Advertisement

Canadian Journal of Public Health

, Volume 94, Issue 5, pp 355–359 | Cite as

Requiring Help Injecting as a Risk Factor for HIV Infection in the Vancouver Epidemic

Implications for HIV Prevention
  • Evan Wood
  • Patricia M. Spittal
  • Thomas Kerr
  • Will Small
  • Mark W. Tyndall
  • Michael V. O’Shaughnessy
  • Martin T. Schechter
Article

Abstract

Background

Requiring help injecting was recently associated with syringe sharing, and later HIV-1 and HCV seroconversion among injection drug users (IDU) in Vancouver. This risk factor remains poorly understood. The present study investigates this risk factor among Vancouver IDUs.

Methods

We evaluated factors associated with requiring help injecting among participants enrolled in the Vancouver Injection Drug User Study (VIDUS) using univariate and logistic regression analyses. VIDUS participants who were followed-up during the period December 2000 to December 2001 were eligible for the present analyses. We also evaluated self-reported reasons for requiring help injecting.

Results

Overall, 661 active injection drug users were interviewed during the study period. Among this population, 151 (22.8%) had required help injecting during the last six months, whereas 510 (77.2%) indicated that they had not. Variables that were independently associated with requiring help injecting included borrowing a used syringe (adjusted odds ratio [AOR] = 2.18), frequent cocaine injection (AOR = 1.57), and female gender (AOR = 2.29). Among males, the most common reasons for requiring help injecting were: having no viable veins (77.1%), and anxiousness or being drug sick (42.9%). Among females, the most common reasons reported were: having no viable veins (71.6%), jugular injection or ‘jugging’ (45.7%), and being anxious or drug sick (27.2%). Almost twice as many females (13.6% vs 7.1%) reported not knowing how to inject as their reason for requiring help injecting.

Conclusion

Although current public health approaches, such as needle exchange, are unable to address the concerns associated with requiring help injecting, available evidence suggests that safer injecting facilities have the potential to substantially mitigate this risk behaviour.

Résumé

Contexte

On a récemment associé le fait d’avoir besoin d’aide pour se piquer au partage des seringues, et plus tard à la séroconversion VIH-1 et VHC chez les utilisateurs de drogues injectables (UDI) de Vancouver. Nous avons voulu étudier ce facteur de risque, encore mal compris, chez les UDI de Vancouver.

Méthode

À l’aide d’analyses univariées et de régression logistique, nous avons évalué les facteurs associés au fait d’avoir besoin d’aide pour se piquer chez les participants de la VIDUS (enquête vancouveroise auprès des utilisateurs de drogues injectables). Les analyses portaient sur les participants à la VIDUS ayant fait l’objet d’un suivi entre décembre 2000 et décembre 2001. Nous avons également évalué les motifs pour lesquels les intéressés déclaraient avoir besoin d’aide pour se piquer.

Résultats

Dans l’ensemble, 661 utilisateurs actifs de drogues injectables ont été interviewés durant la période de référence. De ce nombre, 151 (22,8 %) avaient eu besoin d’aide pour se piquer au cours des six mois précédents, et 510 (77,2 %) n’en avaient pas eu besoin. Certaines variables présentaient une corrélation indépendante avec le fait d’avoir besoin d’aide pour se piquer: l’emprunt d’une seringue usagée (rapport de cotes ajusté [RCA] = 2,18), l’injection fréquente de cocaïne (RCA=1,57) et le fait d’être une femme (RCA=2,29). Chez les hommes, les raisons le plus souvent déclarées d’avoir besoin d’aide pour se piquer étaient l’absence de veines adéquates (77,1 %) et l’anxiété ou l’état de manque (42,9 %). Chez les femmes, les raisons le plus souvent déclarées étaient l’absence de veines adéquates (71,6 %), l’injection dans une veine jugulaire (45,7 %) et l’anxiété ou l’état de manque (27,2 %). Les femmes étaient près de deux fois plus nombreuses que les hommes (13,6 % contre 7,1 %) à déclarer avoir besoin d’aide parce qu’elles ne savaient pas comment s’y prendre.

