title: Reducing widespread pipe sharing and risky sex among crystal methamphetamine smokers in Toronto: do safer smoking kits have a potential role to play?
abstract: BACKGROUND
  Crystal methamphetamine smoking is associated with many negative health consequences, including the potential for transmission of hepatitis. We examined whether or not a kit for crystal methamphetamine smoking might have some potential to reduce the negative health effects of crystal methamphetamine smoking.
  
  
  METHODS
  Five focus groups were conducted with crystal methamphetamine smokers recruited by community health agencies and youth shelters in Toronto, Canada. Target groups included homeless/street-involved youth, sex workers, men who have sex with men, and youth in the party scene. Participants (n = 32) were asked questions about motivations for crystal methamphetamine use, the process of smoking, health problems experienced, sharing behaviour, risky sexual practices, and the ideal contents of a harm reduction kit.
  
  
  RESULTS
  Pipe sharing was widespread among participants and was deemed integral to the social experience of smoking crystal methamphetamine. Heated pipes were unlikely to cause direct injuries, but participants mentioned having dry, cracked lips, which may be a vector for disease transmission. Many reported having sex with multiple partners and being less likely to use condoms while on the drug. Demand for harm reduction kits was mixed.
  
  
  CONCLUSIONS
  Changing pipe sharing behaviours may be difficult because many participants considered sharing to be integral to the social experience of smoking crystal methamphetamine. Within the context of a broader health promotion and prevention program, pilot testing of safer smoking kits to initiate discussion and education on the risks associated with sharing pipes and unprotected sex for some communities (e.g., homeless/street-involved youth) is worth pursuing.
authors.affiliation: Dalla Lana School of Public Health, University of Toronto; Centre for Addiction and Mental Health, Toronto, Canada. carol.strike@utoronto.ca.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Hunter
authors.forename: Carol
authors.initials: C
authors.lastname: Strike
authors.forename: Lorraine
authors.initials: L
authors.lastname: Barnaby
authors.forename: Adam
authors.initials: A
authors.lastname: Busch
authors.forename: Chantel
authors.initials: C
authors.lastname: Marshall
authors.forename: Susan
authors.initials: S
authors.lastname: Shepherd
authors.forename: Shaun
authors.initials: S
authors.lastname: Hopkins