angeles and San Francisco California 2016-18. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 92:103052. [PMID: 33257087 PMCID: PMC8155098 DOI: 10.1016/j.drugpo.2020.103052] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 11/16/2020] [Accepted: 11/18/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Assisted injection is a high-risk and common practice among people who inject drugs (PWID) and occurs for diverse reasons according to qualitative research. To develop interventions for reducing assisted injection risks, it is important to understand the practices of PWID who provide injection assistance, including their motivations for providing assistance. METHODS Using follow-up data from an efficacy trial among PWID recruited in Los Angeles and San Francisco, CA (n=601), we present descriptive statistics on motivations for providing injection assistance and use multivariable logistic regression modelling to examine factors associated with these motivations. RESULTS PWID provided injection assistance most commonly to friends and acquaintances. A quarter provided assistance on a daily basis. The most common motivations for providing assistance were skill and injury prevention. PWID also provided assistance to stop pestering and for compensation in money or drugs. In separate models examining factors associated with the five main motivations, we found injury prevention to be associated with skill injecting others, neck injection, methamphetamine use, and recycling income. Pestering was associated with injury prevention, neck and hand injection, speedball use, and syringe selling. Skill was associated with injury prevention, neck and hand injection, being physically assaulted, and age. Providing assistance for money was associated with providing assistance for food or drugs, armpit injections, being female, and providing assistance more frequently. Providing assistance for drugs was associated with compensation in food or money, goofball injection, selling drugs, and panhandling. CONCLUSION Providing injection assistance is associated with injection needs of recipients and drug scene participation. We urgently need new interventions for reducing assisted injection risks. Since injection providers report being motivated by skill and to prevent injury, interventions such as training in safer injection techniques are likely to be met with enthusiasm.
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Affiliation(s)
- Sarah Brothers
- Department of Sociology, Yale University, 493 College Street, New Haven, CT 06511, United States.
| | - Alex H Kral
- Behavioral Health Research Division, RTI International, 2150 Shattuck Avenue, Suite 800, Berkeley, CA 94704, United States
| | - Lynn Wenger
- Behavioral Health Research Division, RTI International, 2150 Shattuck Avenue, Suite 800, Berkeley, CA 94704, United States
| | - Kelsey Simpson
- Department of Preventive Medicine, Health Behavior Research Division, Keck School of Medicine, University of Southern California, 2001 N Soto Street, Los Angeles, CA 90032, United States
| | - Ricky N Bluthenthal
- Department of Preventive Medicine, Health Behavior Research Division, Keck School of Medicine, University of Southern California, 2001 N Soto Street, Los Angeles, CA 90032, United States
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Urbanik MM, Greene C. Operational and contextual barriers to accessing supervised consumption services in two Canadian cities. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 88:102991. [PMID: 33166847 DOI: 10.1016/j.drugpo.2020.102991] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 10/03/2020] [Accepted: 10/06/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND AIMS While previous scholarship has documented barriers to Supervised Consumption Services (SCS) access, little is known about how Non-SCS-users perceive available, sanctioned SCS, and how such perceptions may hinder their SCS use. The objectives of this study were to examine: 1) barriers to accessing SCS for SCS-users and Non-SCS-users; and 2) the extent to which these barriers are consistent between groups. METHODS We conducted semi-structured interviews with 75 PWUD in two cities in Western Canada, Edmonton and Calgary, who may or may not have accessed available SCS. Participants were recruited on the streets near SCS via traditional fieldwork and snowball sampling. We employed a generalized prompt guide and asked a range of questions about how PWUD perceived and/or experienced SCS in the area. All interviews were digitally recorded, transcribed, thematically coded, and analysed. RESULTS Despite PWUD's generally positive perceptions of SCS, we identified several operational barriers to SCS access, including wait times and time limits, restrictions on injection assistance, and client bans from clinics. We also identified contextual barriers, including perceptions of the 'unnecessary' use of naloxone and police surveillance. Importantly, these barriers were consistent between SCS-users and Non-SCS-users, though some SCS-users actively worked to counter contextual barriers among peers. CONCLUSION Operational and contextual barriers to SCS use contribute to intermittent access for existing clients and preclude SCS access for others. Addressing such barriers may increase SCS uptake, thereby further extending the well-documented and critical reach of these harm reduction initiatives.
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Affiliation(s)
| | - Carolyn Greene
- Athabasca University, 1 University Drive, Athabasca, AB, T9S 3A3
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Kennedy MC, Milloy MJ, Hayashi K, Holliday E, Wood E, Kerr T. Assisted injection within supervised injection services: Uptake and client characteristics among people who require help injecting in a Canadian setting. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 86:102967. [PMID: 33039705 PMCID: PMC8026755 DOI: 10.1016/j.drugpo.2020.102967] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/18/2020] [Accepted: 09/24/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND People who require help injecting illicit drugs experience elevated rates of a range of health-related harms, including overdose and acquisition of blood-borne pathogens. In response, some supervised injection services (SIS) in Canada have begun to permit clients to be physically injected by fellow clients or staff members. However, little is known about uptake and characteristics of clients who engage in this practice. We therefore sought to examine factors associated with receiving injection assistance at SIS among people who require help injecting drugs in Vancouver, Canada. METHODS Data were drawn from two community-recruited prospective cohort studies of people who inject drugs (PWID). We used multivariable generalized estimating equation (GEE) analyses with time-updated covariates to identify factors associated with self-reported receipt of injection assistance at SIS. RESULTS Between June 2017 and December 2018, 319 individuals who reported having recently required help injecting were included in the study. Of these, 160 (51.0%) were women and the median age was 42 years at baseline. In total, 54 (16.9%) participants reported receiving injection assistance at a SIS at least once over an average of 3.3 months of follow-up. In multivariable GEE analyses, recent homelessness (Adjusted Odds Ratio [AOR] = 2.04; 95% confidence interval [CI]: 1.13 - 3.66), fentanyl injection (AOR = 3.45; 95% CI: 1.42 - 8.41), non-fatal overdose (AOR = 1.86; 95% CI: 1.02 - 3.38) and enrolment in methadone maintenance therapy (AOR = 1.89; 95% CI: 1.03 - 3.47) were associated with increased odds of receiving injection assistance at SIS. CONCLUSION Although uptake of assisted injection at SIS was relatively low among this sample of people who require help injecting, this practice was associated with several indicators of structural vulnerability and drug-related risk. These findings suggest that accommodating assisted injection within SIS may be providing opportunities to engage and reduce harms among higher-risk subpopulations of PWID in this setting.
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Affiliation(s)
- Mary Clare Kennedy
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, CANADA, V6Z 2A9; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, CANADA, V6Z 1Y6.
| | - M-J Milloy
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, CANADA, V6Z 2A9; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, CANADA, V6Z 1Y6
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, CANADA, V6Z 2A9; Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, BC, CANADA, V5A 1S6
| | - Elizabeth Holliday
- Vancouver Coastal Health, 2775 Laurel Street, Vancouver, BC, CANADA V5Z 1M9
| | - Evan Wood
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, CANADA, V6Z 2A9; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, CANADA, V6Z 1Y6
| | - Thomas Kerr
- British Columbia Centre on Substance Use, 400-1045 Howe Street, Vancouver, BC, CANADA, V6Z 2A9; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, CANADA, V6Z 1Y6
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Prevalence and high risk behaviours associated with HCV testing among people who inject drugs: a systematic review and Meta-analysis. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2020; 15:64. [PMID: 32831107 PMCID: PMC7445934 DOI: 10.1186/s13011-020-00306-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 08/19/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Hepatitis C diagnosis could be a gateway to behavioral change and subsequent decline in transmission among people who inject drugs (PWIDs). We assessed the association between the social determinants of PWID, their risk behaviors and hepatitis C testing. METHODS We searched for studies in English published before May 1, 2020, on PubMed, Scopus, Cochrane, and Web of Science to identify primary studies on the factors associated with hepatitis C virus (HCV) testing among PWID. After reviewing for study duplicates, the full-text of selected articles were assessed for eligibility using Population, Intervention, Comparator, Outcomes (PICO) criteria. i) population: individuals who report injecting drugs; ii) intervention: HCV testing in the past year; iii) comparator: PWIDs who did not have an HCV test; iv) outcome: HCV testing among PWIDs and v) study type: cross-sectional, cohort, and case-control studies. Two independent reviewers (author BA and AB) chose the references in a two-phased monitoring process. The authors gathered data from selected papers, including the surname of the first author, publication date, participant demographic data (age, sex, and level of education) and other characteristics like previous HCV testing, past treatment attempts, duration of injecting drug use and condomless sex. We used fixed and random-effects meta-analysis models to estimate the pooled prevalence, pooled odds ratio (OR), and 95% confidence intervals. The data were analyzed using Stata 12.0 software. RESULTS After a detailed assessment of over 12,000 articles, a total of 16 studies containing 38,952 participants met the eligibility criteria. Our findings showed a pooled prevalence rate of 61.01% (95% CI, 34.65-84.32%) for recent HCV testing among PWIDs. Being female (OR = 1.69, 95%CI = 1.13, 2.26), aged > 30 years, (OR = 2.61, 95%CI = 1.66-3.56) having past treatment attempt (OR = 2.24, 95%CI = 1.80-2.68), and reporting a previous test (OR = 2.03, 95%CI = 1.23-2.82). were significantly associated with having a recent HCV test.,,. Finding of present study was that unprotected sex had a negative association with HCV testing. Those PWIDs who had unprotected sex were 0.56 times less likely to have completed HCV testing during last year (OR = 0.56, 95%CI = 0.33-0.78). CONCLUSION Prevention programs that address age > 30 years, being female, past treatment attempt, previous testing of safe sexual practices, are strongly recommended to prioritize HCV risk reduction strategies.
