Search

Background. Mental health and wellbeing, including addressing impacts of historical trauma and substance use among young people, has been identified as a key priority by Indigenous communities and leaders across Canada and globally. Yet, research to understand mental health among young Indigenous people who have used drugs is limited. Aims. To examine longitudinal risk and strengths-based factors associated with psychological distress among young Indigenous people who use drugs. Method. The Cedar Project is an ongoing cohort study involving young Indigenous people who use drugs in Vancouver, Prince George, and Chase, British Columbia, Canada. This study included participants who completed the Symptom Checklist-90-Revised, returned for follow-up between 2010 and 2012, and completed the Childhood Trauma Questionnaire. Adjusted linear mixed-effects models estimated effects of study variables on changes in area T-scores of psychological distress. Results. Of 202 eligible participants, 53% were women and the mean age was 28 years. Among men, childhood mal- treatment (emotional abuse, physical abuse, sexual abuse, physical neglect), any drug use, blackouts from drinking, and sex work were associated with increased distress. Among women, childhood maltreatment (emotional abuse, physical abuse, physical neglect), blackouts from drinking, and sexual assault were associated with increased distress, while having attempted to quit using drugs was associated with reduced distress. Marginal associations were observed between speaking their traditional language and living by traditional culture with lower distress among men. Conclusion. Culturally safe mental wellness interventions are urgently needed to address childhood trauma and harmful coping strategies that exacerbate distress among young Indigenous people who use drugs. [ABSTRACT FROM AUTHOR]

We undertook this study to provide a profile of Aboriginal people initiating antiretroviral therapy and their response to treatment. Aboriginal peoples were identified through self-report. Baseline socio-demographics and risk factors were compared between Aboriginal and non-Aboriginal participants as were baseline factors associated with two consecutive plasma viral load measures below 500 copies/ml using contingency table analysis. Multivariate survival analysis of the prognostic factors associated with time to two consecutive plasma viral load measures below 500 copies/ml among eligible participants was undertaken to characterize response to antiretroviral therapy. There were 892 participants with available data for this analysis, of those 146 (16%) self-identified as Aboriginal. Aboriginal participants were more likely to be female (p&VeryThinSpace;≤&VeryThinSpace;0.001), have lower baseline plasma viral loads (p&VeryThinSpace;=&VeryThinSpace;0.010), be co-infected with HCV (p&VeryThinSpace;<&VeryThinSpace;0.001), live in unstable housing (p&VeryThinSpace;≤&VeryThinSpace;0.001), and report an income of >10K CDN (p&VeryThinSpace;≤&VeryThinSpace;0.001) per annum. Aboriginal people were less likely to report men who have sex with men (p&VeryThinSpace;≤&VeryThinSpace;0.001) and more likely to report injection drug use (p&VeryThinSpace;≤&VeryThinSpace;0.001) as a risk factor for HIV infection. Aboriginal participants were more likely to receive double versus triple combination antiretroviral therapy (p&VeryThinSpace;=&VeryThinSpace;0.002), be less adherent in the first year on therapy (p&VeryThinSpace;=&VeryThinSpace;0.001) and to have a physician less experienced with treating HIV (p&VeryThinSpace;≤&VeryThinSpace;0.001). When these factors were controlled for, Aboriginal people treated with triple combination therapy were as likely to respond and suppress their viral load below 500 copies. In the era of HAART, our results indicate that Aboriginal people living with HIV/AIDS were less likely to receive optimal therapy. However, when Aboriginals did receive triple drug therapy they suppressed just as well as non-Aboriginals. [ABSTRACT FROM AUTHOR]

The health and social conditions of women living in Vancouver's Downtown Eastside has recently been the focus of substantial international attention. Since few studies have examined rates and correlates of death among addicted women in Canada, we have characterized patterns of mortality among female injection drug users (IDUs) in Vancouver. The Vancouver Injection Drug Users Study (VIDUS) is a prospective open cohort study of IDUs. The analyses presented here, were restricted to women enrolled between May 1996 and May 2002 and who were aged 14 years or older. We estimated cumulative mortality rates using Kaplan-Meier methods and Cox regression was used to calculate univariate and adjusted relative hazards. Between May 1996 and May 2002, 520 female IDUs have been recruited from the Vancouver area among whom 68 died during the study period. Elevated rates of mortality were observed among those who reported, baseline sex-trade involvement, those with HIV-infection at baseline, and those who lived in unstable housing at baseline (all log-rank: p [ABSTRACT FROM AUTHOR]

