38 syringes represented 6.6 % of the estimated required number

syringes represented 6.6 % of the estimated required number.
Conclusions : Despite an extensive network of programs providing
access to sterile injection equipment (more than 25 sites scattered
across the city), syringes distributed represent less than 10% of the
estimated needs. This proportion has to be drastically increased to have
an impact on HIV and HCV incidence. All current distribution programs
must adhere to “best practices” recommendations (mainly, never limit
the number of syringes distributed per day or per visit, and never base
distribution on material returned). Innovative distribution strategies
offering a variety of accesses, schedules, and locations must be
implemented. Factors limiting use by IDUs of existing distribution
programs must be understood and actions to modify them have to be
undertaken. In parallel, renewed efforts are needed to educate injectors
about the importance of using sterile injection equipment and the risks of
sharing material, and access to testing and treatment for IDUs has to be
evaluated.
Différences dans la prévalence du VIH et du VHC des consommateurs de crack selon leur
histoire d'injection.
Auteur
principal
Pascale Leclerc - Direction de santé publique de l’Agence de la santé
et des services sociaux de Montréal.
Coauteurs
Carole Morissette - Direction de santé publique de l’Agence de la santé
et des services sociaux de Montréal.
Élise Roy - Direction de santé publique de l’Agence de la santé et des
services sociaux de Montréal. Université de Sherbrooke.
Claude Tremblay - Direction de santé publique de l’Agence de la santé
et des services sociaux de Montréal.
Résumé
Background : In Montreal (Canada), needle and syringe programs
(NSP) have initiated distribution of crack smoking equipment in response
to users’ demand.
Objectives : A cross-sectional study was conducted to document risk
behaviours and estimate HIV and HCV prevalence among crack users
attending NSPs.
Methods : Individuals having recently (in the past six months) used
crack were recruited in the three main downtown NSPs. They completed
interviewer-administered questionnaires and provided saliva samples for
HIV and HCV-antibody testing.
Results : From 12/2006 to 10/2007, 259 current-injectors (having
injected recently), 58 past-injectors (having not injected recently) and 83
never-injectors were recruited. In these three groups, proportions of
male participants were 81.1 %, 79.3 % and 74.7 %, mean age at
recruitment was 36.3, 38.9 and 36.2 years and mean age at first crack
use was 24.8, 25.4 and 26.1 years. In the past month, 33.3 % of currentinjectors reported that, when using drugs, they most often “injected
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cocaine” and 31.0% that they most often “smoked crack”; 89.7 % of
past-injectors and 88.0% of never-injectors most often “smoked crack”.
In that month, daily crack use was reported by 20.5 % of currentinjectors, 46.6 % of past-injectors and 50.6% of never-injectors. Most
participants recently used crack pipes previously used by someone else
(current-injectors: 83.8 %, past-injectors: 81.0 % and never-injectors:
81.9%). Observed HIV prevalence rate among current-injectors was 22.3
%, among past-injectors, 8.6 %, and among never-injectors, 6.0 %;
observed HCV prevalence rates were 74.5 %, 33.9 % and 3.7%
respectively.
Conclusions : To maintain the lower HIV and HCV prevalence among
non-injecting crack users, interventions must go beyond promoting the
non sharing of crack pipes. Interventions should be developed to prevent
initiation of drug injection for never-injectors and to prevent relapse into
drug injection for past-injectors. Safe sex interventions might also be
needed for all crack users to prevent the HIV sexual transmission
suggested by the observed HIV prevalence.
Améliorations requises pour l'accès au dépistage et au suivi médical pour le VIH et le VHC
pour les UDI dans le contexte d'une épidémie importante de VHC.
Auteur
principal
Pascale Leclerc - Direction de santé publique de l’Agence de la santé
et des services sociaux de Montréal.
Coauteurs
Carole Morissette - Direction de santé publique de l’Agence de la santé
et des services sociaux de Montréal. Institut national de santé publique
du Québec.
Élise Roy - Direction de santé publique de l’Agence de la santé et des
services sociaux de Montréal. Institut national de santé publique du
Québec. Université de Sherbrooke.
Michel Alary - Institut national de santé publique du Québec.
Raymond Parent - Institut national de santé publique du Québec
Groupe de travail SurvUDI.
Résumé
Background : Access to treatment and care depends on knowledge of
infection status.
Objectives : Our objectives were to estimate the proportion of infected
IDUs knowing their status and, among those who knew they were
infected, the proportion having HIV/HCV medical follow-up.
Methods : The SurvUDI network, implemented in 1995, monitors HIV
and HCV and their associated risk factors among IDUs. It covers the
province of Quebec and the City of Ottawa (Ontario), Canada.
Participants, individuals having injected in the past six months, are
mainly recruited in centres providing free injection material. Interviews
include completion of interviewer-administered questionnaires and
collection of saliva samples for HIV and HCV antibody testing.
Results : From 03/2004 to 06/2007, 3,084 participants were recruited:
39