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Biomedical subjects

Patricia M Spittal

Publications and source records attributed to Patricia M Spittal.

17 recordsLinked to original sources
PubMed2006

Elevated rates of HIV infection among young Aboriginal injection drug users in a Canadian setting.

OBJECTIVES: Recent reports have suggested that Aboriginal and American Indian people are at elevated risk of HIV infection. We undertook the present study to compare socio-demographic and risk variables between Aboriginal and non-Aboriginal young (aged 13 - 24 years) injection drug users (IDUs) and characterize the burden of HIV infection among young Aboriginal IDUs. METHODS: We compared socio-demographic and risk variables between Aboriginal and non-Aboriginal young IDUs. Data were collected through the Vancouver Injection Drug Users Study (VIDUS). Semi-annually, participants have completed an interviewer-administered questionnaire and have undergone serologic testing for HIV and Hepatitis C (HCV). RESULTS: To date over 1500 Vancouver IDU have been enrolled and followed, among whom 291 were aged 24 years and younger. Of the 291 young injectors, 80 (27%) were Aboriginal. In comparison to non-Aboriginal youth, Aboriginal youth were more likely to test seropositive for either HIV (20% vs 7%, p=< 0.001) or Hepatitis C virus (HCV) (66% vs 38%, p =< 0.001), be involved in sex work and live in the city's IDU epi-centre at baseline. After 48 months of follow-up, Aboriginal youth experienced significantly higher HIV seroconversion rates than non-Aboriginal youth, 27.8 per ppy (95% CI: 13.4-42.2) vs. 7.0 per ppy (95% CI: 2.3-11.8) respectively (log-rank p = 0.005) and the incidence density over the entire follow-up period was 12.6 per 100 pyrs (CI: 6.49-21.96) and 3.9 per 100 pyrs (CI: 1.8-7.3) respectively. INTERPRETATION: These findings demonstrate that culturally relevant, evidence based prevention programs are urgently required to prevent HIV infection among Aboriginal youth.

Journal Article↗
PubMed2006

Binge drug use independently predicts HIV seroconversion among injection drug users: implications for public health strategies.

Several studies have highlighted risk factors that cause HIV vulnerability among injection drug users (IDUs); these studies in turn have prompted public health officials to take action to minimize these risks. We sought to evaluate the potential association between binge drug use and HIV seroconversion and, subsequently, risk factors associated with binge drug use among a cohort of IDUs. To do this, we performed analyses of (1) associations with HIV seroconversion and (2) associations with binge drug use among participants enrolled in the Vancouver Injection Drug Users Study (VIDUS), a prospective cohort of IDU. Because serial measures for each individual were available, we undertook a time-updated Cox regression analysis to detect associations with HIV incidence and variables potentially associated with binge drug use were evaluated by using generalized estimating equations (GEE). Overall, 1548 IDU were enrolled into the VIDUS cohort between May 1996 and May 2003. There were 1013 individuals who were HIV seronegative at enrollment and had at least one follow-up visit; 125 (12%) became HIV positive during the study period for a cumulative incidence rate of 14% at 64 months after enrollment. In the final multivariate model, binge drug use [Adjusted Hazards Ratio: 1.61 (CI: 1.12, 2.31)] was independently associated with HIV seroconversion. In subanalyses, when we evaluated associations with binge drug use in GEE analyses, borrowing [Odds Ratio (OR): 153 (CI: 1.33-1.76)] and lending [OR: 1.73 (CI: 1.50-1.98)] syringes, sex trade work [OR: 1.14 (CI: 1.01-1.29)], frequent cocaine [OR: 2.34 (CI: 2.11-2.60)] and heroin [OR: 1.29 (CI: 1.17-1.43)] injection were independently associated with binge drug use and methadone [OR: 0.80 (CI: 0.71-0.89)] was protective against binge drug use. Our study identified an independent association between binge drug use and HIV incidence and demonstrated several high-risk drug practices associated with bingeing. Given the unaddressed public health risks associated with bingeing, a public health response protocol must be developed to minimize the personal and public health risks associated with the binge use of drugs.

British Columbia↗
PubMed2005

Incarceration, addiction and harm reduction: inmates experience injecting drugs in prison.

