Abstract
Background
Injection drug users (IDUs) are at risk for acquiring human immunodefiency virus (HIV) and hepatitis C virus (HCV) via parenteral and sexual transmission. We determined the seroprevalence and correlates of HIV and HCV for IDUs recruited in Edmonton, Alberta.
Methods
Edmonton was one site of a multi-site, national survey (I-Track Study). From April to June 2005, IDUs were recruited and administered a questionnaire collecting information on demographics, drug use, sexual behaviours, and HIV/HCV testing behaviours. Finger-prick blood samples were collected for serology testing. Seroprevalence of HIV and HCV was determined and correlates of infection were assessed using logistic regression.
Results
Of 275 IDUs, 68% were male, the median age was 38 years and 70.6% were Aboriginal. HIV prevalence was 23.9%, HCV prevalence was 66.1% and HIV/HCV co-infection was 22.8%. Cocaine (36.9%) was reported to be the drug injected most often in the previous six months. Correlates for HIV were sex trade (OR 2.9, 95% CI 1.0–8.3) for women, and older age (OR 1.1, 95% CI 1.0–1.2) and needle exchange program (NEP) use (OR 5.7, 95% CI 1.3–23.7) for men. For women, having a casual sex partner was protective for HCV (OR 0.28, 95% CI 0.10–0.78). Independent correlates for HCV among males included age (AOR 1.2, 95% CI 1.1–1.3) and younger age of first injection (AOR 0.92, 95% CI 0.87–0.96).
Conclusion
The high HIV and HCV prevalence found in this study among IDUs in Edmonton highlights the complex needs of the IDU community and the continued need for targeted programming.
Keywords: HIV, HCV, injection drug use, Canada
Résumé
Objectifs
Les utilisateurs de drogues par injection (UDI) sont à risque d’être infectés par le virus de l’immunodéficience humaine (VIH) et le virus de l’hépatite C (VHC) par la voie parentérale et la transmission sexuelle. Nous avons déterminé la séroprévalence et les corrélats du VIH et VHC chez des UDI recrutés à Edmonton (Alberta).
Méthode
Edmonton était l’un des nombreux sites d’une enquête nationale (étude I-Track). D’avril à juin 2005, nous avons recruté des UDI et nous leur avons administré un questionnaire sur leur profil démographique, leur consommation de drogue, leur comportement sexuel et leur comportement à l’égard de la détection du VIH et du VHC. Des échantillons de sang ont été prélevés par ponction digitale pour des tests sérologiques. Nous avons déterminé la séroprévalence du VIH et VHC et évalué les corrélats des infections par régression logistique.
Résultats
Des 275 UDI, 68% étaient des hommes, leur âge médian était de 38 ans, et 70,6% étaient des Autochtones. Les prévalences du VIH et VHC étaient respectivement de 23,9% et de 66,1%, et la coinfection par le VIH et le VHC était de 22,8%. La cocaïne (36,9%) était la drogue injectée le plus souvent au cours des six derniers mois. Chez les femmes, le commerce du sexe était corrélé avec le VIH (RC 2,9, IC 95% 1,0–8,3), tandis que chez les hommes, les corrélats du VIH étaient le fait d’être plus âgé (RC 1,1, IC 95% 1,0–1,2) et le recours aux programmes d’échange de seringues (PES) (RC 5,7, IC 95% 1,3–23,7). Pour les femmes, avoir un partenaire sexuel occasionnel était un facteur de protection contre le VHC (RC 0,28, IC 95% 0,10–0,78). Les corrélats indépendants pour le VHC chez les hommes incluaient l’âge (RCa 1,2, IC 95% 1,1–1,3) et un plus jeune âge lors de la première injection (RCa 0,92, IC 95% 0,87–0,96).
Conclusion
La forte prévalence du VIH et du VHC dans cette étude auprès des UDI d’Edmonton met en évidence la complexité des besoins de la communauté UDI et la nécessité continuelle d’avoir des programmes ciblés.
Motsclés: VIH, VHC, utilisation de drogues par injection, Canada
Footnotes
Conflict of Interest: None to declare.
References
- 1.Institute of Medicine. The Hidden Epidemic: Confronting Sexually Transmitted Diseases. Washington, DC: National Academy Press; 1997. [Google Scholar]
- 2.Cohen E, Navaline H, Metzger D. High-risk behaviors for HIV: A comparison between crack-abusing and opioid-abusing African-American women. J Psychoactive Drugs. 1994;26(3):233–41. doi: 10.1080/02791072.1994.10472436. [DOI] [PubMed] [Google Scholar]
- 3.Kim MY, Marmor M, Dubin N, Wolfe H. HIV risk-related sexual behaviors among heterosexuals in New York City: Associations with race, sex, and intravenous drug use. AIDS. 1993;7(3):409–14. doi: 10.1097/00002030-199303000-00016. [DOI] [PubMed] [Google Scholar]
- 4.Public Health Agency of Canada. HIV and AIDS in Canada: Surveillance Report to December 31, 2006. Ottawa, ON: Surveillance and Risk Assessment Division, Centre for Infectious Disease Prevention and Control, Public Health Agency of Canada; 2007. [Google Scholar]
- 5.Public Health Agency of Canada. Notifiable Diseases On-Line. Available at: https://doi.org/dsol-smed.phac-aspc.gc.ca/dsol-smed/ndis/c_ind_e.html#top_list (Accessed February 3, 2008).