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Kolla G, Kenny KS, Bannerman M, Boyce N, Chapman L, Dodd Z, Ko J, Ovens S. Help me fix: The provision of injection assistance at an unsanctioned overdose prevention site in Toronto, Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 76:102617. [PMID: 31838246 DOI: 10.1016/j.drugpo.2019.102617] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 11/10/2019] [Accepted: 12/03/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND There is an acute public health crisis from opioid-related poisoning and overdose in Canada. The Moss Park Overdose Prevention Site (MP-OPS) - an unsanctioned overdose prevention site - opened in a downtown park in Toronto in August 2017, when no other supervised consumption services existed in the province. As an unsanctioned site, MP-OPS was not constrained by federal rules prohibiting assisted injection, and provided a unique opportunity to examine assisted injection within a supervised setting. Our objective was to examine the association between assisted injection and overdose, and whether any association between assisted injection and overdose differs according to gender. METHODS Drawing on data from 5657 visits to MP-OPS from October 2017 to March 2018, we used multivariable logistic regression to investigate the relationship between assisted injection and overdose. To examine the influence of gender on this relationship, we further conducted stratified analyses by gender. RESULTS Among 5657 visits to MP-OPS, 471 (8.3%) received assisted injection, of which 242 (51.4%) were received by women and 226 (48.0%) by men. Using multivariable logistic regression, assisted injection was not associated with overdose in the overall sample (adjusted odds ratio [aOR]1.58, 95% confidence interval [CI]: 0.94, 2.67). In gender-stratified models, women receiving assisted injection were more than twice as likely (aOR 2.23, 95% CI: 1.17, 4.27) to experience overdose than women who did not receive assisted injection, and no association between assisted injection and overdose was found among men. CONCLUSION Findings that women receiving assisted injecting are at higher odds of overdose within the supervised setting of the MP-OPS are consistent with previous literature on assisted injection in community settings. Rules banning assisted injection in supervised consumption services may be putting a group of people, particularly women and those injecting fentanyl, at higher risk of health harms by denying them access to a supervised space where prompt overdose response is available.
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Affiliation(s)
- Gillian Kolla
- University of Toronto, Canada; Toronto Overdose Prevention Society, Canada.
| | - Kathleen S Kenny
- Toronto Overdose Prevention Society, Canada; University of North Carolina at Chapel Hill, United States.
| | | | - Nick Boyce
- Toronto Overdose Prevention Society, Canada
| | - Leigh Chapman
- University of Toronto, Canada; Toronto Overdose Prevention Society, Canada.
| | - Zoë Dodd
- Toronto Overdose Prevention Society, Canada; South Riverdale Community Health Centre, Canada.
| | - Jen Ko
- Toronto Overdose Prevention Society, Canada; South Riverdale Community Health Centre, Canada.
| | - Sarah Ovens
- Toronto Overdose Prevention Society, Canada.
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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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HIV- and hepatitis C-related risk behaviors among people who inject drugs in Uganda: implications for policy and programming. Harm Reduct J 2019; 16:56. [PMID: 31481086 PMCID: PMC6724292 DOI: 10.1186/s12954-019-0324-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 08/21/2019] [Indexed: 11/20/2022] Open
Abstract
Background There is a dearth of evidence on injecting drug use and associated HIV and hepatitis C virus (HCV) infections in Uganda. As such, policy and programming for people who inject drugs (PWID) is limited due to scarcity of epidemiological data. We therefore conducted this study to assess the injecting drug and sexual practices among PWID in Kampala Capital City and Mbale Municipality. Methods Using a rapid situation assessment framework, we conducted semi-structured interviews among 125 PWID (102 males and 23 females)—recruited through outreach and snowball sampling. We assessed their injecting drug and sexual practices. We also conducted 12 focus group discussions among PWID and 30 in-depth interviews among key informants. Results A total of 125 PWID (81.6% males and 18.4% females) were recruited into the study. Approximately three quarters of PWID started injecting before the age of 25. More females (21.7%) compared to males (13.7%) started injecting by the age of 17. Fifty-seven percent of the PWID in Kampala and 50% in Mbale shared injecting equipment in the last 3 months prior to the study. There was an emerging practice of mixing drugs with blood and sharing it among different PWID as a sign of oneness. Heroin was being injected by 72% of the participants. Less than one half of the PWID had used a condom during the last casual sex, and 42.7% did not use a condom the last time they engaged in sex work. Seventy-six percent of the PWID had undertaken an HIV test in the last 12 months, and 9.2% self-reported to be HIV positive. Conclusions This study highlights the need for introducing harm reduction policies and services including increased access to sterile injecting equipment and education around safer injecting and sexual practices. Programs for PWID should also address the specific needs of female sex workers who inject drugs.
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A good “doctor” is hard to find: Assessing uncredentialed expertise in assisted injection. Soc Sci Med 2019; 237:112446. [DOI: 10.1016/j.socscimed.2019.112446] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 07/21/2019] [Accepted: 07/24/2019] [Indexed: 11/20/2022]
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Navigating social norms of injection initiation assistance during an overdose crisis: A qualitative study of the perspectives of people who inject drugs (PWID) in Vancouver, Canada. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 69:24-33. [PMID: 31029914 DOI: 10.1016/j.drugpo.2019.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 03/27/2019] [Accepted: 04/13/2019] [Indexed: 01/24/2023]
Abstract
Despite the proliferation of fentanyl and fentanyl-adulterated opioids in North America, the impacts of this drug market change on injection initiation processes have not been examined. With the aim of informing structural interventions to address injection initiation and related harms, we explore how people who inject drugs (PWID) in Vancouver, Canada understand and navigate social norms of initiating others into injecting within the context of an overdose crisis. In-depth qualitative interviews were conducted with 19 PWID who reported helping someone inject for the first time. Participants were recruited from two cohort studies of PWID. Participants articulated moral dilemmas about assisting others with injecting. While participants described a 'moral code' prohibiting assisting injection-naïve individuals, this code was not the sole consideration shaping social action around injection initiation. Rather, PWID exercised agency about whether and how to assist novice injectors within the context of constraining and enabling social norms around practicing interpersonal responsibility. Changes to the drug market heightened feelings of moral culpability and criminal liability among PWID who assisted others into injection, given that injecting heightened initiates' risk of overdose. These concerns operated in tension with the aim of protecting novice injectors from harms associated with an increasingly potent and unpredictable drug supply by providing them with injection assistance, education and supervision. Our analysis of how PWID practice interpersonal responsibility helps conceptualise how 'moral codes' prohibiting initiation assistance are managed and negotiated amidst structural vulnerability. Structural interventions reducing the vulnerability of novice injectors should be prioritized, including the implementation of supervised injection sites allowing for assisted injection, Good Samaritan laws, and policy changes conducive to a safer drug supply.
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Reddon H, Marshall BDL, Milloy MJ. Elimination of HIV transmission through novel and established prevention strategies among people who inject drugs. Lancet HIV 2018; 6:e128-e136. [PMID: 30558843 DOI: 10.1016/s2352-3018(18)30292-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 10/01/2018] [Accepted: 10/12/2018] [Indexed: 11/16/2022]
Abstract
Despite the effectiveness of existing HIV prevention strategies for people who inject drugs (PWID), uncontrolled outbreaks of HIV among this group are common and occur around the world. In this Review, we summarise recent evidence for novel and established HIV prevention approaches to eliminate HIV transmission among PWID. Effective HIV prevention strategies include mobile needle and syringe programmes, pre-exposure prophylaxis, supervised injection facilities, and, to a lesser extent, some behavioural interventions. Studies have also shown the cost-effectiveness of long-standing HIV prevention strategies including needle and syringe programmes, opioid agonist therapy, and antiretroviral therapy for prevention. Although each individual intervention can reduce the risk of HIV acquisition among PWID, there is a consensus that a combination of approaches is required to achieve substantial and durable reductions in HIV transmission. Unfortunately, in many settings, the implementation of these interventions is often limited by public and political opposition that manifests as structural barriers to HIV prevention, such as the criminalisation of drug use. Given that there is ample evidence showing the effectiveness of several HIV prevention methods, social and political advocacy will be needed to overcome these barriers and integrate innovative HIV prevention approaches with addiction science to create effective drug policies.
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Affiliation(s)
- Hudson Reddon
- British Columbia Centre on Substance Use, Vancouver, BC, Canada; Canadian Institutes of Health Research, Canadian HIV Trials Network, Vancouver, BC, Canada
| | - Brandon D L Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - M-J Milloy
- British Columbia Centre on Substance Use, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, St Paul's Hospital, Vancouver, BC, Canada.