Within Canadian prisons HIV/AIDS is becoming more common among inmates. While injection drug use in correctional facilities is documented to be a problem, qualitative research into the HIV risks faced by inmates is lacking. The goal of this research was to qualitatively examine HIV risk associated with injecting inside British Columbia prisons. A sample of 26 former male inmates who had recently used drugs within correctional facilities were recruited from a ongoing cohort study of injection drug users in Vancouver, Canada. Data for this study were collected through in-depth interviews conducted in 2001/2002. Analysis of these data involved identifying emergent themes and then exploring these central concepts in further interviews to confirm the accuracy of interpretation. The harms normally associated with drug addiction, and injection drug use are exacerbated in prison. Interpersonal relationships and the possession of exchangeable resources determine access to scarce syringes. The scarcity of syringes has resulted in patterns of sharing amongst large numbers of persons. Continual reuse of scarce syringes poses serious health hazards and bleach distribution is an inadequate solution. The findings of this study emphasize the need for effective harm reduction programs that provide an appropriate response to the problem of injection drug use among inmates.

Anecdotes as Topic↗
PubMed2004

Unstable housing, associated risk behaviour, and increased risk for HIV infection among injection drug users.

We sought to examine the relationship between housing status and risk of HIV-infection among injection drug users in Vancouver, Canada. Using Kaplan-Meier survival analysis, we found an elevated HIV incidence rate among those who reported residing in unstable housing (log-rank p=0.006). In Cox's regression survival analysis, unstable housing remained marginally associated with elevated risks of HIV infection (relative hazard=1.40 (95% confidence interval: 0.09-2.00); p=0.084) after adjustment for potential confounders including syringe sharing. Adjusted generalized estimating equations analysis that examined factors associated with unstable housing demonstrated that residing in unstable housing was independently associated with several HIV risk behaviours including borrowing used needles (adjusted odds ratio (OR)=1.14) and sex-trade involvement (adjusted OR=1.19). Our findings suggest that unstable housing environments are associated with elevated risk of HIV- infection due to risk behaviours that take place in these environments. Implications for policy including more comprehensive housing interventions (e.g. 'floating support') are discussed.

British Columbia↗
PubMed2004

The future face of coinfection: prevalence and incidence of HIV and hepatitis C virus coinfection among young injection drug users.

The purpose of this study was to determine the prevalence and incidence of HIV and hepatitis C virus (HCV) coinfection among young (aged 29 years or younger) injection drug users (IDUs) and to compare sociodemographic and risk characteristics between (HIV/HCV) coinfected, monoinfected, or HIV- and HCV-negative youth. Data were collected through the Vancouver Injection Drug Users Study (VIDUS). To date, more than 1400 IDUs have been enrolled and followed, of whom 479 were aged 29 years or younger. Semiannually, participants have completed an interviewer-administered questionnaire and have undergone serologic testing for HIV and HCV. Univariate and multivariate logistic regression analyses were undertaken to investigate predictors of baseline coinfection. Cox regression models with time-dependent covariates were used to identify predictors of time to secondary infection seroconversion. A Cochran-Armitage trend test was used to determine risk associations across 3 categories: no infection, monoinfection, and coinfection. Of the 479 young injectors, 78 (16%) were coinfected with HIV and HCV at baseline and a further 45 (15%) with follow-up data became coinfected during the study period. Baseline coinfection was independently associated with being female, being aboriginal, older age, greater number of years injecting, and living in the IDU epicenter. Factors independently associated with time to secondary infection seroconversion were borrowing needles and greater than once-daily cocaine injection, and accessing methadone maintenance therapy in the previous 6 months was protective. There were clear trends across the 3 categories for increasing proportions of female subjects, aboriginal subjects, older age, greater number of years injecting, living in the IDU epicenter, and daily cocaine use. There were a shocking number of youth living with coinfection, particularly female and aboriginal youth. The median number of years injecting for youth seroconverting to a secondary infection was 3 years, suggesting that appropriate public health interventions should be implemented immediately.

Adolescent↗
PubMed2004

Displacement of Canada's largest public illicit drug market in response to a police crackdown.