Conclusion

Bien que les approches actuelles de santé publique, comme l’échange de seringues, ne répondent pas aux préoccupations liées au fait d’avoir besoin d’aide pour se piquer, les données disponibles donnent à penser que des piqueries plus sûres pourraient peut-être atténuer considérablement ce comportement à risque.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Strathdee SA, Patrick DM, Archibald CP, Ofner M, Cornelisse PG, Rekart M, et al. Social determinants predict needle-sharing behaviour among injection drug users in Vancouver, Canada. Addiction 1997;92:1339–47.CrossRefPubMedGoogle Scholar
  2. 2.
    Wood E, Schechter MT, Tyndall MW, Montaner JS, O’Shaughnessy MV, Hogg, RS. Antiretroviral medication use among injection drug users: Two potential futures. AIDS 2000;14:1229–35.CrossRefPubMedGoogle Scholar
  3. 3.
    Strathdee SA, Patrick DM, Currie SL, Cornelisse PG, Rekart ML, Montaner JS, et al. Needle exchange is not enough: Lessons from the Vancouver injecting drug use study. AIDS 1997;11:F59-65.CrossRefPubMedGoogle Scholar
  4. 4.
    The Needle Exchange Programs Prohibition Act of 1998 — Statements on Introduced bills and Joint Resolutions (Senate — April 21, 1998); Congressional Record, 1998;S3356.Google Scholar
  5. 5.
    Bennett, SS. Needle-exchange programmes in the USA [letter; comment]. Lancet 1998;351(9105):839.CrossRefPubMedGoogle Scholar
  6. 6.
    Bellm J. Needle-exchange programmes are not the answer [letter; comment]. Lancet 1999;353:1657–61.CrossRefGoogle Scholar
  7. 7.
    Wood E, Tyndall MW, Spittal P, Li K, R.S. H, O’Shaughnessy M, et al. Needle exchange and difficulty with needle access during an ongoing HIV epidemic. Int J Drug Policy 2002;13:95–102.CrossRefGoogle Scholar
  8. 8.
    Schechter MT, Strathdee SA, Cornelisse PG, Currie S, Patrick DM, Rekart ML, et al. Do needle exchange programmes increase the spread of HIV among injection drug users?: An investigation of the Vancouver outbreak. AIDS 1999;13:F45–51.CrossRefPubMedGoogle Scholar
  9. 9.
    Tyndall MW, Currie S, Spittal P, Li K, Wood E, O’Shaughnessy MV, et al. Intensive injection cocaine use as a primary risk factor of HIV seroconversion among polydrug users in Vancouver. AIDS 2003;17(6):887–93.CrossRefPubMedGoogle Scholar
  10. 10.
    Wood E, Tyndall MW, Spittal PM, Li K, Kerr T, Hogg RS, et al. Unsafe injection practices in a cohort of injection drug users in Vancouver: Could safer injecting rooms help? CMAJ 2001;165:405–10.PubMedPubMedCentralGoogle Scholar
  11. 11.
    Kerr T, Palepu A. Safe injection facilities in Canada: Is it time? CMAJ 2001;165:436–37.PubMedPubMedCentralGoogle Scholar
  12. 12.
    Harm reduction: Closing the distance. CMAJ 2001;165:389, 391.Google Scholar
  13. 13.
    Spittal PM, Craib KJ, Wood E, Laliberte N, Li K, Tyndall MW, et al. Risk factors for elevated HIV incidence rates among female injection drug users in Vancouver. CMAJ 2002;166:894–99.PubMedPubMedCentralGoogle Scholar
  14. 14.
    Miller CL, Johnston C, Spittal PM, Li K, Laliberte N, Montaner JS, et al. Opportunities for prevention: Hepatitis C prevalence and incidence in a cohort of young injection drug users. Hepatology 2002;36:737–42.CrossRefPubMedGoogle Scholar
  15. 15.
    Wood E, Tyndall MW, Spittal PM, Li K, Anis AH, Hogg RS, et al. Impact of supply-side policies for control of illicit drugs in the face of the AIDS and overdose epidemics: Investigation of a massive heroin seizure. CMAJ 2003;168:165–69.PubMedPubMedCentralGoogle Scholar
  16. 16.
    Wood E, Tyndall MW, Spittal PM, Li K, Hogg RS, Montaner JS, et al. Factors associated with persistent high-risk syringe sharing in the presence of an established needle exchange programme. AIDS 2002;16:941–43.CrossRefPubMedGoogle Scholar
  17. 17.
    Spittal PM, Schechter, MT. Injection drug use and despair through the lens of gender. CMAJ 2001;164:802–3.PubMedPubMedCentralGoogle Scholar
