title: A mixed methods approach to delineating and understanding injection practices among clientele of a Victoria, British Columbia needle exchange program.
abstract: OBJECTIVE
  Systematic reviews and meta-analyses show that needle exchange programs reduce HIV and HCV transmission for injection drug users (IDUs) but far less is known about the injection practices of IDUs enrolled in these programs. This study adopts a mixed methods approach to quantify high-risk injection practice patterns among IDUs enrolled in a needle exchange program in Victoria, British Columbia, Canada and gather qualitative data to understand underlying injection behaviour rationales and patterns.
  
  
  METHODS
  Survey data collected in 2008 from 105 IDUs registered as clientele of the AIDS Vancouver Island-Street Outreach Services (AVI-SOS) Needle Exchange were analysed via univariate and multivariate statistical methods. Presentation of this analysis to an AVI-SOS needle exchange clientele group generated qualitative data offering an explanation for quantitative results.
  
  
  RESULTS
  . Univariate analysis showed all respondents reporting at least one high-risk practice within the past month. Multivariate logistic regression analysis using input from AVI-SOS clientele confirmed the importance of housing status as a determinant of injection practices.
  
  
  CONCLUSIONS
  The importance of housing status points to the need to combine harm reduction services, for example needle exchange and appropriate housing and highlights the benefits of including IDUs in data interpretation.
authors.affiliation: AIDS Vancouver Island, Victoria, Canada.
authors.forename: Erin K
authors.initials: EK
authors.lastname: Gibson
authors.forename: Heidi
authors.initials: H
authors.lastname: Exner
authors.forename: Ryan
authors.initials: R
authors.lastname: Stone
authors.forename: Jennifer
authors.initials: J
authors.lastname: Lindquist
authors.forename: Laura
authors.initials: L
authors.lastname: Cowen
authors.forename: Eric A
authors.initials: EA
authors.lastname: Roth
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000635:transmission; D000328:Adult; D001955:British Columbia; D032882:Comprehension; D016208:Databases, Factual; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology / Q000635:transmission; D006679:HIV Seropositivity; D016174:Hepacivirus; D006526:Hepatitis C / Q000150:complications / Q000453:epidemiology / Q000635:transmission; D006801:Humans; D007267:Injections; D008297:Male; D008875:Middle Aged; D016485:Needle Sharing / Q000523:psychology* / Q000706:statistics & numerical data; D018671:Needle-Exchange Programs / Q000706:statistics & numerical data*; D012307:Risk Factors; D012309:Risk-Taking; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000453:epidemiology / Q000523:psychology*