- 6.Public Health Agency of Canada. I-Track: Enhanced Surveillance of Risk Behaviours among People who Inject Drugs. Procedural Guidelines. Phase I, November 2004. Surveillance and Risk Assessment Division, Centre for Infectious Disease Prevention and Control, Public Health Agency of Canada. 2004. [Google Scholar]
- 7.Wild TC, Prakash M, O’Connor H, Taylor M, Edwards J, Predy G. Injection Drug Use in Edmonton’s Inner City: A Multimethod Study. Edmonton, AB: Centre for Health Promotion Studies, University of Alberta; 2003. [Google Scholar]
- 8.Wolfe R, Sykes B. Needleworks: Prevention of HIV in Injection Drug Users. Final Report and Evaluation. 1992. [Google Scholar]
- 9.Public Health Agency of Canada. I-Track: Enhanced Surveillance of Risk Behaviours among People who Inject Drugs. Phase I Report, August 2006. Surveillance and Risk Assessment Division, Centre for Infectious Disease Prevention and Control, Public Health Agency of Canada. 2006. [Google Scholar]
- 10.Fischer B, Manzoni P, Rehm J. Comparing injecting and non-injecting illicit opioid users in a multisite Canadian sample (OPICAN Cohort) Eur Addict Res. 2006;12(4):230–39. doi: 10.1159/000094425. [DOI] [PubMed] [Google Scholar]
- 11.Strathdee S, Patrick DM, Currie SL, Cornelisse PG, Rekart ML, Montaner JS, et al. AIDS. 1997. Needle exchange is not enough: Lessons from the Vancouver injecting drug use study. [DOI] [PubMed] [Google Scholar]
- 12.Poulin C, Alary M, Bernier F, Ringuet J, Joly JR. Prevalence of Chlamydia tra-chomatis, Neisseria gonorrhoeae, and HIV infection among drug users attending an STD/HIV prevention and needle-exchange program in Quebec City, Canada. Sex Transm Dis. 1999;26(7):410–20. doi: 10.1097/00007435-199908000-00009. [DOI] [PubMed] [Google Scholar]
- 13.Wylie JL, Shah L, Jolly AM. BMC Public Health. 2006. Demographic, risk behaviour and personal network variables associated with prevalent hepatitis C, hepatitis B, and HIV infection in injection drug users in Winnipeg, Canada. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Kral AH, Bluthenthal RN, Lorvick J, Gee L, Bacchetti P, Edlin BR. Sexual transmission of HIV-1 among injection drug users in San Francisco, USA: Risk-factor analysis. Lancet. 2001;357(9266):1397–401. doi: 10.1016/S0140-6736(00)04562-1. [DOI] [PubMed] [Google Scholar]
- 15.Plitt SS, Sherman SG, Strathdee SA, Taha TE. Herpes simplex virus 2 and syphilis among young drug users in Baltimore, Maryland. Sex Transm Infect. 2005;81(3):248–53. doi: 10.1136/sti.2004.011544. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.Evans JL, Hahn JA, Page-Shafer K, Lum PJ, Stein ES, Davidson PJ, et al. Gender differences in sexual and injection risk behavior among active young injection drug users in San Francisco (the UFO Study) J Urban Health. 2003;80(1):137–46. doi: 10.1093/jurban/jtg137. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.Powis B, Griffiths P, Gossop M, Strang J. The differences between male and female drug users: Community samples of heroin and cocaine users compared. Subst Use Misuse. 1996;31(5):529–43. doi: 10.3109/10826089609045825. [DOI] [PubMed] [Google Scholar]
- 18.Henderson DJ, Boyd C, Mieczkowski T. Gender, relationships, and crack cocaine: A content analysis. Res Nurs Health. 1994;17(4):265–72. doi: 10.1002/nur.4770170405. [DOI] [PubMed] [Google Scholar]
- 19.Schechter MT, Strathdee SA, Cornelisse PG, Currie S, Patrick DM, Rekart ML, et al. Do needle exchange programmes increase the spread of HIV among injection drug users?: An investigation of the Vancouver outbreak. AIDS. 1999;13(6):F45–F51. doi: 10.1097/00002030-199904160-00002. [DOI] [PubMed] [Google Scholar]
- 20.Cao W, Treloar C. Comparison of needle and syringe programme attendees and non-attendees from a high drug-using area in Sydney, New South Wales. Drug Alcohol Rev. 2006;25(5):439–44. doi: 10.1080/09595230600891282. [DOI] [PubMed] [Google Scholar]
- 21.Wood E, Lloyd-Smith E, Li K, Strathdee S, Small W, Tyndall M, et al. Frequent needle exchange use and HIV incidence in Vancouver, Canada. Am J Med. 2007;120(2):172–79. doi: 10.1016/j.amjmed.2006.02.030. [DOI] [PubMed] [Google Scholar]
- 22.Stoltz JA, Wood E, Small W, Li K, Tyndall M, Montaner J, et al. Changes in injecting practices associated with the use of a medically supervised safer injection facility. J Public Health (Oxf) 2007;29(1):35–39. doi: 10.1093/pubmed/fdl090. [DOI] [PubMed] [Google Scholar]
- 23.Cornish JW, O’Brien CP. Crack cocaine abuse: An epidemic with many public health consequences. Annu Rev Public Health. 1996;17:259–73. doi: 10.1146/annurev.pu.17.050196.001355. [DOI] [PubMed] [Google Scholar]
- 24.Statistics Canada. 2001 Census Aboriginal Population Profiles. Released June 17, 2003. Last modified: 2005-11-30. Statistics Canada Catalogue no. 93F0043XIE. 2002. [Google Scholar]
- 25.Public Health Agency of Canada. HIV/AIDS Epi Updates, May 2003. Ottawa, ON: Surveillance and Risk Assessment Division, Centre for Infectious Disease Prevention and Control, Public Health Agency of Canada; 2005. [Google Scholar]