title: Performance and image enhancing drug injectors' access to needle syringe programs: Responding to a public policy dilemma.
abstract: BACKGROUND
  The number of people who inject performance and image enhancing drugs (PIEDs) attending Australian needle syringe programs (NSPs) has increased recently with cost and capacity implications for this already stretched public health program. The need to prioritise populations' NSP access poses dilemmas for a program that has always sought to minimise entry barriers.
  
  
  METHODS
  To assess their injecting-related risk of HIV and HCV, the Kirketon Road Centre (KRC) surveyed PIEDs injectors attending its two NSPs in inner Sydney in late 2013. Demographic, injecting risk, HIV and HCV testing, and NSP access data were analysed and then compared with similar data collected in the Australian Needle Syringe Program Survey (ANSPS) and the NSW NSP Enhanced Data Collection (NNEDC) survey conducted in the state of NSW in the same time period.
  
  
  RESULTS
  PIEDs injectors surveyed (n=103) were predominantly male (99%) and only one reported ever receptive needle syringe sharing any injecting equipment. KRC participants were similar to the other survey populations in having rarely ever injected intravenously (6%); being tested for HIV and HCV in the last year (44% and 32% respectively), and reporting low rates of HCV (0%). But they were much more likely to be gay or bisexual (42% vs 2% and 4% in the NSW surveys, p<0.001). Compared to their heterosexual counterparts at KRC, this subgroup was older (35 vs 31 years, p=0.011), and more likely to: have been injecting for <3 years (70% vs 44%, p=0.025); to have ever been tested for HIV (88% vs 46%, p<0.001); to have been tested for HIV and HCV in the last year (72% vs 24%, p<0.001 and 51% vs 19%, p=0.001 respectively); and to report being HIV positive (9% vs 0%, p<0.001).
  
  
  CONCLUSIONS
  PIEDs injectors with no other risk factors were at low risk of HIV and HCV, informing KRC's more targeted approach to their health needs. This included providing PIEDs-focused health information and promoting more frequent BBI testing, while encouraging injecting equipment access through other legal sources. This is a case study of how evidence can help resolve public policy dilemmas at the local level, thereby ensuring that scarce public health resources continue to be directed towards those people who inject drugs most at risk of BBIs.
authors.affiliation: Kirketon Road Centre, South Eastern Sydney Local Health District, PO Box 22, Kings Cross, NSW 1340, Australia; School of Public Health and Community Medicine, Faculty of Medicine, UNSW Australia, Sydney, NSW 2052, Australia. Electronic address: Ingrid.vanBeek@sesiahs.health.nsw.gov.au.
authors.forename: Ingrid
authors.initials: I
authors.lastname: van Beek
authors.affiliation: Kirketon Road Centre, South Eastern Sydney Local Health District, PO Box 22, Kings Cross, NSW 1340, Australia; Viral Hepatitis Epidemiology and Prevention Program, Kirby Institute, Faculty of Medicine, UNSW Australia, Sydney, NSW 2052, Australia.
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Chronister
mesh_terms: D000328:Adult; D001315:Australia / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology; D006297:Health Services Accessibility; D006526:Hepatitis C / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D008297:Male; D018671:Needle-Exchange Programs; D058573:Performance-Enhancing Substances / Q000008:administration & dosage*; D011634:Public Health; D011640:Public Policy; D012307:Risk Factors; D015819:Substance Abuse, Intravenous / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D058573:Performance-Enhancing Substances
keywords: HIV and HCV testing; Hepatitis C; Image and performance enhancing drugs; Injecting risk behaviour; Needle syringe program; PIEDs injectors