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Lamb S, Kral AH, Dominguez-Gonzalez K, Wenger LD, Bluthenthal RN. Peer-to-peer injection: Demographic, drug use, and injection-related risk factors. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 61:44-51. [PMID: 30388569 DOI: 10.1016/j.drugpo.2018.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 07/02/2018] [Accepted: 07/06/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Peer-to-peer injection (either providing or receiving an injection to/from a person who injects drugs [PWID]) is common (19%-50%) among PWID. Most studies of peer-to-peer injection have focused on receiving injection assistance, with fewer examining providing injection assistance and none considering characteristics of PWID who do both. We examined characteristics of PWID by peer-to-peer injection categories (receiving, providing, both, and neither) and determined if these behaviors were associated with receptive and distributive syringe sharing. METHODS Los Angeles and San Francisco PWID (N = 777) were recruited using targeted sampling methods and interviewed during 2011-2013. Multinomial logistic regression was used to determine characteristics associated with peer-to-peer injection categories and logistic regression was used to examine if peer-to-peer categories were independently associated with distributive and receptive syringe sharing. RESULTS Recent peer-to-peer injection was reported by 42% of PWID (18% provider; 14% recipient; 10% both). In multinomial regression analysis, PWID reporting any peer-to-peer injection were more likely to inject with others than those who did neither. Injection providers and those who did both were associated with more frequent injection, illegal income source, and methamphetamine injection while injection recipients were associated with fewer years of injection. Injection providers were younger, had more years of injecting, and were more likely to inject heroin than PWID who did neither. In multivariate analyses, we found that providers and PWID who did both were significantly more likely to report receptive and distributive syringe sharing than PWID who did neither. CONCLUSION Peer-to-peer injection is associated with HIV/HCV risk. Current prevention strategies may not sufficiently address these behaviors. Modification of existing interventions and development of new interventions to better respond to peer-to-peer injection is urgently needed.
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Affiliation(s)
- Shona Lamb
- Keck School of Medicine, University of Southern California, 1975 Zonal Ave, Los Angeles, CA 90033, United States
| | - Alex H Kral
- Behavioral and Urban Health Program, RTI International, 351 California Street, Suite 500, San Francisco, CA 94104, United States
| | - Karina Dominguez-Gonzalez
- Department of Preventive Medicine, Institute for Prevention Research, Keck School of Medicine, University of Southern California, 2001 N Soto St, 3rd floor, Los Angeles, CA 90033, United States
| | - Lynn D Wenger
- Behavioral and Urban Health Program, RTI International, 351 California Street, Suite 500, San Francisco, CA 94104, United States
| | - Ricky N Bluthenthal
- Department of Preventive Medicine, Institute for Prevention Research, Keck School of Medicine, University of Southern California, 2001 N Soto St, 3rd floor, Los Angeles, CA 90033, United States.
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May T, Bennett T, Holloway K. RETRACTED: The impact of medically supervised injection centres on drug-related harms: a meta-analysis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 59:98-107. [PMID: 30077946 DOI: 10.1016/j.drugpo.2018.06.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 02/22/2018] [Accepted: 06/15/2018] [Indexed: 01/09/2023]
Affiliation(s)
- Tom May
- Centre for Criminology, University of South Wales, Pontypridd, CF37 1DL, United Kingdom
| | - Trevor Bennett
- Centre for Criminology, University of South Wales, Pontypridd, CF37 1DL, United Kingdom
| | - Katy Holloway
- Centre for Criminology, University of South Wales, Pontypridd, CF37 1DL, United Kingdom
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15
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Bozinoff N, Luo L, Dong H, Krüsi A, DeBeck K. Street-involved youth engaged in sex work at increased risk of syringe sharing. AIDS Care 2018; 31:69-76. [PMID: 29999421 DOI: 10.1080/09540121.2018.1497134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Syringe sharing places street-involved young people at risk of acquiring HIV and hepatitis C. While markers of economic marginalization, such as homelessness, have been linked with syringe sharing and have led to targeted interventions, the relationship between syringe sharing and other markers of economic vulnerability, such as sex work, are not well documented among young people. This study examines whether those engaged in sex work are at increased risk of syringe borrowing and syringe lending among street-involved youth who use injection drugs in Vancouver, Canada. Between September 2005 and May 2014, data was collected from the At-Risk Youth Study (ARYS), a prospective cohort of street involved youth aged 14-26. Generalized estimating equations with a confounding model building approach was used to examine the relationship between sex work and syringe borrowing and lending. 498 youth reported injecting drugs at some point during the study period and were therefore included in the analysis. In multivariable analysis, youth who engaged in sex work were at an elevated risk of both syringe borrowing (Adjusted Odds Ratio (AOR) = 2.17, 95% Confidence Interval [CI] = 1.40-3.36) and syringe lending (AOR = 1.66, 95% CI = 1.07-2.59). Our study found that youth engaged in street-based sex work were at a significantly higher risk of both syringe borrowing and lending among youth who use injection drugs in Vancouver. Ready access to clean syringes, safer working conditions for sex workers to enable risk reduction measures, and increased access to addiction treatment are identified as promising opportunities for reducing syringe sharing in this setting.
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Affiliation(s)
- Nikki Bozinoff
- a British Columbia Centre for Excellence in HIV/AIDS , Vancouver , BC , Canada.,b Department of Family and Community Medicine , University of Toronto , Toronto , ON , Canada.,c B.C. Centre on Substance Use , Vancouver , BC , Canada
| | - Lerly Luo
- a British Columbia Centre for Excellence in HIV/AIDS , Vancouver , BC , Canada.,c B.C. Centre on Substance Use , Vancouver , BC , Canada
| | - Huiru Dong
- a British Columbia Centre for Excellence in HIV/AIDS , Vancouver , BC , Canada.,c B.C. Centre on Substance Use , Vancouver , BC , Canada
| | - Andrea Krüsi
- a British Columbia Centre for Excellence in HIV/AIDS , Vancouver , BC , Canada.,c B.C. Centre on Substance Use , Vancouver , BC , Canada.,d Department of Medicine , University of British Columbia , Vancouver , BC , Canada
| | - Kora DeBeck
- a British Columbia Centre for Excellence in HIV/AIDS , Vancouver , BC , Canada.,c B.C. Centre on Substance Use , Vancouver , BC , Canada.,e School of Public Policy , Simon Fraser University , Vancouver , BC , Canada
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16
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Fraser H, Mukandavire C, Martin NK, Hickman M, Cohen MS, Miller WC, Vickerman P. HIV treatment as prevention among people who inject drugs - a re-evaluation of the evidence. Int J Epidemiol 2018; 46:466-478. [PMID: 27524816 DOI: 10.1093/ije/dyw180] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2016] [Indexed: 01/01/2023] Open
Abstract
Background Population-level associations between community measures of HIV viral load and HIV incidence have been interpreted as evidence for HIV anti-retroviral treatment (ART) as prevention among people who inject drugs (PWID). However, investigation of concurrent HCV and HIV incidence trends allows examination of alternative explanations for the fall in HIV incidence. We estimate the contribution of ART and reductions in injecting risk for reducing HIV incidence in Vancouver between 1996 and 2007. Methods A deterministic model of HIV and HCV transmission among PWID was calibrated to the baseline (1996) HIV and HCV epidemic among PWID in Vancouver. While incorporating parameter uncertainty, the model projected what levels of ART protection and decreases in injecting risk could reproduce the observed reduction in HIV and HCV incidence for 1996-2007, and so what impact would have been achieved with just ART or just reductions in injecting risk. Results Model predictions suggest the estimated reduction (84%) in HCV incidence for 1996-2007 required a 59% (2.5-97.5 percentile range 49-76%) reduction in injecting risk, which accounted for nine-tenths of the observed decrease in HIV incidence; the remainder was achieved with a moderate ART efficacy for reducing sexual HIV infectivity (70%, 51-89%) and an uncertain ART efficacy for reducing injection-related HIV infectivity (44%, 0-96%). Despite this uncertainty, projections suggest that the decrease in injecting risk reduced HIV incidence by 76% (63-85%) and ART further reduced HIV incidence by 8% (2-19%), or on its own by 3% (-34-37%). Conclusions Observed declines in HIV incidence in Vancouver between 1996 and 2007 should be seen as a success for intensive harm reduction, whereas ART probably played a small role.