BACKGROUND: Law enforcement is often used in an effort to reduce the social, community and health-related harms of illicit drug use by injection drug users (IDUs). There are, however, few data on the benefits of such enforcement or on the potential harms. A large-scale police "crackdown" to control illicit drug use in Vancouver's Downtown Eastside provided us with an opportunity to evaluate the effect. METHODS: As part of our ongoing prospective cohort study of IDUs in Vancouver, we examined data collected from 244 IDUs in the 3 months before the police crackdown and from 142 IDUs in the 3 months after the start of the crackdown, on Apr. 7, 2003. All study subjects were active drug users. We also examined external data on needle exchanges and syringe disposal. RESULTS: The 2 groups of IDUs were statistically similar: they were mainly young (mean age 39 years) and male (63%), and they had injected illicit drugs for 13 years on average. Ethnic background and the proportion homeless were also similar. There were no statistically significant reported differences (all p > 0.1) in the street price of heroin, cocaine or "crack" in the 2 periods. In the 3-month periods before and after the crackdown, respectively, the rates of daily heroin injection were 27.9% and 26.8%, daily cocaine injection 28.7% and 27.5%, and daily crack use 59.4% and 60.6% (all p > 0.1). The proportions of study subjects receiving methadone treatment, 41.0% and 44.4% (p = 0.516), did not differ. However, the proportions reporting a change in where drugs were used, 22.5% and 33.8% (p < 0.05), and the proportions reporting a change in the neighbourhood of use because of police presence, 18.1% and 26.8% (p < 0.05), increased significantly. Needle-exchange data confirmed that the community levels of drug use were unchanged. Disposal statistics demonstrated that the monthly average number of used syringes found on the streets outside the traditional area of drug use increased from 784 in the 3 months before Apr. 1 to 1253 in the subsequent 3 months (p = 0.002) and the monthly average number of used syringes found in public boxes for the safe disposal of syringes decreased from 865 to 502 (p = 0.018). INTERPRETATION: The effort to control illicit drug use did not alter the price of drugs or the frequency of use, nor did it encourage enrollment in methadone treatment programs. Several measures indicated displacement of injection drug use from the area of the crackdown into adjacent areas of the city, which has implications for both recruitment of new initiates into injection drug use and HIV prevention efforts.

Adult↗
PubMed2003

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.

BACKGROUND: More than 93% of the nearly $500 million spent annually on Canada's drug strategy goes toward efforts to reduce the illicit drug supply. However, little is known about the effectiveness of this strategy. On Sept. 2, 2000, Canadian police seized approximately 100 kg of heroin in one of the nation's largest-ever seizures of this drug. An ongoing prospective cohort study of injection drug users afforded an opportunity to evaluate the impact of this seizure. METHODS: The Vancouver Injection Drug User Study is a prospective cohort study of injection drug users that began in 1996. The present study relied primarily on data acquired from participants who were seen during the 30-day periods immediately before and after the seizure. We compared drug use and behavioural characteristics, heroin and cocaine prices, and participants' reports of whether law enforcement had affected their source of drugs or the types of drugs available on the street, as well as overdoses, in these 2 periods. RESULTS: The 138 participants seen before the seizure were similar to the 123 participants seen after the seizure with respect to age, sex, ethnic background, education, HIV serostatus, neighbourhood residence, instability of housing, employment status, use of methadone maintenance therapy and all other measured potential confounders (all p > 0.10). We found no difference in the extent to which participants in the 2 groups reported daily use of heroin, frequency of nonfatal overdoses, or whether law enforcement had affected their source of drugs or the types of drugs available on the street (all p > 0.10). Although we detected no difference in the price of cocaine, the median reported price of heroin went down after the seizure (p = 0.034), which suggests that other shipments compensated for the seizure. External evaluations of deaths from overdoses and heroin purity indicated that the seizure had no impact, nor was any impact seen when the periods of analysis were extended. INTERPRETATION: The massive heroin seizure appeared to have no measurable public health benefit. Closer scrutiny of enforcement efforts is warranted to ensure that resources are delivered to the most efficient and cost-effective public health programs.

Acquired Immunodeficiency Syndrome↗
PubMed2003

Risk factors for elevated HIV incidence among Aboriginal injection drug users in Vancouver.

