Abstract
BackgroundAssisted 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).MethodsUsing 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.ResultsFrom 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).ConclusionsOur 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.
Highlights
Assisted injection and public injection have both been associated with a variety of individual harms including an increased risk of HIV infection
In multivariate analyses, assisted injection outdoors was 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)
Given that assisted injection has been shown to be independently associated with syringe sharing [10,11] and is a risk factor for HIV infection [10,13] and overdose [12], these findings indicate that novel programs are needed to target the distinct needs of this subpopulation of inject drugs (IDU) who engage in this practice in outdoor venues
Summary
Assisted injection and public injection have both been associated with a variety of individual harms including an increased risk of HIV infection. The transmission of bacterial and viral infections and risk of overdose persists in a range of settings despite considerable differences in drugs consumed and local injecting practices [1]. There is concern that these individuals are left to obtain assistance with their injections in unsafe injecting environments, including public and unhygienic settings such as alleyways [9]. Research has consistently demonstrated the high risks associated with assisted injection such as increased syringe sharing [10,11], non fatal overdose [12], and elevated HIV incidence [10,13]
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