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Affiliation(s)
- Hannah Fraser
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | | | - Natasha K Martin
- School of Social and Community Medicine, University of Bristol, Bristol, UK
- Division of Global Public Health, University of California San Diego, CA, USA and
| | - Matthew Hickman
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Myron S Cohen
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - William C Miller
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - Peter Vickerman
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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17
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Gilchrist G, Swan D, Shaw A, Keding A, Towers S, Craine N, Munro A, Hughes E, Parrott S, Mdege N, Strang J, Taylor A, Watson J. Preventing blood-borne virus infection in people who inject drugs in the UK: systematic review, stakeholder interviews, psychosocial intervention development and feasibility randomised controlled trial. Health Technol Assess 2017; 21:1-312. [PMID: 29208190 PMCID: PMC5733383 DOI: 10.3310/hta21720] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Opioid substitution therapy and needle exchanges have reduced blood-borne viruses (BBVs) among people who inject drugs (PWID). Some PWID continue to share injecting equipment. OBJECTIVES To develop an evidence-based psychosocial intervention to reduce BBV risk behaviours and increase transmission knowledge among PWID, and conduct a feasibility trial among PWID comparing the intervention with a control. DESIGN A pragmatic, two-armed randomised controlled, open feasibility trial. Service users were Steering Group members and co-developed the intervention. Peer educators co-delivered the intervention in London. SETTING NHS or third-sector drug treatment or needle exchanges in Glasgow, London, Wrexham and York, recruiting January and February 2016. PARTICIPANTS Current PWID, aged ≥ 18 years. INTERVENTIONS A remote, web-based computer randomisation system allocated participants to a three-session, manualised, psychosocial, gender-specific group intervention delivered by trained facilitators and BBV transmission information booklet plus treatment as usual (TAU) (intervention), or information booklet plus TAU (control). MAIN OUTCOME MEASURES Recruitment, retention and follow-up rates measured feasibility. Feedback questionnaires, focus groups with participants who attended at least one intervention session and facilitators assessed the intervention's acceptability. RESULTS A systematic review of what works to reduce BBV risk behaviours among PWID; in-depth interviews with PWID; and stakeholder and expert consultation informed the intervention. Sessions covered improving injecting technique and good vein care; planning for risky situations; and understanding BBV transmission. Fifty-six per cent (99/176) of eligible PWID were randomised: 52 to the intervention group and 47 to the control group. Only 24% (8/34) of male and 11% (2/18) of female participants attended all three intervention sessions. Overall, 50% (17/34) of men and 33% (6/18) of women randomised to the intervention group and 47% (14/30) of men and 53% (9/17) of women randomised to the control group were followed up 1 month post intervention. Variations were reported by location. The intervention was acceptable to both participants and facilitators. At 1 month post intervention, no increase in injecting in 'risky' sites (e.g. groin, neck) was reported by participants who attended at least one session. PWID who attended at least one session showed a trend towards greater reduction in injecting risk behaviours, a greater increase in withdrawal planning and were more confident about finding a vein. A mean cost of £58.17 per participant was calculated for those attending one session, £148.54 for those attending two sessions and £270.67 for those attending all three sessions, compared with £0.86 in the control group. Treatment costs across the centres vary as a result of the different levels of attendance, as total session costs are divided by attendees to obtain a cost per attendee. The economic analysis suggests that a cost-effectiveness study would be feasible given the response rates and completeness of data. However, we have identified aspects where the service use questionnaire could be abbreviated given the low numbers reported in several care domains. No adverse events were reported. CONCLUSIONS As only 19% of participants attended all three intervention sessions and 47% were followed up 1 month post intervention, a future definitive randomised controlled trial of the intervention is not feasible. Exposure to information on improving injecting techniques did not encourage riskier injecting practices or injecting frequency, and benefits were reported among attendees. The intervention has the potential to positively influence BBV prevention. Harm reduction services should ensure that the intervention content is routinely delivered to PWID to improve vein care and prevent BBVs. FUTURE WORK The intervention did not meet the complex needs of some PWID, more tailoring may be needed to reach PWID who are more frequent injectors, who are homeless and female. LIMITATIONS Intervention delivery proved more feasible in London than other locations. Non-attendance at the York trial site substantially influenced the results. TRIAL REGISTRATION Current Controlled Trials ISRCTN66453696 and PROSPERO 014:CRD42014012969. FUNDING This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 72. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Gail Gilchrist
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Davina Swan
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - April Shaw
- School of Media, Culture and Society, University of the West of Scotland, Paisley, UK
| | - Ada Keding
- Department of Health Sciences, University of York, York, UK
| | - Sarah Towers
- Betsi Cadwaladr University Health Board, Bangor, UK
| | - Noel Craine
- Public Health Wales, Microbiology, Bangor, UK
| | - Alison Munro
- School of Media, Culture and Society, University of the West of Scotland, Paisley, UK
| | - Elizabeth Hughes
- Centre for Applied Research in Health, School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Steve Parrott
- Department of Health Sciences, University of York, York, UK
| | - Noreen Mdege
- Department of Health Sciences, University of York, York, UK
| | - John Strang
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Avril Taylor
- School of Media, Culture and Society, University of the West of Scotland, Paisley, UK
| | - Judith Watson
- Department of Health Sciences, University of York, York, UK
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18
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Public Health and Public Order Outcomes Associated with Supervised Drug Consumption Facilities: a Systematic Review. Curr HIV/AIDS Rep 2017; 14:161-183. [DOI: 10.1007/s11904-017-0363-y] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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19
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Gagnon M. It's time to allow assisted injection in supervised injection sites. CMAJ 2017; 189:E1083-E1084. [PMID: 28847779 DOI: 10.1503/cmaj.170659] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Marilou Gagnon
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ont.
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20
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Kerr T, Mitra S, Kennedy MC, McNeil R. Supervised injection facilities in Canada: past, present, and future. Harm Reduct J 2017; 14:28. [PMID: 28521829 PMCID: PMC5437687 DOI: 10.1186/s12954-017-0154-1] [Citation(s) in RCA: 128] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 05/08/2017] [Indexed: 01/09/2023] Open
Abstract
Canada has long contended with harms arising from injection drug use. In response to epidemics of HIV infection and overdose in Vancouver in the mid-1990s, a range of actors advocated for the creation of supervised injection facilities (SIFs), and after several unsanctioned SIFs operated briefly and closed, Canada’s first sanctioned SIF opened in 2003. However, while a large body of evidence highlights the successes of this SIF in reducing the health and social harms associated with injection drug use, extraordinary efforts were needed to preserve it, and continued activism by local people who inject drugs (PWID) and healthcare providers was needed to promote further innovation and address gaps in SIF service delivery. A growing acceptance of SIFs and increasing concern about overdose have since prompted a rapid escalation in efforts to establish SIFs in cities across Canada. While much progress has been made in that regard, there is a pressing need to create a more enabling environment for SIFs through amendment of federal legislation. Further innovation in SIF programming should also be encouraged through the creation of SIFs that accommodate assisted injecting, the inhalation of drugs. As well, peer-run, mobile, and hospital-based SIFs also constitute next steps needed to optimize the impact of this form of harm reduction intervention.
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Affiliation(s)
- Thomas Kerr
- British Columbia Centre on Substance Use, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, B.C., V6Z 1Y6, Canada. .,Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
| | - Sanjana Mitra
- Ontario HIV Treatment Network, 1300 Yonge Street, Suite 600, Toronto, ON, M4T 1X3, Canada
| | - Mary Clare Kennedy
- British Columbia Centre on Substance Use, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, B.C., V6Z 1Y6, Canada.,School of Population and Public Health, University of British Columbia, 5804 Fairview Avenue, Vancouver, BC, V6T 1Z3, Canada
| | - Ryan McNeil
- British Columbia Centre on Substance Use, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, B.C., 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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21
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Behavioral risk assessment for infectious diseases (BRAID): Self-report instrument to assess injection and noninjection risk behaviors in substance users. Drug Alcohol Depend 2016; 168:69-75. [PMID: 27615403 PMCID: PMC5086299 DOI: 10.1016/j.drugalcdep.2016.07.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 07/26/2016] [Accepted: 07/29/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND Infectious diseases such as Human Immunodeficiency Virus and Hepatitis C are a significant problem among substance abusers. Current risk behavior measures [e.g., HIV Risk Taking Behaviour Scale (HRBS) and Risk Assessment Battery (RAB)] were developed for injection drug users and do not include newly identified risks or noninjection drug use behaviors. This study developed and provided initial, internal validation of the Behavioral Risk Assessment for Infectious Diseases (BRAID) to assess infectious disease risk behaviors among alcohol and other drug users. METHODS A self-report measure was developed from literature regarding risk behaviors. Participants (total N=998) with alcohol/substance use disorder completed the measure in 2 phases to establish initial psychometric validity. RESULTS Phase 1 (N=270) completed 65 self-report questions; factor analysis revealed a 12-item solution with 5 factors (Unprotected Sex with Risky Partners, Injection Use, Sex on Cocaine/Crack, Condom Availability, and Intranasal Drug Use). Infectious disease history was positively associated with Injection Use (Sample 1) and Unprotected Sex with Risky Partners (Sample 2) and negatively associated with Intranasal Drug Use (Samples 1 and 2). Phase 2 (N=728) added additional injection-related items and confirmed the factor structure of the existing BRAID. CONCLUSIONS The BRAID is a 5-factor, 14-item self-report measure of past 6 month risk behaviors that is composed of noninjection and injection risk behaviors and was psychometrically confirmed. Though additional external (convergent/divergent) validation is needed, this report provides preliminary support for the use of the BRAID to assess infectious disease risk in substance users.
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22
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Cheng T, Kerr T, Small W, Dong H, Montaner J, Wood E, DeBeck K. High Prevalence of Assisted Injection Among Street-Involved Youth in a Canadian Setting. AIDS Behav 2016; 20:377-84. [PMID: 26040989 DOI: 10.1007/s10461-015-1101-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Many people who inject illicit drugs receive manual assistance when injecting, and this practice has been linked to increased risk of HIV infection and other harms. Little is known, however, about this practice among youth. This study uses a multivariate generalized estimating equation to identify factors associated with receiving assistance with injecting among a cohort of street-involved youth aged 14-26 in Vancouver, Canada. A total of 253 participants reported injecting drugs during the study period, and 49 % (n = 125) of these youth reported receiving assistance with injecting in the past 6 months. In multivariate analysis, younger age, female gender, binge drug use, heroin injecting, cocaine injecting, crystal methamphetamine injecting, and syringe sharing were positively and independently associated with assisted injection (all p < 0.05). These findings underscore the need for expanding substance abuse treatment alongside HIV prevention and health promotion interventions to empower youth to enact safer injection practices.
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Affiliation(s)
- Tessa Cheng
- 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
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - 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
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Will Small
- 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
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Huiru Dong
- 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
| | - Julio Montaner
- 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
- Faculty of Medicine, University of British Columbia, Vancouver, 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
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Kora DeBeck
- 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 Public Policy, Simon Fraser University, Burnaby, Canada.