BACKGROUND: Because of established links between entrenched poverty and risk of HIV infection, there have long been warnings that HIV/AIDS will disproportionately affect Aboriginal people in Canada. We compared HIV incidence rates among Aboriginal and non-Aboriginal injection drug users (IDUs) in Vancouver and studied factors associated with HIV seroconversion among Aboriginal participants. METHODS: This analysis was based on 941 participants (230 Aboriginal people) recruited between May 1996 and December 2000 who were seronegative at enrollment and had completed at least one follow-up visit. Incidence rates were calculated using the Kaplan-Meier method. The Cox proportional hazards regression model was used to identify independent predictors of time to HIV seroconversion among female and male Aboriginal IDUs. RESULTS: As of May 31, 2001, seroconversion had occurred in 112 (11.9%) of the participants, yielding a cumulative incidence of HIV infection at 42 months of 12.7% (95% confidence interval [CI] 10.3%-15.1%). The cumulative incidence at 42 months was significantly higher among the Aboriginal participants than among the non-Aboriginal participants (21.1% v. 10.7%, p < 0.001). This elevation in risk was present in both female and male Aboriginal IDUs. Among the female Aboriginal IDUs, frequent speedball (combined cocaine and heroin) injection (adjusted relative risk [RR] 3.1; 95% CI 1.4-7.1) and going on binges of injection drug use (adjusted RR 2.3; 95% CI 1.0-5.2) were found to be independent predictors of HIV seroconversion. Among the male Aboriginal IDUs, the independent predictors of seroconversion were frequent speedball injection (adjusted RR 2.9; 95% CI 1.0-8.5) and frequent cocaine injection (adjusted RR 2.5; 95% CI 1.0-6.5). INTERPRETATION: In Vancouver, Aboriginal IDUs are becoming HIV positive at twice the rate of non-Aboriginal IDUs. Our findings emphasize the urgent need for an appropriate and effective public health strategy--planned and implemented in partnership with Aboriginal AIDS service organizations and the Aboriginal community--to reduce the harms of injection drug use in this population.

Adolescent↗
PubMed2003

The potential public health and community impacts of safer injecting facilities: evidence from a cohort of injection drug users.

BACKGROUND: Although medically supervised safer injecting facilities (SIFs) remain untested in North America, their implementation is currently being debated. Reluctance of health policy makers to initiate a pilot study of SIFs may in part be hindered by outstanding questions regarding the potential community and public health impact of the intervention. Specifically, it is presently unknown if those at greatest risk of overdose and HIV transmission or those responsible for community impact of injection drug use will be willing to attend. METHODS: The current study was conducted to evaluate the proportion of injection drug users (IDU) willing to attend medically supervised SIFs, if they were available, among participants enrolled in the Vancouver Injection Drug User Study (VIDUS). The authors also evaluated factors associated with willingness to use a SIF using univariate and logistic regression analyses. Participants who were followed from June 2001 to June 2002 were eligible for the present analyses. RESULTS: Overall, 587 active IDU responded to a questionnaire during the study period. Among respondents, 215 (36.6%) expressed willingness to attend a SIF. Variables that were independently associated with willingness to attend a SIF in multivariate analyses included having difficulty accessing sterile syringes (adjusted odds ratio [AOR] = 2.07), requiring help injecting (AOR = 1.52), frequently injecting heroin (AOR = 1.81), sex trade work (AOR = 2.02), and injecting in public spaces (AOR = 2.00). CONCLUSIONS: Several variables that have recently been associated with overdose, syringe sharing, HIV and HCV incidence, and community impact of illicit drug use in this setting were associated with willingness to attend medically supervised SIFs. Although the impact of SIFs in North America can only be quantified by scientific evaluation, these data indicate a high potential for immediate community and public health benefits if SIFs were presently available.

Adult↗
PubMed2003

An external evaluation of a peer-run "unsanctioned" syringe exchange program.

