A preliminary needs assessment of American Indians who inject drugs in northeastern Montana

Mike Anastario,Elizabeth Rink,Adriann Ricker,Kris Fourstar,Monica C Skewes,Rebecca Dick

doi:10.1186/s12954-017-0146-1

Abstract

BackgroundInjection drug use has not been well documented in American Indians living in the USA. American Indian and Alaskan Natives (AI/ANs) show higher rates of substance use compared to the general population, and have historically been subject to a number of risk factors that are known to increase the likelihood of substance use. AI/ANs also experience increased risk for infectious diseases that are transmitted via injection drug use and/or sexual activity. Harm reduction approaches have been shown to be effective for decreasing risk of disease transmission in at-risk populations, and may be well suited for AI/AN injection drug users residing in rural reservation communities. In this study, we aimed to examine the characteristics of American Indians (AI) who use injection drugs (PWUID) in northeastern Montana to identify needs that could be addressed with harm reduction programming.MethodsFor the present study, we used a respondent-driven sampling approach to generate a sample of 51 self-identified male and female injection drug users ≥18 years of age who were American Indians living on the Fort Peck Indian Reservation. Sampling weights were applied to all analyses using Respondent-Driven Sampling Analysis Tool (RDSAT).ResultsThere were no strong recruitment patterns by age, sex, or ethnic identity status of the recruiter or participant, but there were strong within-group recruitment patterns by location within the reservation. The majority of the sample reported initiating substance use before the age of 18. Participants reported significant risk for HIV, hepatitis, and other infectious diseases through their drug use and/or risky sexual behavior. Sixty-five percent reported having reused syringes, and 53% reported drawing from the same filter. Seventy-five percent reported inconsistent condom use during the 3 months preceding the survey, and 53% reported injecting drugs during sex during the 3 months preceding the survey. Only 66% of participants reported having been tested for HIV in the 12 months preceding the survey. The vast majority (98%) of respondents expressed interest in a harm reduction program. Seventy-six percent reported that it was easy or very easy to obtain new syringes.ConclusionsWe documented several risks for blood-borne pathogens, including elevated levels of syringe reuse. Further, we documented significant interest in harm reduction interventions in the present sample of AI/AN injection drug users. Findings suggest a need for increased access to harm reduction programming for AI/AN injection drug users to reduce the transmission of infectious disease and increase access to compassionate care.

Highlights

Injection drug use has not been well documented in American Indians living in the USA
Future assessments may benefit from collecting serological data in addition to behavioral data in order to estimate the seroprevalence of Human immunodeficiency virus (HIV) and hepatitis C among people who use injection drugs (PWUID) in Fort Peck. In this preliminary needs assessment of injection drug use among Assiniboine and Sioux Tribe members on the Fort Peck Reservation in northeastern Montana, we documented elevated levels of syringe reuse and several risks for HIV and hepatitis C, which are public health concerns that could be addressed with harm reduction programming
We identified specific gaps in knowledge and psychosocial determinants of risk behavior, which suggest the need for a client-centered approach to prevention

Summary

Introduction

Injection drug use has not been well documented in American Indians living in the USA. American Indian and Alaska Native (AI/AN) people in the USA experience health disparities in rates of substance use disorders and rates of some infectious diseases due to blood-borne pathogens, such as hepatitis C [1] These disparities can often be more pronounced in tribal communities located in rural areas with limited access to services and interventions. Harm reduction interventions such as needle exchange programs have been shown to effectively reduce transmission of infectious disease and increase access to substance abuse treatment among injection drug users [2,3,4]. There is a notable lack of access to substance abuse treatment and other quality health care services in rural reservation communities, further promulgating risk for health problems resulting from injection drug use

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