Abstract
BackgroundWhilst injecting drugs in public places is considered a proxy for high risk behaviour among people who inject drugs (PWID), studies quantifying its relationship with multiple drug-related harms are lacking and none have examined this in the context of an ongoing HIV outbreak (located in Glasgow, Scotland). We aimed to: 1) estimate the prevalence of public injecting in Scotland and associated risk factors; and 2) estimate the association between public injecting and HIV, current HCV, overdose, and skin and soft tissue infections (SSTI). MethodsCross-sectional, bio-behavioural survey (including dried blood spot testing to determine HIV and HCV infection) of 1469 current PWID (injected in last 6 months) recruited by independent interviewers from 139 harm reduction services across Scotland during 2017–18. Primary outcomes were: injecting in a public place (yes/no); HIV infection; current HCV infection; self-reported overdose in the last year (yes/no) and SSTI the last year (yes/no). Multi-variable logistic regression was used to determine factors associated with public injecting and to estimate the association between public injecting and drug-related harms (HIV, current HCV, overdose and SSTI). ResultsPrevalence of public injecting was 16% overall in Scotland and 47% in Glasgow city centre. Factors associated with increased odds of public injecting were: recruitment in Glasgow city centre (aOR=5.45, 95% CI 3.48–8.54, p<0.001), homelessness (aOR=3.68, 95% CI 2.61–5.19, p<0.001), high alcohol consumption (aOR=2.42, 95% CI 1.69–3.44, p<0.001), high injection frequency (≥4 per day) (aOR=3.16, 95% CI 1.93–5.18, p<0.001) and cocaine injecting (aOR=1.46, 95% CI 1.00 to 2.13, p = 0.046). Odds were lower for those receiving opiate substitution therapy (OST) (aOR=0.37, 95% CI 0.24 to 0.56, p<0.001) and older age (per year increase) (aOR=0.97, 95% CI 0.95 to 0.99, p = 0.013). Public injecting was associated with an increased risk of HIV infection (aOR=2.11, 95% CI 1.13–3.92, p = 0.019), current HCV infection (aOR=1.49, 95% CI 1.01–2.19, p = 0.043), overdose (aOR=1.59, 95% CI 1.27–2.01, p<0.001) and SSTI (aOR=1.42, 95% CI 1.17–1.73, p<0.001). ConclusionsThese findings highlight the need to address the additional harms observed among people who inject in public places and provide evidence to inform proposals in the UK and elsewhere to introduce facilities that offer safer drug consumption environments.
Highlights
There are approximately 15.6 million people who inject drugs (PWID) (Degenhardt et al, 2017) who are at risk of a range of harms including blood-borne viruses (BBVs), skin and soft tissue infections (SSTI) (Gordon & Lowy, 2005) and fatal and non-fatal overdose (Degenhardt et al, 2011; Mathers et al, 2013)
In the context of one of the most persistent recent outbreaks of HIV infection among PWID internationally (Des Jarlais et al, 2018) and the largest the UK has seen in 30 years, we have examined the extent of public injecting and associated harms in Scotland
We found that public injecting was strongly associated with HIV infection, current HCV infection, and self-reported overdose and SSTI in the last year
Summary
There are approximately 15.6 million people who inject drugs (PWID) (Degenhardt et al, 2017) who are at risk of a range of harms including blood-borne viruses (BBVs), skin and soft tissue infections (SSTI) (Gordon & Lowy, 2005) and fatal and non-fatal overdose (Degenhardt et al, 2011; Mathers et al, 2013). Fear of assault and being discovered by the public or the police encourages rushed higher risk injections where PWID are less likely to follow safer injection practices (Dovey, Fitzgerald & Choi, 2001; Small et al, 2007) These conditions increase the risk of fatal and non-fatal overdose, which has been consistently demonstrated in the literature (Darke, Kaye & Ross, 2001; Hunter et al, 2018; Sutter, Curtis & Frost, 2019; Vallance et al, 2018; Wallace, Kennedy, Kerr & Pauly, 2019).
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