In Vancouver, British Columbia, Canada, difficulty accessing syringes at night has been shown to be strongly associated with human immunodeficiency virus (HIV) risk behavior among the city's injection drug users (IDUs). On September 1, 2001, the Vancouver Area Network of Drug Users (VANDU) initiated an unsanctioned all-night needle-exchange program on a street corner in the heart of the neighborhood where many of the city's IDUs are concentrated. An external evaluation of the population reached by the VANDU exchange was performed through the Vancouver Injection Drug User's Study, a prospective cohort study of IDUs begun in 1996. Persons accessing syringes through the exchange were compared to those active injectors who acquired their syringes from other sources, including the city's fixed site exchange, which closes at 8:00 PM. Overall, 587 active IDUs were seen during the period September 2001 to June 2002; of these individuals, 165 (28.1%) reported using the VANDU exchange. In multivariate analyses, participants who used the VANDU table were more likely to frequently inject cocaine (adjusted odds ratio [AOR]=1.56; 95% confidence interval [CI]=1.00-2.44), inject in public (AOR=2.71; 95% CI=1.62-4.53), and require help injecting (OR=2.13; 95% CI=1.33-3.42). Interestingly, use of the table was also independently associated with safer syringe disposal (AOR=2.69; 95% CI=1.38-5.21). Results indicate that the unsanctioned exchange appears to have reached those IDUs at highest risk of HIV infection. Although the cross-sectional nature of the study design warrants caution, we also found that use of the nighttime exchange was strongly associated with higher rates of safe syringe disposal. The data suggest that drug user organizations can play a major role in reducing harm among their peers by reaching the highest risk drug users with harm reduction services. The findings also suggest that other forms of syringe-exchange programs should consider the benefits of offering fixed site nighttime service.

Adult↗
PubMed2002

Females experiencing sexual and drug vulnerabilities are at elevated risk for HIV infection among youth who use injection drugs.

OBJECTIVES: To compare sociodemographic, drug-related, and sexual risk variables between young (13-24 years of age) and older (> or =25 years of age) injection drug users (IDUs); and to determine HIV prevalence and associated risk factors for HIV infection among young IDUs. METHODS: Data were collected through the Vancouver Injection Drug Users Study (VIDUS). To date, over 1400 Vancouver area IDUs have been enrolled and observed during follow-up. Sociodemographic, drug-related, and sexual risk variables were compared between younger and older IDUs using nonparametric methods. Mantel-Haenszel and logistic regression methods were used to compare HIV-positive and HIV-negative female youth. RESULTS: Younger injectors (N = 232) were more likely to be female; work in the sex trade; report condom use; inject heroin daily; smoke crack cocaine daily; and need help injecting. HIV prevalence at baseline among the youth was 10%. HIV prevalence was associated with female gender; history of sexual abuse; engaging in survival sex; injecting heroin daily; injecting speedballs (a mixture of heroin and cocaine) daily; and having numerous lifetime sexual partners. CONCLUSION: Our data show that HIV positivity among young IDUs is concentrated among females engaged in dual sexual and drug-related risk exposure categories. Over half the HIV-positive youth were Aboriginal (a classification used by the federal government in Canada to include native peoples of all ethnic groups). Targeted interventions that take into account sexual and drug risk for young female and Aboriginal peoples are urgently needed.

Adolescent↗
PubMed2002

Factors associated with persistent high-risk syringe sharing in the presence of an established needle exchange programme.

Vancouver has experienced an explosive HIV epidemic despite the presence of a needle exchange programme (NEP). We sought possible explanations for high-risk syringe sharing among Vancouver injection drug users over the period January 1999 to October 2000. Overall, 14% of participants reported high-risk sharing. Although acquiring needles exclusively from the NEP was independently associated with less sharing, we identified several risk factors for persistent sharing, including difficulty accessing sterile needles, bingeing, and frequent cocaine injection.

British Columbia↗
PubMed2002

Risk factors for elevated HIV incidence rates among female injection drug users in Vancouver.

