title: Healthcare utilisation and disclosure of injecting drug use among clients of Australia's needle and syringe programs.
abstract: BACKGROUND
  People who inject drugs (PWID) report limited access to healthcare, and may avoid disclosing drug use. Health service utilisation was examined among participants in the Australian Needle and Syringe Program Survey (ANSPS), an annual cross-sectional sero-survey of needle syringe program (NSP) attendees.
  
  
  METHODS
  An anonymous questionnaire was self-completed by 2,395 NSP clients throughout Australia. Multivariable logistic regressions identified variables independently associated with (i) disclosure of injecting to the most recent healthcare provider; and (ii) recent presentation to emergency departments.
  
  
  RESULTS
  Seventy-eight percent of participants reported accessing healthcare in the preceding 12 months. Reasons for presentation included general health issues (46%); medication seeking (17%); and both (37%). Participants who recently accessed healthcare or had previously visited their most recent provider were more likely to disclose injecting drug use. Participants presenting to a GP or medical centre were less likely than others to disclose injecting. Those accessing emergency departments were more likely to report recent imprisonment.
  
  
  CONCLUSIONS
  Despite Australia's universal healthcare system and harm reduction policies, NSP-participants remain reluctant to disclose injecting, potentially hindering appropriate care and highlighting the need for multiple entry points to the healthcare system, including NSPs and opioid substitution therapy clinics.
authors.affiliation: Viral Hepatitis Epidemiology and Prevention Program, The Kirby Institute, University of New South Wales, Darlinghurst, NSW, Australia.
authors.forename: M Mofizul
authors.initials: MM
authors.lastname: Islam
authors.forename: Libby
authors.initials: L
authors.lastname: Topp
authors.forename: Jenny
authors.initials: J
authors.lastname: Iversen
authors.forename: Carolyn
authors.initials: C
authors.lastname: Day
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Conigrave
authors.forename: Lisa
authors.initials: L
authors.lastname: Maher
mesh_terms: D000328:Adult; D000368:Aged; D001315:Australia / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D055030:Drug Users / Q000523:psychology* / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018671:Needle-Exchange Programs; D010342:Patient Acceptance of Health Care; D015819:Substance Abuse, Intravenous / Q000453:epidemiology / Q000523:psychology*; D011795:Surveys and Questionnaires; D014342:Truth Disclosure