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23
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Pedersen JS, Dong H, Small W, Wood E, Nguyen P, Kerr T, Hayashi K. Declining trends in the rates of assisted injecting: a prospective cohort study. Harm Reduct J 2016; 13:2. [PMID: 26817687 PMCID: PMC4728798 DOI: 10.1186/s12954-016-0092-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 12/24/2015] [Indexed: 11/18/2022] Open
Abstract
Background Assisted injecting has been associated with increased risk of blood-borne infections, overdose, and other harms among people who inject drugs (PWID), particularly women. Given the changing availability of relevant harm reduction interventions in Vancouver, Canada, in recent years, we conducted a gender-based analysis to examine changes in rates and correlates of assisted injecting over time among active PWID. Methods Using data from a prospective cohort of PWID in Vancouver, we employed gender-stratified multivariable generalized estimating equations to examine trends in assisted injecting and identify the correlates during two periods: June 2006–November 2009 and December 2009–May 2014. Results Among 1119 participants, 376 (33.6 %) were females. Rates of assisted injecting declined between 2006 and 2014 among males (21.9 to 13.8 %) and females (37.0 to 25.6 %). In multivariable analyses, calendar year of interview also remained independently and negatively associated with assisted injecting among males (adjusted odds ratio [AOR] 0.95, 95 % confidence interval [CI] 0.92–0.99) and females (AOR 0.93, 95 % CI 0.89–0.97). Syringe borrowing remained independently associated with assisted injecting throughout the study period among females (AOR 1.53, 95 % CI 1.10–2.11 during 2006–2009; AOR 2.15, 95 % CI 1.24–3.74 during 2009–2014) and during 2009–2014 among males (AOR 1.88, 95 % CI 1.02–3.48). Conclusions Our findings demonstrate assisted injecting has significantly decreased for both males and females over the past decade. Nevertheless, rates of assisted injecting remain high, especially among women, and are associated with high-risk behavior, indicating a need to provide safer assisted injecting services to these vulnerable sub-populations of PWID.
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Affiliation(s)
- Jeanette Somlak Pedersen
- Cumming School of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.
| | - Huiru Dong
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
| | - Will Small
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. .,Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, 15A 1S6, Canada.
| | - Evan Wood
- 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.
| | - Paul Nguyen
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
| | - Thomas Kerr
- 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.
| | - Kanna Hayashi
- 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. .,B.C. Centre for Excellence in HIV/AIDS, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
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24
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Scheidell J, Khan M, Clifford L, Dunne E, Keen II. L, Latimer W. Gender differences in planning ability and hepatitis C virus among people who inject drugs. Addict Behav 2015; 47:33-7. [PMID: 25863005 DOI: 10.1016/j.addbeh.2015.03.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 02/20/2015] [Accepted: 03/16/2015] [Indexed: 12/19/2022]
Abstract
Hepatitis C virus (HCV) is primarily spread through risky injection practices, including sharing needles, cookers, cottons, rinse water, and the practice of backloading. An important aspect of harm reduction for people who inject drugs (PWID) is to identify factors that contribute to safer injection. Planning ability may influence risky injection practices and gender differences in factors that drive injection practices indicate a need to examine associations between planning and injection behaviors in men versus women. Data from the NEURO-HIV Epidemiologic Study was restricted to those who had ever injected in their lifetime (n=456). Impaired planning ability was assessed with the Tower of London and defined as a standardized total excess move score below the 10th percentile. We used logistic regression to estimate the gender-specific adjusted odds ratios (AOR) and 95% confidence intervals (CI) for associations between impaired planning, each injection practice, and biologically-confirmed HCV. Impaired planning ability was associated with sharing needles (AOR=2.93, 95% CI: 1.33, 6.47), cookers (AOR=3.13, 95% CI: 1.22, 8.02), cottons (AOR=2.89, 95% CI: 1.23, 6.78), rinse water (AOR=2.43, 95% CI: 1.15, 5.14), and backloading (AOR=2.68, 95% CI: 1.26, 5.70) and HCV (AOR=3.42, 95% CI: 1.03, 11.38) among men. Planning ability was not significantly associated with the injection behaviors or HCV among women, suggesting that other factors likely contribute to risky injection practices. Interventions to promote harm reduction among PWID should ascertain and strengthen planning ability. Women may have additional barriers to practicing safe injection beyond impaired planning abilities, which should also be addressed.
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Syvertsen JL, Agot K, Ohaga S, Strathdee SA, Camlin CS, Omanga E, Odonde P, Rota G, Akoth K, Peng J, Wagner KD. Evidence of injection drug use in Kisumu, Kenya: Implications for HIV prevention. Drug Alcohol Depend 2015; 151:262-6. [PMID: 25861945 PMCID: PMC4447587 DOI: 10.1016/j.drugalcdep.2015.02.037] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 02/26/2015] [Accepted: 02/28/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Injection drug use is increasingly contributing to the HIV epidemic across sub-Saharan Africa. This paper provides the first descriptive analysis of injection drug use in western Kenya, where HIV prevalence is already highest in the nation at 15.1%. METHODS We draw on quantitative data from a study of injection drug use in Kisumu, Kenya. We generated descriptive statistics on socio-demographics, sexual characteristics, and drug-related behaviors. Logistic regression models were adjusted for sex to identify correlates of self-reported HIV positive status. RESULTS Of 151 participants, mean age was 28.8 years, 84% (n = 127) were male, and overall self-reported HIV prevalence reached 19.4%. Women had greater than four times the odds of being HIV positive relative to men (Odds Ratio [OR] 4.5, CI: 1.7, 11.8, p = .003). Controlling for sex, ever experiencing STI symptoms (Adjusted Odds ratio [AOR] 4.6, 95% CI 1.7, 12.0, p = .002) and sharing needles or syringes due to lack of access (AOR 3.6, 95% CI 1.2, 10.5, p = .02) were significantly associated with HIV positive status. Lower education (AOR 2.3, 95% CI 0.9, 5.6, p=.08), trading sex for drugs (AOR 2.8, 95% CI 0.9, 8.8, p = .08), being injected by a peddler (AOR 2.9, 95% CI 1.0, 8.5, p = .05), and injecting heroin (AOR 2.3, 95% CI 1.0, 5.7, p = .06), were marginally associated with HIV. CONCLUSIONS This exploratory study identified patterns of unsafe drug injection and concurrent sexual risk in western Kenya, yet few resources are currently available to address addiction or injection-related harm. Expanded research, surveillance, and gender sensitive programming are needed.
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Affiliation(s)
- Jennifer L. Syvertsen
- Department of Anthropology, The Ohio State University, 4046 Smith Laboratory, 174 W. 18th Ave. Columbus, OH 43210-1106 USA, phone: +1 614-247-6815, fax: +1 614-292-4155
| | - Kawango Agot
- Impact Research and Development Organization, P.O. Box 9171-40141, Kisumu, Kenya
| | - Spala Ohaga
- Impact Research and Development Organization, P.O. Box 9171-40141, Kisumu, Kenya
| | - Steffanie A. Strathdee
- Division of Global Public Health, University of California, San Diego, Central Research Services Facility (CRSF), La Jolla, CA, 92093-0507, USA
| | - Carol S. Camlin
- Department of Obstetrics, Gynecology & Reproductive Sciences and Center for AIDS Prevention Studies, University of California at San Francisco, 550 16th St., 3rd Floor [UCSF Mailcode 1224], San Francisco, CA 94158-2549 USA
| | - Eunice Omanga
- Impact Research and Development Organization, P.O. Box 9171-40141, Kisumu, Kenya
| | - Petronilla Odonde
- Impact Research and Development Organization, P.O. Box 9171-40141, Kisumu, Kenya
| | - Grace Rota
- Kenya Medical Research Institute, P.O. Box 614-40100, Kisumu, Kenya
| | - Kelvin Akoth
- Kenya Medical Research Institute, P.O. Box 614-40100, Kisumu, Kenya
| | - Juan Peng
- Center for Biostatistics, The Ohio State University, 2012 Kenny Road, Columbus, Ohio, 43221 USA
| | - Karla D. Wagner
- School of Community Health Sciences, University of Nevada, Reno, 1664 N. Virginia St. MS 0274, Reno, NV 89557 USA
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McNeil R, Small W, Lampkin H, Shannon K, Kerr T. "People knew they could come here to get help": an ethnographic study of assisted injection practices at a peer-run 'unsanctioned' supervised drug consumption room in a Canadian setting. AIDS Behav 2014; 18:473-85. [PMID: 23797831 DOI: 10.1007/s10461-013-0540-y] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
People who require help injecting are disproportionately vulnerable to drug-related harm, including HIV transmission. North America's only sanctioned SIF operates in Vancouver, Canada under an exemption to federal drug laws, which imposes operating regulations prohibiting assisted injections. In response, the Vancouver Area Network of Drug Users (VANDU) launched a peer-run unsanctioned SIF in which trained peer volunteers provide assisted injections to increase the coverage of supervised injection services and minimize drug-related harm. We undertook qualitative interviews (n = 23) and ethnographic observation (50 h) to explore how this facility shaped assisted injection practices. Findings indicated that VANDU reshaped the social, structural, and spatial contexts of assisted injection practices in a manner that minimized HIV and other health risks, while allowing people who require help injecting to escape drug scene violence. Findings underscore the need for changes to regulatory frameworks governing SIFs to ensure that they accommodate people who require help injecting.
