Vancouver, Canada has been the site of an epidemic of human immunodeficiency virus (HIV) amongst injection drug users (IDU). In response, the Vancouver Area Network of Drug Users (VANDU) initiated a peer-run outreach-based syringe exchange programme (SEP) called the Alley Patrol. We conducted an external evaluation of this programme, using data obtained from the Vancouver Injection Drug Users Study (VIDUS).
Using generalised estimating equations (GEE) we examined the prevalence and correlates of use of the SEP amongst VIDUS participants followed from 1 December 2000 to 30 November 2003.
Of 854 IDU, 233 (27.3%) participants reported use of the SEP during the study period. In multivariate GEE analyses, service use was positively associated with living in unstable housing (adjusted odds ratio [AOR]=1.83, 95% confidence interval [CI]: 1.39-2.40), daily heroin injection (AOR=1.31, 95% CI: 1.01-1.70), daily cocaine injection (AOR=1.34, 95% CI: 1.03-1.73), injecting in public (AOR=3.07, 95% CI: 2.32-4.06), and negatively associated with needle reuse (AOR=0.65, 95% CI: 0.46-0.92).
The VANDU Alley Patrol SEP succeeded in reaching a group of IDU at heightened risk for adverse health outcomes. Importantly, access to this service was associated with lower levels of needle reuse. This form of peer-based SEP may extend the reach of HIV prevention programmes by contacting IDU traditionally underserved by conventional syringe exchange programmes.
In Vancouver, British Columbia, Canada, difficulty accessing syringes at night has been shown to be strongly associated with human immunodeficiency virus (HIV) risk behavior among the city's injection drug users (IDUs). On September 1, 2001, the Vancouver Area Network of Drug Users (VANDU) initiated an unsanctioned all-night needle-exchange program on a street corner in the heart of the neighborhood where many of the city's IDUs are concentrated. An external evaluation of the population reached by the VANDU exchange was performed through the Vancouver Injection Drug User's Study, a prospective cohort study of IDUs begun in 1996. Persons accessing syringes through the exchange were compared to those active injectors who acquired their syringes from other sources, including the city's fixed site exchange, which closes at 8:00 PM. Overall, 587 active IDUs were seen during the period September 2001 to June 2002; of these individuals, 165 (28.1%) reported using the VANDU exchange. In multivariate analyses, participants who used the VANDU table were more likely to frequently inject cocaine (adjusted odds ratio [AOR]=1.56; 95% confidence interval [CI]=1.00-2.44), inject in public (AOR=2.71; 95% CI=1.62-4.53), and require help injecting (OR=2.13; 95% CI=1.33-3.42). Interestingly, use of the table was also independently associated with safer syringe disposal (AOR=2.69; 95% CI=1.38-5.21). Results indicate that the unsanctioned exchange appears to have reached those IDUs at highest risk of HIV infection. Although the cross-sectional nature of the study design warrants caution, we also found that use of the nighttime exchange was strongly associated with higher rates of safe syringe disposal. The data suggest that drug user organizations can play a major role in reducing harm among their peers by reaching the highest risk drug users with harm reduction services. The findings also suggest that other forms of syringe-exchange programs should consider the benefits of offering fixed site nighttime service.
North America's first government sanctioned supervised injection facility (SIF) was opened in Vancouver in response to the serious health and social consequences of injection drug use and the perseverance of committed advocates and drug user groups who demanded change. This analysis was conducted to describe the attendance, demographic characteristics, drug use patterns, and referrals made during the first 18 months of operation.
As part of the evaluation strategy for the SIF, information is collected through a comprehensive on-site database designed to track attendance and the daily activities within the facility. All users of the SIF must sign a waiver form and are then entered into a database using a unique identifier of their choice. This identifier is used at each subsequent visit to provide a prospective record of attendance, drug use, and interventions.
From 10 March 2004 to 30 April 2005 inclusive, there were 4764 unique individuals who registered at the SIF. The facility successfully attracted a range of community injection drug users including women (23%) and members of the Aboriginal community (18%). Although heroin was used in 46% of all injections, cocaine was injected 37% of the time. There were 273 witnessed overdoses with no fatalities. During just 12 months of observation, 2171 individual referrals were made with the majority (37%) being referred for addiction counseling.
Vancouver's SIF has successfully been integrated into the community, has attracted a wide cross section of community injection drug users, has intervened in overdoses, and initiated over 2000 referrals to counseling and other support services. These findings should be useful for other settings considering SIF trials.
The identification of individuals at the highest risk of human immunodeficiency virus (HIV) infection is critical for targeting prevention strategies. We evaluated self-perceived risk of HIV infection and rates of subsequent HIV seroconversion among a prospective cohort study of injection drug users (IDUs).
We performed an analysis of the time to HIV infection among 994 baseline HIV negative IDUs enrolled in the Vancouver injection drug users study (VIDUS). IDUs were stratified based on their baseline self-perceived risk of HIV seroconversion (higher than others vs same or lower). Kaplan-Meier methods were used to estimate cumulative HIV incidence rates and Cox regression was used to determine adjusted relative hazards for HIV seroconversion.