BACKGROUND: In 1997, we found a higher prevalence of HIV among female than among male injection drug users in Vancouver. Factors associated with HIV incidence among women in this setting were unknown. In the present study, we sought to compare HIV incidence rates among male and female injection drug users in Vancouver and to compare factors associated with HIV seroconversion. METHODS: This analysis was based on 939 participants recruited between May 1996 and December 2000 who were seronegative at enrolment with at least one follow-up visit completed, and who were studied prospectively until March 2001. Incidence rates were calculated using the Kaplan-Meier method. The Cox proportional hazards regression model was used to identify independent predictors of time to HIV seroconversion. RESULTS: As of March 2001, seroconversion had occurred in 110 of 939 participants (64 men, 46 women), yielding a cumulative incidence rate of HIV at 48 months of 13.4% (95% confidence interval [CI] 11.0%-15.8%). Incidence was higher among women than among men (16.6% v. 11.7%, p = 0.074). Multivariate analysis of the female participants' practices revealed injecting cocaine once or more per day compared with injecting less than once per day (adjusted relative risk [RR] 2.6, 95% CI 1.4-4.8), requiring help injecting compared with not requiring such assistance (adjusted RR 2.1, 95% CI 1.1-3.8), having unsafe sex with a regular partner compared with not having unsafe sex with a regular partner (adjusted RR 2.9, 95% CI 0.9-9.5) and having an HIV-positive sex partner compared with not having an HIV-positive sex partner (adjusted RR 2.7, 95% CI 1.0-7.7) to be independent predictors of time to HIV seroconversion. Among male participants, injecting cocaine once or more per day compared with injecting less than once per day (adjusted RR 3.3, 95% CI 1.9-5.6), self-reporting identification as an Aboriginal compared with not self-reporting identification as an Aboriginal (adjusted RR 2.5, 95% CI 1.4-4.2) and borrowing needles compared with not borrowing needles (adjusted RR 2.0, 95% CI 1.1-3.4) were independent predictors of HIV infection. INTERPRETATION: HIV incidence rates among female injection drug users in Vancouver are about 40% higher than those of male injection drug users. Different risk factors for seroconversion for women as opposed to men suggest that sex-specific prevention initiatives are urgently required.

Adolescent↗
PubMed2002

Opportunities for prevention: hepatitis C prevalence and incidence in a cohort of young injection drug users.

The objective of this study was to compare sociodemographic, drug, and sexual risk characteristics between hepatitis C virus (HCV) baseline positive and negative young (13-24 years) injection drug users (IDUs) and to determine prospective risk factors for HCV seroconversion among the youth. Data were collected through the Vancouver Injection Drug Users Study (VIDUS). To date, more than 1,400 Vancouver-area IDUs have been enrolled and followed up; 234 were aged 24 years and younger. Semiannually, participants have completed an interviewer-administered questionnaire and have undergone serologic testing for human immunodeficiency virus (HIV) and HCV. Univariate and multivariate logistic regression analyses were undertaken to investigate predictors of baseline HCV positivity. In the multivariate analyses, Cox regression models with time-dependent covariates were used to identify predictors of HCV seroconversion. Of the 232 young injectors, 107 (46%) were HCV positive at baseline and a further 37 HCV seroconverted during the study period for an incidence rate of 37.3 per 100 person-years. Baseline positivity was associated with Aboriginal ancestry, older age, greater number of years injecting drugs, recent incarceration, sex trade work, more than 100 lifetime sexual partners, a previous sexually transmitted disease, living in the IDU epicenter, and injection more than once per day of heroin, cocaine, and speedball. Factors independently associated with HCV seroconversion were having a partner who uses injection drugs, requiring help to inject, and injection of cocaine more than once daily. In conclusion, unlike older IDUs, more than one half of young injectors were HCV negative at recruitment. Thus, there is a window of opportunity for prevention. However, the incidence rate of HCV among these young IDUs is alarming, suggesting that the opportunity to intervene is exceedingly small.

Adolescent↗
PubMedDate not supplied

Requiring help injecting as a risk factor for HIV infection in the Vancouver epidemic: implications for HIV prevention.

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.

British Columbia↗
PubMedDate not supplied

HIV and hepatitis C outbreaks among high-risk youth in Vancouver demands a public health response.

This paper is a call to action. We present Kaplan Meier cumulative HIV and HCV incidence rates among youth aged < or = 24 participating in the Vancouver Injection Drug Users Study (VIDUS), and demonstrate the alarming increase in HIV and HCV incidence rates in addicted youth. The incidence rates among VIDUS youth were 11.1% for HIV and 52.1% for HCV at 36 months after enrollment in the study. The growing epidemic of HIV and HCV among addicted youth calls for policy-makers and program planners to concentrate resources into prevention and treatment of blood-borne infections among British Columbia's vulnerable youth. Without focussing such resources, further HIV and HCV infections and subsequent higher health care costs appear imminent.

Adult↗