Continuing HIV transmission among injection drug users in Eastern Central Canada: the SurvUDI Study, 1995 to 2000.
OBJECTIVE
To document HIV prevalence/incidence trends from 1995-2000 and associated risk factors among injection drug users (IDUs) in Eastern Central Canada as an indication of harm reduction strategy effectiveness.


METHODS
Nonnominal cross-sectional data (one-time participants) and longitudinal data (repeat participants) were collected using convenience sampling. Participants provided informed consent for face-to-face interviews focused on injection drug use and sexual practices during the previous 6 months; oral fluid samples were taken for HIV testing by enzyme immunoassay. Unique encrypted codes for initially HIV-negative repeat participants permitted incidence rate calculations.


RESULTS
In all, 6387 IDUs (median age, 31 years; range, 13-67; males, 73.5%) participated on 9724 occasions. HIV prevalence ranged from 4.7% (95% confidence interval [CI], 2.9-6.5) in semiurban areas to 20.1% (95% CI, 17.6-22.7) in Ottawa, Ontario. HIV incidence was 6.0 (95%CI, 4.5-7.6) per 100 person-years (py) in Montréal, Québec, 3.2 (95% CI, 2.2-4.2) per 100 py in Québec City and 7.0 (95% CI, 4.1-9.8) per 100 py in Ottawa/Hull. Reusing other IDUs' needles was reported by 38.4%. In multivariate logistic regression, IDUs injecting for 6 or more years were more likely to be HIV positive, particularly if cocaine was the predominant drug injected. Multivariate Cox regression revealed higher HIV incidence among those who predominantly injected cocaine, reused others' needles, had injected 6 years or more, injected with strangers, or were men reporting commercial sex work.


CONCLUSIONS
These results reveal a volatile situation of continuing HIV transmission among IDUs in Eastern Central Canada.
Hankins
Catherine
C
Direction de la santé publique de Montréal-centre, Montréal, Canada. catherine.hankins@mcgill.ca
Alary
Michel
M
Parent
Raymond
R
Blanchette
Caty
C
Claessens
Christiane
C
D015492:AIDS Serodiagnosis; D000293:Adolescent; D000328:Adult; D000368:Aged; D002170:Canada / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000635:transmission*; D006306:Health Surveys; D006801:Humans; D007124:Immunoenzyme Techniques; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009055:Mouth / Q000276:immunology; D018671:Needle-Exchange Programs; D011159:Population Surveillance; D015995:Prevalence; D012307:Risk Factors; D012463:Saliva / Q000276:immunology; D015819:Substance Abuse, Intravenous / Q000150:complications*