Decreasing Impact of Requiring Assistance Injecting on HIV Incidence.

Abstract

To the Editor: The proportion of new HIV infections attributable to injection drug use is very high, with estimates of 30% globally outside of sub-Saharan Africa.1 Persons who inject drugs (PWID) continue to be at risk of HIV infection primarily through shared injecting equipment, and to a lesser extent unprotected sexual behavior.2,3 In our setting, in Vancouver Canada, up to 40% of PWID have reported requiring assistance with injection of illicit drugs,4 a behavior which has been identified as a strong risk factor for syringe sharing,5,6 and nearly doubles the risk of HIV infection compared to PWID who self-inject.4 In order to mitigate the well-established health risks associated with requiring assistance with injection, a number of harm reduction strategies have been implemented. Since opening in 2003, Insite, North America's first sanctioned medically supervised injection facility, has been associated with a large number of health and community benefits including significant reductions in syringe sharing.7,8 Insite staff provide clients with safer injection education, and, when necessary, provide verbal guidance and teaching to help users obtain venous access. Previous studies have demonstrated that many PWID who require assistance injecting benefit from instruction given at Insite.9,10 Federal guidelines governing the facility, however, require that all illicit drugs are self-administered and assisted injections are prohibited.11 As a result of this restriction, some PWID who are unable to inject on their own, are compelled to seek assistance with injection in less hygienic environments. In response to this, a local drug user organization known as the Vancouver Area Network of Drug Users (VANDU) formed an Injection Support Team (IST) in 2005. The team, comprised of experienced PWID who have received extensive training in safer injecting education, provide outreach services to encourage safer injecting in the community. Guided by a detailed procedures manual that the group developed, members of the team provide instruction on injecting technique to PWID.12 Since these interventions have been aimed at reducing vulnerability associated with requiring help injecting, the present study was undertaken to see if requiring assistance injecting was associated with ongoing risk of HIV infection over time in this setting.