Minimal uptake of sterile drug preparation equipment in a predominantly cocaine injecting population: implications for HIV and hepatitis C prevention.
OBJECTIVE
To identify factors associated with using sterile drug injection equipment by injection drug users (IDUs).


METHODS
275 IDUs were recruited from syringe exchange programs in Montreal, Canada in 2004-2005. A structured, interviewer-administered questionnaire collected information about demographics, drug injection practices, self-reported HIV and hepatitis C virus (HCV) status, and harm reduction behaviours. Logistic regression was used to model variables in relation to the use of sterile syringes, containers, filters, and drug preparation water.


RESULTS
Sterile syringes, containers, filters, and water were used for at least half of injecting episodes by 95%, 23%, 23%, and 75% of subjects, respectively. In multivariate analysis, users of sterile syringes had higher odds of being older and injecting alone, and were less likely to report problems obtaining sterile syringes and requiring or providing help with injecting. Using sterile filters was associated with having at least high school education, injecting heroin, and injecting alone. In addition to the factors associated with filters, users of sterile containers were more likely to be HCV-negative and older. Using sterile water was associated with daily injecting and being HCV-negative.


CONCLUSIONS
Improving the uptake of sterile drug preparation equipment among IDUs could be aided by considering drug-specific risks, such as drug of choice and injecting context, while reinforcing existing messages on safer injecting. The association between sterile equipment use and HCV-negative status may be representative of an established subgroup of safer injectors who have remained free of infection because of consistent safe injecting practices.
Morissette
Carole
C
Montreal Public Health Department, Division of Infectious Diseases, 1301 Sherbrooke Street East, Montreal, Quebec, H2L 1M3, Canada. cmorisse@santepub-mtl.qc.ca <cmorisse@santepub-mtl.qc.ca>
Cox
Joseph
J
De
Prithwish
P
Tremblay
Claude
C
Roy
Elise
E
Allard
Robert
R
Stephenson
Randolph
R
Graves
Lisa
L
D000328:Adult; D000367:Age Factors; D002170:Canada / Q000453:epidemiology; D019970:Cocaine-Related Disorders; D003625:Data Collection; D004209:Disposable Equipment; D004866:Equipment Contamination / Q000517:prevention & control*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D040261:Harm Reduction; D006526:Hepatitis C / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D006556:Heroin Dependence; D006801:Humans; D008297:Male; D016485:Needle Sharing; D018671:Needle-Exchange Programs; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D015819:Substance Abuse, Intravenous