  18. 18.
    Dolan K, Kimber J, Fry C, Fitzgerald J, McDonald D, Frautmann F. Drug consumption facilities in Europe and the establishment of supervised injecting centres in Australia. Drug and Alcohol Review 2000;19:337–46.CrossRefGoogle Scholar
  19. 19.
    de Jong W, Weber U. The professional acceptance of drug use: A closer look at drug consumption rooms in the Netherlands, Germany, and Switzerland. Int J Drug Policy 1999;10:99–108.CrossRefGoogle Scholar
  20. 20.
    Ronco C, Spuhler G, Coda P, Schopfer R. Evaluation for alley-rooms I, II, and III in Basel. Soc Prev Med 1996;41:S58–68.CrossRefGoogle Scholar
  21. 21.
    Kemmesies U. Final Report: The open drug scene and the safe injection room offers in Frankfurt am Main. 1999.Google Scholar
  22. 22.
    van Beek I, Gilmour S. Preference to have used a medically supervised injecting centre among injecting drug users in Kings Cross, Sydney. Aust N Z J Public Health 2000;24:540–42.CrossRefPubMedGoogle Scholar
  23. 23.
    Wood E, Kerr T, Spittal PM, Li K, Small W, Tyndall MW, et al. The potential public health and community impacts of safer injecting facilities: Evidence from a cohort of injection drug users. J Acquir Immune Defic Syndr 2003;32:2–8.CrossRefPubMedGoogle Scholar
  24. 24.
    Kimber J, MacDonald M. Six Month Process Report on the Medically Supervised Injecting Centre. National Alcohol and Drug Research Centre, University of New South Wales, 2002.Google Scholar
  25. 25.
    Broadhead, RS. Kerr, TH. Grund JP, Altice, FL. Safer injection facilities in North America: Their place in public policy and health initiatives. J Drug Issues 2002;32(1):329–55.CrossRefGoogle Scholar
  26. 26.
    Wood A, Stewart W, Zetel P. Supervising consumption: Exploring the implications for nursing in Canada. Annual Conference of the Canadian Association for Nurses in AIDS Care. Vancouver, BC, 2002.Google Scholar
  27. 27.
    Vancouver Sun, Friday April 12, 2002, A2. Nurses help addicts inject heroin.Google Scholar
  28. 28.
    Vancouver Sun, Saturday April 13, 2002, B6. Nothing illegal at AIDS clinic: police.Google Scholar
  29. 29.
    Malkin I, Gold J, Elliott R. Safe Injection Sites: Issues, Obstacles & Obligations. Montreal: Canadian HIV/AIDS Legal Network, 2002.Google Scholar
  30. 30.
    Elliot R, Malkin I, Gold J. Establishing Safe Injection Facilities in Canada: Legal and Ethical Issues. Canadian HIV/AIDS Legal Network, 2002.Google Scholar
  31. 31.
    De Irala J, Bigelow C, McCusker J, Hindin R, Zheng L. Reliability of self-reported human immunodeficiency virus risk behaviours in a residential drug treatment population. Am J Epidemiol 1996;143:725–32.CrossRefPubMedGoogle Scholar
  32. 32.
    Des Jarlais DC, Paone D, Milliken J, Turner CF, Miller H, Gribble J, et al. Audio-computer interviewing to measure risk behaviour for HIV among injecting drug users: A quasi-randomised trial. Lancet 1999;353:1657–61.CrossRefPubMedGoogle Scholar
  33. 33.
    Canadian HIV/AIDS Legal Network. Injection Drug Use and HIV/AIDS: Legal and Ethical Issues. Montreal: Canadian HIV/AIDS Legal Network, 1999.Google Scholar

Copyright information

© The Canadian Public Health Association 2003

Authors and Affiliations

  • Evan Wood
    • 1
    • 2
  • Patricia M. Spittal
    • 1
    • 2
  • Thomas Kerr
    • 1
    • 3
  • Will Small
    • 1
  • Mark W. Tyndall
    • 1
    • 2
  • Michael V. O’Shaughnessy
    • 1
    • 4
  • Martin T. Schechter
    • 1
    • 2
  1. 1.BC Centre for Excellence in HIV/AIDSSt. Paul’s HospitalVancouverCanada
  2. 2.Department of Health Care and EpidemiologyUniversity of British ColumbiaCanada
  3. 3.Department of Educational PsychologyUniversity of VictoriaCanada
  4. 4.Department of Pathology and Laboratory MedicineUBCCanada

Personalised recommendations