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Affiliation(s)
- Ryan McNeil
- 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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Syvertsen JL, Robertson AM, Strathdee SA, Martinez G, Rangel MG, Wagner KD. Rethinking risk: gender and injection drug-related HIV risk among female sex workers and their non-commercial partners along the Mexico-U.S. border. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2014; 25:836-44. [PMID: 24641906 DOI: 10.1016/j.drugpo.2014.02.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 01/17/2014] [Accepted: 02/04/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Studies of injection drug-using couples suggest a gendered performance of risk in which men exert greater control over drug use and render their female partners vulnerable to HIV infection and other negative health outcomes. This study assesses gender roles in injection drug use as practiced among female sex workers and their intimate male partners within a risk environment marked by rapid socioeconomic changes. METHODS We draw on quantitative surveys, semi-structured interviews, and ethnographic fieldwork conducted as part of cohort study of HIV/STI risk among female sex workers and their intimate, non-commercial partners along the Mexico-U.S. border. This study employed descriptive statistics and inductive analyses of transcripts and field notes to examine practices related to drug procurement, syringe sharing, and injection assistance among couples in which both partners reported injecting drugs in the past 6 months. RESULTS Among 156 couples in which both partners injected drugs (n=312), our analyses revealed that women's roles in drug use were active and multidimensional, and both partners' injection risk practices represented embodied forms of cooperation and compassion. Women often earned money to purchase drugs and procured drugs to protect their partners from the police. Sharing drugs and syringes and seeking injection assistance were common among couples due to drug market characteristics (e.g., the use of "black tar" heroin that clogs syringes and damages veins). Both women and men provided and received injection assistance, which was typically framed as caring for the partner in need of help. CONCLUSION Our mixed methods study suggests that in certain risk environments, women are more active participants in injection-related practices than has often been revealed. This participation is shaped by dynamic relationship and structural factors. Our suggestion to consider gendered injection risk as a nuanced and relational process has direct implications for future research and interventions.
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Affiliation(s)
- Jennifer L Syvertsen
- Department of Anthropology, The Ohio State University, 4046 Smith Laboratory, 174 W. 18th Avenue, Columbus, OH 43210, USA; Division of Global Public Health, Department of Medicine, University of California, San Diego La Jolla, CA 92093-0507, USA
| | - Angela M Robertson
- Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA; The Fenway Institute, Fenway Health, 1340 Boylston Street, 8th Floor, Boston, MA 02215, USA
| | - Steffanie A Strathdee
- Division of Global Public Health, Department of Medicine, University of California, San Diego La Jolla, CA 92093-0507, USA
| | - Gustavo Martinez
- Federación Mexicana de Asociaciones Privadas, Ciudad Juárez, Chihuahua, Mexico
| | - M Gudelia Rangel
- El Colegio de la Frontera Norte, Tijuana, Baja California, Mexico
| | - Karla D Wagner
- Division of Global Public Health, Department of Medicine, University of California, San Diego La Jolla, CA 92093-0507, USA.
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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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Leung LTF, Ti L, Hayashi K, Suwannawong P, Kaplan K, Wood E, Kerr T. Health and safety risks associated with public injecting among people who inject drugs in Bangkok, Thailand. Drug Alcohol Rev 2013; 32:582-7. [DOI: 10.1111/dar.12060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Accepted: 05/16/2013] [Indexed: 11/26/2022]
Affiliation(s)
- Leslie Tze Fung Leung
- British Columbia Centre for Excellence in HIV/AIDS; St. Paul's Hospital; Vancouver Canada
- Faculty of Medicine; University of British Columbia; Vancouver Canada
| | - Lianping Ti
- British Columbia Centre for Excellence in HIV/AIDS; St. Paul's Hospital; Vancouver Canada
- School of Population & Public Health; University of British Columbia; Vancouver Canada
| | - Kanna Hayashi
- British Columbia Centre for Excellence in HIV/AIDS; St. Paul's Hospital; Vancouver Canada
- Interdisciplinary Studies Graduate Program; University of British Columbia; Vancouver Canada
| | - Paisan Suwannawong
- Mitsampan Harm Reduction Center/Thai AIDS Treatment Action Group; Bangkok Thailand
| | - Karyn Kaplan
- Mitsampan Harm Reduction Center/Thai AIDS Treatment Action Group; Bangkok Thailand
| | - Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS; St. Paul's Hospital; Vancouver Canada
- Faculty of Medicine; University of British Columbia; Vancouver Canada
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS; St. Paul's Hospital; Vancouver Canada
- Faculty of Medicine; University of British Columbia; Vancouver Canada
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Control over drug acquisition, preparation and injection: Implications for HIV and HCV risk among young female injection drug users. ISRN ADDICTION 2013; 2013. [PMID: 24364027 PMCID: PMC3866021 DOI: 10.1155/2013/289012] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Young female injection drug users (IDUs) are at risk for HIV/HCV, and initiating the use of a new drug may confer additional and unexpected risks. While gender differences in the social context of injection drug use have been identified, it is unknown whether those differences persist during the initiation of a new drug. This mixed-methods study examined the accounts of 30 young female IDUs in Los Angeles, CA, USA from 2004 to 2006, who described the social context of initiating injection drug use and initiating ketamine injection. The analysis aimed to understand how the social context of young women's injection events contributes to HIV/HCV risk. Women's initiation into ketamine injection occurred approximately 2 years after their first injection of any drug. Over that time, women experienced changes in some aspects of the social context of drug injection, including the size and composition of the using group. A significant proportion of women described injection events characterized by a lack of control over the acquisition, preparation, and injection of drugs, as well as reliance on friends and sexual partners. Findings suggest that lack of control over drug acquisition, preparation, and injection may elevate women's risk; these phenomena should be considered as a behavioral risk factor when designing interventions.
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McElrath K, Harris J. Peer injecting: implications for injecting order and blood-borne viruses among men and women who inject heroin. JOURNAL OF SUBSTANCE USE 2013. [DOI: 10.3109/14659891.2012.716901] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Robertson AM, Lozada R, Pollini RA, Rangel G, Ojeda VD. Correlates and contexts of US injection drug initiation among undocumented Mexican migrant men who were deported from the United States. AIDS Behav 2012; 16:1670-80. [PMID: 22246511 DOI: 10.1007/s10461-011-0111-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Preventing the onset of injection drug use is important in controlling the spread of HIV and other blood borne infections. Undocumented migrants in the United States face social, economic, and legal stressors that may contribute to substance abuse. Little is known about undocumented migrants' drug abuse trajectories including injection initiation. To examine the correlates and contexts of US injection initiation among undocumented migrants, we administered quantitative surveys (N = 309) and qualitative interviews (N = 23) on migration and drug abuse experiences to deported male injection drug users in Tijuana, Mexico. US injection initiation was independently associated with ever using drugs in Mexico pre-migration, younger age at first US migration, and US incarceration. Participants' qualitative interviews contextualized quantitative findings and demonstrated the significance of social contexts surrounding US injection initiation experiences. HIV prevention programs may prevent/delay US injection initiation by addressing socio-economic and migration-related stressors experienced by undocumented migrants.
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Small W, Moore D, Shoveller J, Wood E, Kerr T. Perceptions of risk and safety within injection settings: Injection drug users' reasons for attending a supervised injecting facility in Vancouver, Canada. HEALTH RISK & SOCIETY 2012. [DOI: 10.1080/13698575.2012.680950] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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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: 59] [Impact Index Per Article: 4.9] [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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Thorne C, Semenenko I, Malyuta R. Prevention of mother-to-child transmission of human immunodeficiency virus among pregnant women using injecting drugs in Ukraine, 2000-10. Addiction 2012; 107:118-28. [PMID: 21819473 PMCID: PMC3272221 DOI: 10.1111/j.1360-0443.2011.03609.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Revised: 04/20/2011] [Accepted: 08/02/2011] [Indexed: 12/01/2022]
Abstract
AIMS To compare clinical status, mother-to-child transmission (MTCT) rates, use of prevention of (PMTCT) interventions and pregnancy outcomes between HIV-infected injecting drug users (IDUs) and non-IDUs. DESIGN AND SETTING Prospective cohort study conducted in seven human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) Centres in Ukraine, 2000-10. PARTICIPANTS Pregnant HIV-infected women, identified before/during pregnancy or intrapartum, and their live-born infants (n = 6200); 1028 women followed post-partum. MEASUREMENTS Maternal and delivery characteristics, PMTCT prophylaxis, MTCT rates, preterm delivery (PTD) and low birth weight (LBW). FINDINGS Of 6200 women, 1111 (18%) reported current/previous IDU. The proportion of IDUs diagnosed with HIV before conception increased from 31% in 2000/01 to 60% in 2008/09 (P < 0.01). Among women with undiagnosed HIV at conception, 20% of IDUs were diagnosed intrapartum versus 4% of non-IDUs (P < 0.01). At enrolment, 14% of IDUs had severe/advanced HIV symptoms versus 6% of non-IDUs (P < 0.001). IDUs had higher rates of PTD and LBW infants than non-IDUs, respectively, 16% versus 7% and 22% versus 10% (P < 0.001). IDUs were more likely to receive no neonatal or intrapartum PMTCT prophylaxis compared with non-IDUs (OR 2.81, p < 0.001). MTCT rates were 10.8% in IDUs versus 5.9% in non-IDUs; IDUs had increased MTCT risk (adjusted odds ratio 1.32, P = 0.049). Fewer IDUs with treatment indications received HAART compared with non-IDUs (58% versus 68%, P = 0.03). CONCLUSIONS Pregnant human immunodeficiency virus-infected injecting drug users in Ukraine have worse clinical status, poorer access to prevention of mother-to-child transmission prophylaxis and highly active antiretroviral therapy, more adverse pregnancy outcomes and higher risk of mother-to-child transmission than non-injecting drug user women.
