Abstract
Background
Supervised injection facilities (SIF), a harm reduction intervention, may reduce several risks of public injection drug use. The prospect of conducting a scientific, multi-site pilot project of these facilities is being explored at federal and local levels in Canada. Experiences with SIF in Europe and Australia indicate that successful outcomes for the community ultimately hinge upon the responsiveness and relevance of the facilities to the needs of their primary target group: people who inject drugs in public places. Consideration of the factors and conditions found to influence a potential user’s uptake of SIF, therefore, is imperative. This study sought to assess the acceptability of SIF and to determine factors associated with willingness of injecting drug users (IDU) to use SIF in a city considering their establishment.
Methods
From April 2001 to February 2002, following key informant interviews, a crosssectional study was conducted among publicly injecting IDU participating in an ongoing HIV surveillance study in Montréal. Univariate and bivariate analyses preceded logistic regression.
Results
Participants were 11 key informants and 251 publicly injecting IDU. Key informants generated the Montréal-specific SIF model subsequently presented to IDU. 76% of IDU were willing to use at least one of three proposed SIF sites. Exploratory multivariable models indicated drug-use characteristics and SIF attributes as determinants of outcome: predominant cocaine injection, history of overdose, knowing about SIF, relieving and empowering feelings toward using SIF, and comfort with disclosure of one’s injecting drug use.
Conclusion
User consultations are essential to assess relevance and plan SIF acceptable to IDU.
Résumé
Contexte
Les piqueries supervisées, une mesure de réduction des méfaits, peuvent réduire plusieurs des risques liés à l’utilisation de drogues injectables en public. Au Canada, on étudie aux paliers fédéral et local la possibilité de mener un projet pilote scientifique dans plusieurs installations à la fois. L’expérience des piqueries supervisées a été tentée en Europe et en Australie et semble indiquer que des résultats favorables à la collectivité dépendent en bout de ligne de la polyvalence des installations et de leur adaptation aux besoins de leur principal groupe cible: les personnes qui s’injectent des drogues dans des lieux publics. Il est donc impératif de prendre en considération les facteurs et les conditions connus pour influencer la bonne réaction de cette clientèle à ces installations. La présente étude visait à évaluer l’acceptabilité des piqueries supervisées et à déterminer les facteurs associés à la volonté des utilisateurs de drogues injectables (UDI) d’y recourir dans une ville qui songe à établir de telles installations.
Méthode
Entre avril 2001 et février 2002, à la suite d’entretiens avec des informateurs clés, nous avons mené une étude transversale auprès d’UDI qui s’injectaient dans des lieux publics. Ces UDI participaient déjà à une étude de surveillance du VIH à Montréal. Des analyses univariée et bivariée ont été suivies d’une analyse de régression logistique.
Résultats
Onze informateurs clés et 251 UDI s’injectant dans des lieux publics ont participé à notre étude. Les informateurs clés ont produit le modèle montréalais des piqueries supervisées, que nous avons ensuite présenté aux UDI. Soixante-seize p. cent des UDI étaient disposés à utiliser au moins une des trois piqueries supervisées qui leur étaient proposées. Des modèles multivariables préliminaires ont mis au jour des profils de consommation de drogues et des attributs des piqueries supervisées qui pourraient avoir un effet déterminant sur les résultats, à savoir: l’injection prédominante de cocaïne; les antécédents de surdose; le fait d’avoir entendu parler des piqueries supervisées; les sentiments de soulagement et de renforcement de l’autonomie liés à l’utilisation des piqueries supervisées; et la facilité à divulguer sa propre consommation de drogues injectables.
Conclusion
La consultation des utilisateurs est un élément essentiel lorsqu’on veut évaluer la pertinence des piqueries supervisées et planifier des installations acceptables aux yeux des UDI.
Footnotes
Acknowledgements: This research was supported in part by a grant from the Centre québécois de coordination sur le sida, of the Québec Ministry of Health and Social Services (MSSS, Québec). The authors gratefully acknowledge the Québec Ministry of Health and Social Services (MSSS, Québec) for their support of this research. Thanks to Dr. Joanne Otis for advice on the theoretical aspects and measurements used in this study; to the SurvUDI Study interviewers, Mélissa Prévost and Karine Lavoie, and the study site collaborators; to Dr. Hankins’ research team at the Direction de la Santé Publique à Montréal, Karina Pourreaux, Andréa Hankins-Palmer, Nicole Labrie, and Jing-Ou Shu, who were instrumental in facilitating the planning, data collection, and analysis of this work; and to the 11 key informants and 251 publicly injecting drug users who participated in the SIF Study.
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