Assisted injection in outdoor venues: an observational study of risks and implications for service delivery and harm reduction programming

Harm Reduction Journal - Tập 7 - Trang 1-5 - 2010
Elisa Lloyd-Smith1, Beth S Rachlis1, Diane Tobin2, Dave Stone2, Kathy Li1, Will Small1, Evan Wood1, Thomas Kerr1
1British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, Canada
2Injection Support Team, Vancouver Area Network of Drug Users, Vancouver, Canada

Tóm tắt

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). 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. 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). 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.

Tài liệu tham khảo

UNAIDS: High Coverage Sites HIV Prevention among Injecting Drug Users in Transitional and Developing Countries: Case Studies. Geneva. 2008 Wood E, Kerr T, Lloyd-Smith E, Buchner C, Marsh D, Montaner J: Methodology for evaluating Insite: Canada's first medically supervised safer injection facility for injection drug users. Harm Reduct J. 2004, 1: 9-10.1186/1477-7517-1-9. Buxton J: Vancouver drug use epidemiology: Vancouver site report for the Canadian Community Epidemiology Network on Drug Use (CCENDU). The Netowrk. 2005, [http://vancouver.ca/fourpillars/pdf/report_vancouver_2005.pdf] Wood E, Tyndall M, Li K, Lloyd-Smith E, Small W, Montaner J: Do Supervised Injecting Facilities Attract Higher-Risk Injection Drug Users?. Am J Prev Med. 2005, 29: 126-130. 10.1016/j.amepre.2005.04.011. Kerr T, Tyndall M, Li K, Montaner J, Wood E: Safer injection facility use and syringe sharing in injection drug users. Lancet. 2005, 366: 316-318. 10.1016/S0140-6736(05)66475-6. Kerr T, Wood E, Small D, Palepu A, Tyndall MW: Potential use of safer injecting facilities among injection drug users in Vancouver's Downtown Eastside. CMAJ. 2003, 169: 759-763. Health Canada: Application for an exemption under Section 56 of the Controlled Drugs and Substances Act for a scientific purpose for a pilot supervised injection site. 2002, Office of Drug Strategy and Controlled Substances Programme Pearshouse R, Elliott R: A Helping Hand: Legal Issues Related to Assisted Injection at Supervised Injection Facilities. 2007, Toronto: Canadian HIV/AIDS Legal Network Small W, Rhodes T, Wood E, Kerr T: Public injection settings in Vancouver: Physical environment, social context and risk. International J Drug Policy. 2007, 18: 27-36. 10.1016/j.drugpo.2006.11.019. Wood E, Spittal PM, Kerr T, Small W, Tyndall MW, O'Shaughnessy MV: Requiring help injecting as a risk factor for HIV infection in the Vancouver epidemic: Implications for HIV prevention. Can J Public Health. 2003, 94: 355-359. Kral AH, Bluthenthal RN, Erringer EA, Lorvick J, Edlin BR: Risk factors among IDUs who give injections to or receive injections from other drug users. Addiction. 1999, 94: 675-683. 10.1046/j.1360-0443.1999.9456755.x. Kerr T, Fairbairn N, Tyndall M, Marsh D, Li K, Montaner J: Predictors of non-fatal overdose among a cohort of polysubstance-using injection drug users. Drug Alcohol Depend. 2007, 87: 39-45. 10.1016/j.drugalcdep.2006.07.009. O'Connell JM, Kerr T, Li K, Tyndall MW, Hogg RS, Montaner JS: Requiring help injecting independently predicts incident HIV infection among injection drug users. J Acquir Immune Defic Syndr. 2005, 40: 83-88. 