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MESH Headings
- Adult
- Analgesics, Opioid
- Anti-Retroviral Agents/therapeutic use
- Antiretroviral Therapy, Highly Active/statistics & numerical data
- CD4 Lymphocyte Count
- Female
- HIV Infections/drug therapy
- HIV Infections/epidemiology
- HIV Infections/prevention & control
- HIV Infections/transmission
- Health Status
- Healthcare Disparities
- Humans
- Infant, Low Birth Weight
- Infant, Newborn
- Infectious Disease Transmission, Vertical/prevention & control
- Infectious Disease Transmission, Vertical/statistics & numerical data
- Male
- Post-Exposure Prophylaxis/methods
- Post-Exposure Prophylaxis/statistics & numerical data
- Pregnancy
- Pregnancy Complications, Infectious/drug therapy
- Pregnancy Complications, Infectious/epidemiology
- Pregnancy Complications, Infectious/prevention & control
- Pregnancy Outcome
- Prospective Studies
- Risk Factors
- Substance Abuse, Intravenous/epidemiology
- Ukraine/epidemiology
- Young Adult
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Affiliation(s)
- Claire Thorne
- MRC Centre of Epidemiology for Child Health, UCL Institute of Child Health, University College London, London, UK.
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Lloyd-Smith E, Tyndall M, Zhang R, Grafstein E, Sheps S, Wood E, Montaner J, Kerr T. DETERMINANTS OF CUTANEOUS INJECTION-RELATED INFECTIONS AMONG INJECTION DRUG USERS AT AN EMERGENCY DEPARTMENT. THE OPEN INFECTIOUS DISEASES JOURNAL 2012; 6:80176398. [PMID: 24339842 PMCID: PMC3856908 DOI: 10.2174/1874279301206010005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Cutaneous injection-related infections (CIRI) are a primary reason injection drug users (IDU) access the emergency department (ED). METHODOLOGY Using Cox proportional hazard regression, we examined predictors of ED use for CIRI, stratified by sex, among 1083 supervised injection facility (SIF) users. RESULTS Over a four-year period, 289 (27%) visited the ED for CIRI, yielding an incidence density for females of 23.8 (95% confidence interval (CI): 19.3 - 29.0) and males of 19.2 per 100 person-years (95% CI: 16.7 - 22.1). Factors associated with ED use for CIRI among females included residing in the Downtown Eastside (DTES) (adjusted hazard ratio [AHR] = 2.06 [1.13 - 3.78]) and being referred to hospital by SIF nurses (AHR = 4.48 [2.76 - 7.30]). Among males, requiring assistance with injection (AHR = 1.38 [1.01 - 1.90]), being HIV-positive (AHR = 1.85 [1.34 - 2.55]), and being referred to hospital by SIF nurses (AHR = 2.97 [1.93 - 4.57]) were associated with an increased likelihood of an ED visit for CIRI. CONCLUSION These results suggest SIF nurses have facilitated referral of hospital treatment for CIRI, highlighting the need for continued development of efficient and collaborative efforts to reduce the burden of CIRI.
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Affiliation(s)
- Elisa Lloyd-Smith
- British Columbia Centre for Excellence in HIV/AIDS, Providence Health Care, 608-1081 Burrard Street, Vancouver, V6Z 1Y6, Canada
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, V6T 1Z3, Canada
| | - Mark Tyndall
- British Columbia Centre for Excellence in HIV/AIDS, Providence Health Care, 608-1081 Burrard Street, Vancouver, V6Z 1Y6, Canada
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, V6T 1Z3, Canada
- Department of Medicine, University of British Columbia, 10203-2275 Laurel Street, Vancouver, V5Z 1M9, Canada
| | - Ruth Zhang
- British Columbia Centre for Excellence in HIV/AIDS, Providence Health Care, 608-1081 Burrard Street, Vancouver, V6Z 1Y6, Canada
| | - Eric Grafstein
- Department of Emergency Medicine, University of British Columbia, 855 West 12 Ave, Vancouver, V5Z 1M9, Canada
| | - Sam Sheps
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, V6T 1Z3, Canada
| | - Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, Providence Health Care, 608-1081 Burrard Street, Vancouver, V6Z 1Y6, Canada
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, V6T 1Z3, Canada
- Department of Medicine, University of British Columbia, 10203-2275 Laurel Street, Vancouver, V5Z 1M9, Canada
| | - Julio Montaner
- British Columbia Centre for Excellence in HIV/AIDS, Providence Health Care, 608-1081 Burrard Street, Vancouver, V6Z 1Y6, Canada
- Department of Medicine, University of British Columbia, 10203-2275 Laurel Street, Vancouver, V5Z 1M9, Canada
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, Providence Health Care, 608-1081 Burrard Street, Vancouver, V6Z 1Y6, Canada
- Department of Medicine, University of British Columbia, 10203-2275 Laurel Street, Vancouver, V5Z 1M9, Canada
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Thibault V, Bara JL, Nefau T, Duplessy-Garson C. Hepatitis C transmission in injection drug users: could swabs be the main culprit? J Infect Dis 2011; 204:1839-42. [PMID: 22013222 DOI: 10.1093/infdis/jir650] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Prevention programs for intravenous drug users have proven their efficacy in decreasing human immunodeficiency virus transmission but have limited effect on hepatitis C virus (HCV) contamination. A study was conducted to document the presence of HCV genome (HCV RNA) in 620 items of used injecting paraphernalia collected from representative sites. Using sensitive molecular techniques, HCV RNA was not detected on used filters or water vials and was seldom detected on cups (9%). However, HCV RNA was frequently found on syringe pools (38%) and on swabs (82%) at high titers. Our investigation, which was conducted in real injecting settings, highlights swabs as a potential source for HCV transmission.
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Affiliation(s)
- Vincent Thibault
- Virology Laboratory, Hôpital Pitié-Salpêtrière, Assistance Publique, and Pierre et Marie Curie University, France.
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Small W, Shoveller J, Moore D, Tyndall M, Wood E, Kerr T. Injection drug users' access to a supervised injection facility in Vancouver, Canada: the influence of operating policies and local drug culture. QUALITATIVE HEALTH RESEARCH 2011; 21:743-756. [PMID: 21378259 DOI: 10.1177/1049732311400919] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
North America's first supervised injection facility (SIF) was established in Vancouver, Canada, in 2003. Although evaluation research has documented reductions in risk behavior among SIF users, there has been limited examination of the influence of operational features on injection drug users' access to these facilities. We conducted an ethnographic study that included observational research within the SIF, 50 in-depth individual interviews with SIF users, and analysis of the regulatory frameworks governing the SIF. The government-granted exemption allowing the facility to operate legally imposes key operating regulations, as well as a cap on capacity, which results in significant wait times to enter the injecting room. Regulations that prohibit practices that are common in the local drug culture also negatively affect SIF utilization. Restructuring policies that shape the operation of the SIF could enhance access to the facility and permit SIF services to better accommodate local drug use practices.
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Affiliation(s)
- Will Small
- University of British Columbia, Vancouver, Canada
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40
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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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41
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Jenness SM, Hagan H, Liu KL, Wendel T, Murrill CS. Continuing HIV risk in New York City injection drug users: the association of syringe source and syringe sharing. Subst Use Misuse 2011; 46:192-200. [PMID: 21303239 PMCID: PMC4797646 DOI: 10.3109/10826084.2011.521467] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Sterile syringe access is an important means to reduce HIV risk, but many injection drug users (IDU) who obtain syringes from sterile sources continue to share syringes. We examined the factors associated with continuing syringe sharing in New York City. We recruited 500 active IDU in 2005 through respondent-driven sampling. In multiple logistic regression, not obtaining all syringes in the past year exclusively from sterile sources was associated with increased syringe sharing. Ensuring adequate syringe availability as well as engaging and retaining nonusers and inconsistent users in sterile syringe services may increase sterile syringe access and decrease syringe sharing.
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Affiliation(s)
- Samuel M Jenness
- HIV Epidemiology and Field Services Program, New York City Department of Health and Mental Hygiene, New York, New York 10013, USA.
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42
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Duncan KC, Reading C, Borwein AM, Murray MCM, Palmer A, Michelow W, Samji H, Lima VD, Montaner JSG, Hogg RS. HIV incidence and prevalence among aboriginal peoples in Canada. AIDS Behav 2011; 15:214-27. [PMID: 20799061 DOI: 10.1007/s10461-010-9792-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We examined incidence, prevalence, and correlates of HIV infection in Aboriginal peoples in Canada and found that among most risk groups both Aboriginal and non-Aboriginal participants showed similar levels of HIV prevalence. Aboriginal peoples who use illicit drugs were found to have higher HIV incidence and prevalence when compared to their non-Aboriginal drug-using peers. Aboriginal street youth and female sex workers were also found to have higher HIV prevalence. Among Aboriginal populations, correlates of HIV-positive sero-status include syringe sharing and frequently injecting drugs, as well as geographic and social factors such as living in Vancouver or having a history of non-consensual sex. This study is relevant to Canada and elsewhere, as Indigenous populations are disproportionately represented in the HIV epidemic worldwide.
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Affiliation(s)
- Katrina C Duncan
- Division of Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
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43
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Robertson AM, Vera AY, Gallardo M, Pollini RA, Patterson TL, Case P, Nguyen L, Strathdee SA. Correlates of seeking injection assistance among injection drug users in Tijuana, Mexico. Am J Addict 2010; 19:357-63. [PMID: 20653644 DOI: 10.1111/j.1521-0391.2010.00053.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Assisted injection among injection drug users (IDUs) remains understudied. We recruited 1,056 IDUs using respondent-driven sampling in Tijuana, Mexico. Participants underwent HIV and syphilis testing and structured interviews. One-quarter (25%) sought injection assistance in the past 6 months. Seeking injection assistance was independently associated with being female (adjusted odds ratio [AOR]= 2.59; 95% confidence interval [CI]= 1.73-3.90), being born outside Baja California (AOR = 1.75; CI = 1.26-2.42), having recent abscesses (AOR = 2.59; CI = 1.93-3.47), using syringes previously used by others in the past 6 months (AOR = 1.99; CI = 1.45-2.71), and ever being arrested for carrying sterile syringes (AOR = 1.55; CI = 1.15-2.09).