Objectives: While much research to date has examined female sex trade work, little has been done to evaluate factors associated with male sex trade involvement or to assess their health service needs. This is particularly true for male sex trade workers who are also injection drug users (IDUs). Therefore, the present analyses were undertaken to evaluate factors associated with sex trade work in a prospective cohort study of male IDUs. Methods: We identified factors associated with sex trade involvement among male participants enrolled in the Vancouver Injection Drug Users Study (VIDUS). Since serial measures for each individual were available at semiannual intervals, variables potentially associated with sex trade involvement were evaluated with adjusted odds ratios (AOR) and 95% confidence intervals (CI) computed using generalised estimating equations (GEE). Results: Between 1996 and 2003, 995 male IDUs were enrolled into the VIDUS cohort among whom 108 (11%) reported being involved in the sex trade at enrolment and 102 (10%) individuals initiated sex trade involvement during the follow up period. In multivariate analyses, factors independently associated with sex trade involvement included HIV positive serostatus (AOR: 1.77 (95% CI: 1.44 to 2.17)), daily cocaine injection (AOR: 1.37 (95% CI: 1.11 to 1.70)), daily crack smoking (AOR: 1.36 (95% CI: 1.07 to 1.72)), borrowing syringes (AOR: 1.73 (95% CI: 1.32 to 2.25)), and inconsistent use of condoms with casual sexual partners (AOR 0.66, CI 0.53 to 0.82). We also found that male sex trade workers were more likely to report having sought but been unable to access substance abuse treatment (AOR: 1.28 (95% CI: 0.98 to 1.67); p=0.076). Conclusions: Males involved in the sex trade in this setting have higher levels of HIV infection and engage in risky injection behaviours at an elevated rate. Since these behaviours have major implications for HIV acquisition and public health, prevention efforts and targeted provision of addiction treatment to this population should be expanded. [ABSTRACT FROM AUTHOR]

Background: In several European countries safer injecting rooms have reduced the public disorder and health-related problems of injection drug use. We explored factors associated with needle-sharing practices that could potentially be alleviated by the availability of safer injecting rooms in Canada.Methods: The Vancouver Injection Drug User Study is a prospective cohort study of injection drug users (IDUs) that began in 1996. The analyses reported here were restricted to the 776 participants who reported actively injecting drugs in the 6 months before the most recent follow-up visit, during the period January 1999 to October 2000. Needle sharing was defined as either borrowing or lending a used needle in the 6-month period before the interview.Results: Overall, 214 (27.6%) of the participants reported sharing needles during the 6 months before follow-up; 106 (13.7%) injected drugs in public, and 581 (74.9%) reported injecting alone at least once. Variables independently associated with needle sharing in a multivariate analysis included difficulty getting sterile needles (adjusted odds ratio [OR] 2.7, 95% confidence interval [CI] 1.8-4.1), requiring help to inject drugs (adjusted OR 2.0, 95% CI 1.4-2.8), needle reuse (adjusted OR 1.8, 95% CI 1.3-2.6), frequent cocaine injection (adjusted OR 1.6, 95% CI 1.1-2.3) and frequent heroin injection (adjusted OR 1.5, 95% CI 1.04-2.1). Conversely, HIV-positive participants were less likely to share needles (adjusted OR 0.5, 95% CI 0.4-0.8), although 20.2% of the HIV-positive IDUs still reported sharing needles.Interpretation: Despite the availability of a large needle-exchange program and targeted law enforcement efforts in Vancouver, needle sharing remains an alarmingly common practice in our cohort. We identified a number of risk behaviours--difficulty getting sterile needles, needle sharing and reuse, injection of drugs in public and injecting alone (one of the main contributing causes of overdose)--that may be alleviated by the establishment of supervised safer injecting rooms. [ABSTRACT FROM AUTHOR]

Comments on a study of the risk and risk behaviors in men and women who inject illicit drugs in Montreal, Quebec. Threat of HIV infection; Focus on the circumstances of women who are injection drug users; Opinion that drug users need to be treated and not condemned.