title: Inability to access addiction treatment and risk of HIV infection among injection drug users.
abstract: It was recently found that 94% of the nearly $500 million allocated annually to Canada's illicit drug strategy has been spent on enforcement-based interventions. As a result, lack of funds for addiction treatment has meant demand for substance abuse treatment among illicit drug users has exceeded availability. This study evaluated whether injection drug users (IDUs) who reported being unable to access addiction treatment were at elevated risk of HIV infection. A prospective analysis was done of factors associated with syringe borrowing by baseline HIV-negative IDUs among participants enrolled in the Vancouver Injecting Drug Users Study (VIDUS). Since serial measures for each individual were available, variables potentially associated with syringe borrowing were evaluated using generalized estimating equations (GEEs) with logit link for binary outcomes. Overall, 1157 HIV-negative IDUs were enrolled into the VIDUS cohort between May 1996 and May 2002. Unsuccessful attempts to access addiction treatment were associated with reporting syringe borrowing during follow-up in both univariate (odds ratio 1.72; 95% CI 1.47-2.00; P<0.001) and in multivariate GEE analyses (adjusted odds ratio 1.29; 95% CI 1.09-1.53; P=0.003). Inability to access addiction treatment was independently associated with syringe borrowing among HIV-negative IDUs at risk for HIV infection. These findings suggest that the limited provision of addiction treatment may result in a major missed opportunity to reduce HIV transmission behavior among IDUs and that the expansion of addiction treatment services has major potential to reduce the substantial human and fiscal costs of HIV infection.
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver and Department of Health Care and Epidemiology; Faculty of Medicine, University of British Columbia, Canada. ewood@hivnet.ubc.ca
authors.forename: Evan
authors.initials: E
authors.lastname: Wood
authors.forename: Patricia
authors.initials: P
authors.lastname: Spittal
authors.forename: Kathy
authors.initials: K
authors.lastname: Li
authors.forename: Thomas
authors.initials: T
authors.lastname: Kerr
authors.forename: Cari L
authors.initials: CL
authors.lastname: Miller
authors.forename: Robert S
authors.initials: RS
authors.lastname: Hogg
authors.forename: Julio S G
authors.initials: JS
authors.lastname: Montaner
authors.forename: Martin T
authors.initials: MT
authors.lastname: Schechter
mesh_terms: D001955:British Columbia / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000635:transmission*; D018023:HIV Seronegativity; D006297:Health Services Accessibility / Q000191:economics; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D015819:Substance Abuse, Intravenous / Q000150:complications* / Q000628:therapy*