At the end of 24 months after enrolment into the cohort, the cumulative HIV incidence rate was significantly elevated among the 5.9% of the sample who perceived their risk for HIV infection to be higher at baseline (26.6% vs 7.8% log-rank P
Comment In: Int J Epidemiol. 2005 Feb;34(1):158-915649963
Internationally, illegal drug use remains a major public health problem. In response, many countries have begun to shift their illegal drug policies away from enforcement and towards public health objectives. Recently, both the Global Commission on Drug Policy and the Supreme Court of Canada have endorsed this change in direction, supporting empirically sound illegal drug policies that reduce criminalization and stigmatization of drug users and bolster treatment and harm reduction efforts. Until recently, Canada was a participant in this growing movement towards rational drug policy. Unfortunately, in recent years, policy changes have made Canada one of the few remaining advocates of a "war-on-drugs" approach. Indeed, the current government has implemented a number of new illegal drug policies that contradict well-established scientific evidence from public health, criminology and other fields. As such, their approach is expected to do little to reduce the harms associated with substance use in Canada. The authors call on the current government to heed the recommendations of the Global Commission's report and learn from the many countries that are innovating in illegal drug policy by prioritizing evidence, human rights and public health.
While there is mounting international acceptance of harm reduction approaches and growing support for policies that balance enforcement with more health-focused interventions, in many settings these developments are not reflected in policy. In October 2007, the Canadian federal government launched a new $64 million dollar 'National Anti-Drug Strategy' in which two-thirds of the new monies was reportedly directed towards drug prevention and treatment initiatives.
However, contrary to the impression left by a host of federal politicians, including the Prime Minister, that this new strategy was investing significantly in drug prevention and drug treatment, this analysis finds that when base funding is considered additional monies provided through the new federal National Anti-Drug Strategy only marginally shifts the allocation of funds within each category.
Specifically, law enforcement initiatives continue to receive the overwhelming majority of drug strategy funding (70%) while prevention (4%), treatment (17%) and harm reduction (2%) combined continue to receive less than a quarter of the overall funding.
These findings suggest that the Canadian government is failing to invest resources in evidence-based drug policies.
Injection drug users (IDUs) are vulnerable to serious health complications resulting from unsafe injection practices. We examined whether the use of a supervised safer injection facility (SIF) promoted change in injecting practices among a representative sample of 760 IDUs who use a SIF in Vancouver, Canada. Consistent SIF use was compared with inconsistent use on a number of self-reported changes in injecting practice variables. More consistent SIF use is associated with positive changes in injecting practices, including less reuse of syringes, use of sterile water, swabbing injection sites, cooking/filtering drugs, less rushed injections, safe syringe disposal and less public injecting.
There have been concerns that safer injecting facilities may promote initiation into injection drug use. We examined length of injecting career and circumstances surrounding initiation into injection drug use among 1065 users of North America's first safer injecting facility and found that the median years of injection drug use were 15.9 years, and that only 1 individual reported performing a first injection at the safer injecting facility. These findings indicate that the safer injecting facility's benefits have not been offset by a rise in initiation into injection drug use.
This cross-sectional study involving a cohort of injection drug users (IDU) examined the relationship between cognitive factors (HIV treatment optimism, self-efficacy and knowledge of vaccine trial concepts) as well as risk factors for seroconversion, and willingness to participate (WTP) in a preventive phase 3 HIV vaccine trial. Willingness to participate overall was 56%. In a multivariate analysis, for a 20-unit increase in a 100-point composite scale, self-efficacy was positively related to WTP (adjusted odds ratio [AOR]=1.95, 95% CI=1.40-2.70). HIV treatment optimism and knowledge of vaccine trial concepts were unrelated to WTP. Aboriginal ethnicity (AOR=3.47, 95% CI=1.68-7.18) and a higher educational level (>or=high school) (AOR=1.96, 95% CI=1.07-3.59) were positively related to WTP. This study provides information on WTP for an HIV vaccine trial. Limitations and future directions are also discussed.
Although injection drug use is known to result in a range of health-related harms, including transmission of HIV and fatal overdose, little is known about the possible role of synthetic drugs in injection initiation. We sought to determine the effect of crystal methamphetamine use on risk of injection initiation among street-involved youth in a Canadian setting.
We used Cox regression analyses to identify predictors of injection initiation among injection-naive street-involved youth enrolled in the At-Risk Youth Study, a prospective cohort study of street-involved youth in Vancouver, British Columbia. Data on circumstances of first injection were also obtained.
Between October 2005 and November 2010, a total of 395 drug injection-naive, street-involved youth provided 1434 observations, with 64 (16.2%) participants initiating injection drug use during the follow-up period, for a cumulative incidence of 21.7 (95% confidence interval [CI] 1.7-41.7) per 100 person-years. In multivariable analysis, recent noninjection use of crystal methamphetamine was positively associated with subsequent injection initiation (adjusted hazard ratio 1.93, 95% CI 1.31-2.85). The drug of first injection was most commonly reported as crystal methamphetamine (14/31 [45%]).
Noninjection use of crystal methamphetamine predicted subsequent injection initiation, and crystal methamphetamine was the most commonly used drug at the time of first injection. Evidence-based strategies to prevent transition to injection drug use among crystal methamphetamine users are urgently needed.
Cites: Reprod Health Matters. 2009 Nov;17(34):180-619962651