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Affiliation(s)
- Angela M Robertson
- Department of Medicine, University of California, San Diego, La Jolla, California, USA
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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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45
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Strathdee SA, Hallett TB, Bobrova N, Rhodes T, Booth R, Abdool R, Hankins CA. HIV and risk environment for injecting drug users: the past, present, and future. Lancet 2010; 376:268-84. [PMID: 20650523 PMCID: PMC6464374 DOI: 10.1016/s0140-6736(10)60743-x] [Citation(s) in RCA: 394] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We systematically reviewed reports about determinants of HIV infection in injecting drug users from 2000 to 2009, classifying findings by type of environmental influence. We then modelled changes in risk environments in regions with severe HIV epidemics associated with injecting drug use. Of 94 studies identified, 25 intentionally examined risk environments. Modelling of HIV epidemics showed substantial heterogeneity in the number of HIV infections that are attributed to injecting drug use and unprotected sex. We estimate that, during 2010-15, HIV prevalence could be reduced by 41% in Odessa (Ukraine), 43% in Karachi (Pakistan), and 30% in Nairobi (Kenya) through a 60% reduction of the unmet need of programmes for opioid substitution, needle exchange, and antiretroviral therapy. Mitigation of patient transition to injecting drugs from non-injecting forms could avert a 98% increase in HIV infections in Karachi; whereas elimination of laws prohibiting opioid substitution with concomitant scale-up could prevent 14% of HIV infections in Nairobi. Optimisation of effectiveness and coverage of interventions is crucial for regions with rapidly growing epidemics. Delineation of environmental risk factors provides a crucial insight into HIV prevention. Evidence-informed, rights-based, combination interventions protecting IDUs' access to HIV prevention and treatment could substantially curtail HIV epidemics.
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Affiliation(s)
- Steffanie A Strathdee
- University of California, San Diego, Division of Global Public Health, Department of Medicine, CA 92093-0507, USA.
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Lloyd-Smith E, Rachlis BS, Tobin D, Stone D, Li K, Small W, Wood E, Kerr T. Assisted injection in outdoor venues: an observational study of risks and implications for service delivery and harm reduction programming. Harm Reduct J 2010; 7:6. [PMID: 20302638 PMCID: PMC2856546 DOI: 10.1186/1477-7517-7-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2009] [Accepted: 03/19/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Assisted injection and public injection have both been associated with a variety of individual harms including an increased risk of HIV infection. As a means of informing local IDU-driven interventions that target or seek to address assisted injection, we examined the correlates of receiving assistance with injecting in outdoor settings among a cohort of persons who inject drugs (IDU). METHODS Using data from the Vancouver Injection Drug Users Study (VIDUS), an observational cohort study of IDU, generalized estimating equations (GEE) were performed to examine socio-demographic and behavioural factors associated with reports of receiving assistance with injecting in outdoor settings. RESULTS From January 2004 to December 2005, a total of 620 participants were eligible for the present analysis. Our study included 251 (40.5%) women and 203 (32.7%) self-identified Aboriginal participants. The proportion of participants who reported assisted injection outdoors ranged over time between 8% and 15%. Assisted injection outdoors was independently and positively associated with being female (Adjusted Odds Ratio (AOR) = 1.74, 95% Confidence Intervals (CI): 1.21-2.50), daily cocaine injection (AOR = 1.70, 95% CI: 1.29-2.24), and sex trade involvement (AOR = 1.44, 95% CI: 1.00-2.06) and was negatively associated with Aboriginal ethnicity (AOR = 0.58, 95% CI: 0.41-0.82). CONCLUSIONS Our findings indicate that a substantial proportion of local IDU engage in assisted injecting in outdoor settings and that the practice is associated with other markers of drug-related harm, including being female, daily cocaine injecting and sex trade involvement. These findings suggest that novel interventions are needed to address the needs of this subpopulation of IDU.
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Affiliation(s)
- Elisa Lloyd-Smith
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada
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McKnight I, Maas B, Wood E, Tyndall MW, Small W, Lai C, Montaner JSG, Kerr T. Factors Associated with Public Injecting Among Users of Vancouver's Supervised Injection Facility. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2009; 33:319-25. [PMID: 17497555 DOI: 10.1080/00952990601175102] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND We evaluated factors associated with public drug injection among a cohort of injection drug users (SEOSI) originally recruited from within Vancouver's supervised injecting facility (SIF). METHODS We used univariate statistics and logistic regression to examine factors associated with public drug injection among SEOSI participants. FINDINGS Between June 2004 and July 2005, 714 IDU were followed up as part of SEOSI. In multivariate analyses, factors associated with public drug injection included homelessness (adjusted odds ratio (aOR) = 3.10; p < .001), syringe lending (aOR = 5.39; p < .001), requiring help injecting (aOR = 1.60; p = .05), and reporting that wait times affected frequency of SIF use (aOR = 3.26; p < .001). INTERPRETATION Persistent public injection was independently associated with elevated HIV risk behaviors, as well as programmatic factors that limit SIF use. SIF program expansion may further help to reduce persistent risk behaviors and the community concerns related to public injection drug use.
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Affiliation(s)
- Ian McKnight
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada
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Milloy MJS, Kerr T, Mathias R, Zhang R, Montaner JS, Tyndall M, Wood E. Non-Fatal Overdose Among a Cohort of Active Injection Drug Users Recruited from a Supervised Injection Facility. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2009; 34:499-509. [DOI: 10.1080/00952990802122457] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Roy E, Boudreau JF, Boivin JF. Hepatitis C virus incidence among young street-involved IDUs in relation to injection experience. Drug Alcohol Depend 2009; 102:158-61. [PMID: 19251382 DOI: 10.1016/j.drugalcdep.2009.01.006] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2008] [Revised: 01/12/2009] [Accepted: 01/14/2009] [Indexed: 11/28/2022]
Abstract
BACKGROUND Young injection drug users (IDUs) are at very high risk of hepatitis C virus (HCV) infection. Using a time scale starting at first injection, we studied the period of HCV susceptibility after initiation into drug injection among street-involved IDUs. METHODS A prospective cohort study was carried out among street youth from 2001 to 2005. Semiannual interviews included completion of an interviewer-administered questionnaire and collection of blood samples for HCV antibody testing. HCV-negative subjects currently injecting drugs (last six months) were included in the analyses. Follow-up started at first questionnaire where current injection was reported and ended at seroconversion or at last questionnaire. Poisson regression was used to assess the predictive power of time elapsed since initiation on incidence rate. Kaplan-Meier technique was used to estimate cumulative infection probabilities. RESULTS Among the 858 cohort participants, 145 were injecting at baseline and 60 were injecting at a subsequent questionnaire (45 youth had started injection and 15 had resumed injection). Mean age was 20 years and 62% were males. In the 395 person-years of follow-up, 61 subjects contracted HCV. The HCV incidence rate increased from 16.1/100 person-years during the first year following first injection to 22.4 in the third year, and then decreased to 7.2 in years 7-13 (p=0.02). Median time to seroconversion after first injection was 3.3 years. CONCLUSION The first years after first injection is the period during which vulnerability to HCV is greatest. Our results show the importance of intervening with new IDUs to optimize the chances to successfully prevent infection.
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Affiliation(s)
- Elise Roy
- Université de Sherbrooke, Service de toxicomanie, 1111 St-Charles Street West, West Tower, Room 500, Longueuil, Québec J4K 5G4, Canada.
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Lloyd-Smith E, Wood E, Zhang R, Tyndall MW, Montaner JS, Kerr T. Determinants of cutaneous injection-related infection care at a supervised injecting facility. Ann Epidemiol 2009; 19:404-9. [PMID: 19364660 DOI: 10.1016/j.annepidem.2009.03.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2008] [Revised: 01/08/2009] [Accepted: 03/02/2009] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the factors associated with receiving cutaneous injection-related infection (CIRI) care among a representative cohort of supervised injecting facility (SIF) users. METHODS Data were collected biannually as part of a prospective cohort, the Scientific Evaluation of Supervised Injection study. Kaplan-Meier methods and Cox proportional hazards regression with recurrent events were used to examine incidence and factors associated with CIRI care, respectively. RESULTS One thousand eighty individuals were recruited between December 1, 2003 and January 31, 2008. The incidence density of participants receiving CIRI care was 22.0 per 100 person-years (95% confidence interval [CI]: 19.6-24.6). In the adjusted Cox proportional hazard model, female sex (adjusted hazard ratio [AHR]=1.87 [95% CI: 1.32-2.64]), unstable housing (AHR=1.39 [95% CI: 1.02-1.88]), and daily heroin injection (AHR=1.52 [95% CI: 1.13-2.04]) were independently associated with receiving CIRI care at the SIF. CONCLUSIONS These results describe who is more likely to receive CIRI care, which is of use to those engaged with policy and practice of treatment regimens involving this population.
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Affiliation(s)
- Elisa Lloyd-Smith
- British Columbia Centre for Excellence in HIV/AIDS, University of British Columbia, Vancouver, Canada
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