10.1097/01.qai.0000157006.28535.mL. Wood E, Tyndall MW, Spittal PM, Li K, Kerr T, Hogg RS: Unsafe injection practices in a cohort of injection drug users in Vancouver: could safer injecting rooms help?. CMAJ. 2001, 165: 405-410. Tyndall MW, Currie S, Spittal P, Li K, Wood E, O'Shaughnessy MV: Intensive injection cocaine use as the primary risk factor in the Vancouver HIV-1 epidemic. AIDS. 2003, 17: 887-893. 10.1097/00002030-200304110-00014. Diggle PJ, Liang K, Zeger S: Analysis of Longitudinal Data. 1996, New York: Oxford University Press Bourgois P, Prince B, Moss A: The everyday violence of Hepatitis C among young women who inject drugs in San Francisco. Human Organization. 2004, 63: 253-264. Fairbairn N, Small W, Van Borek, Wood E, Kerr T: Social and structural factors that shape assisted injecting practices among injection drug users in Vancouver, Canada: A qualitative study. Harm Reduct J. Miller CL, Kerr T, Frankish JC, Spittal PM, Li K, Schechter MT: Binge drug use independently predicts HIV seroconversion among injection drug users: implications for public health strategies. Subst Use Misuse. 2006, 41: 199-210. 10.1080/10826080500391795. Lloyd-Smith E, Kerr T, Hogg RS, Li K, Montaner JS, Wood E: Prevalence and correlates of abscesses among a cohort of injection drug users. Harm Reduct J. 2005, 2: 24-10.1186/1477-7517-2-24. Lloyd-Smith E, Wood E, Zhang R, Tyndall MW, Montaner JS, Kerr T: Risk factors for developing a cutaneous injection-related infection among injection drug users: a cohort study. BMC Public Health. 2008, 8: 405-10.1186/1471-2458-8-405. Lloyd-Smith E, Wood E, Li K, Montaner JSG, Kerr T: Incidence and determinants of initiation into cocaine injection and correlates of frequent cocaine injectors. Drug Alcohol Depend. 2008, 99: 176-182. 10.1016/j.drugalcdep.2008.07.003. Shannon K, Kerr T, Allinott S, Chettiar J, Shoveller J, Tyndall MW: Social and structural violence and power relations in mitigating HIV risk of drug-using women in survival sex work. Soc Sci Med. 2007, 66: 911-921. 10.1016/j.socscimed.2007.11.008. Shannon K, Rusch M, Shoveller J, Alexson D, Gibson K, Tyndall MW: Mapping violence and policing as an environmental-structural barrier to health service and syringe availability among substance-using women in street-level sex work. International J Drug Policy. 2008, 19: 140-147. 10.1016/j.drugpo.2007.11.024. Small W, Wood E, Lloyd-Smith E, Tyndall M, Kerr T: Accessing care for injection-related injections through a medically supervised injecting facility: a qualitative study. Drug Alcohol Depend. 2008, 98: 159-162. 10.1016/j.drugalcdep.2008.05.014. Lloyd-Smith E, Wood E, Zhang R, Tyndall MW, Montaner JS, Kerr T: Determinants of cutaneous injection-related infection care at a supervised injection facility. Ann Epidemiol. 2009, 19: 404-409. 10.1016/j.annepidem.2009.03.007. Kerr T, Small W, Peeace W, Douglas D, Pierre A, Wood W: Harm reducation by a 'user-run' organization: a case study of the Vancouver Area Network of Drug Users (VANDU). International J Drug Policy. 2006, 17: 61-69. 10.1016/j.drugpo.2006.01.003. Tyndall MW, Craib KJ, Currie S, Li K, O'Shaughnessy MV, Schechter MT: Impact of HIV infection on mortality in a cohort of injection drug users. J Acquir Immune Defic Syndr. 2001, 28: 351-357. Darke S: Self-report among injecting drug users: a review. Drug Alcohol Depend. 1998, 51: 253-263. 10.1016/S0376-8716(98)00028-3. Lovell AM: Risking risk: the influence of types of capital and social networks on the injection practices of drug users. Soc Sci Med. 2002, 55: 803-821. 10.1016/S0277-9536(01)00204-0.