Search

To explore syringe access patterns and implications for HIV prevention programming, data from qualitative interviews (n=120) with injection drug users (IDU) and an evaluation of a satellite syringe-exchange program (SEP) were used. Three patterns were identified: IDUs who stockpile supplies to meet their own needs and to provide secondary distribution to friends and drug-using associates; IDUs who keep a several-days supply of syringes available, primarily for their own use; and IDUs who usually obtain equipment at the time of obtaining drugs, in some cases unsterile equipment from other injectors. The first two types of injectors are typically in stable housing, while the last group are generally in unstable housing. This analysis highlights the very direct link between adequate housing and safer injection practices for HIV prevention, and points to the need to advocate more broadly on behalf of IDUs for appropriate housing, harm-reduction and social services.

Background: There are an estimated 40,000 to 90,000 injection opiate users in Canada. The social, economic and health consequences of opiate addiction have been well documented. However, there are no data on the self-perceived health status of opiate users in Canada. Therefore, the goal of this research is to gain an understanding of the selfperceived health status of opiate users by comparing the health-related quality of life of opiate users to chronic disease populations and to the general population. Methods: The SF-36 was administered to a nonrandom sample of 143 opiate users entering low-threshold methadone treatment. Two sample t-tests were performed to assess statistical differences, at a 5% level of significance, between population scores across SF-36 dimensions. Results: Opiate users perceived both their mental and physical health as worse than the general population and individuals with minor and serious medical problems, but comparable to those with diagnosed psychiatric illnesses. Conclusions: Methadone treatment services should incorporate both primary care and psychiatric care into their programs, or at the very least secure appropriate referral mechanisms to ancillary services to ensure that the health concerns of opiate users are dealt with in the context of their treatment program.

To measure HIV prevalence, risk behaviours, and further service needs in needle exchange programs throughout Ontario, and to conduct regional comparisons. Injection drug users (IDU) recruited through the efforts of needle exchange programme (NEP) staff in 9 Ontario cities during 1997–98 completed questionnaires about their drug use and behaviours and provided saliva and/or dried blood samples for anonymous unlinked HIV testing. Demographic and drug use characteristics of participants showed great regional variation. HIV prevalence by region ranged from 1.4% to 14.7%. In addition to region, HIV positivity was associated with injecting for more than 5 years, use of (powder) cocaine, use of crack, binge injection (10 or more times per day at least once in the previous 6 months), and being a longer-term NEP user. Sharing of injection equipment, and especially of other drug injection materials such as water and cookers, remain important issues, although much of the sharing reported is with only one other person. Unmet demand for methadone treatment was identified despite changes in regulation of methadone provision designed to make it more accessible. This study suggested significant further HIV prevention needs among IDU throughout Ontario. There is also evidence of potential to provide additional services such as methadone at NEPs if the required resources are invested. NEPs that have succeeded in gaining the trust of high-risk IDU offer a means to provide access to needed services. Mesurer la prévalence du VIH, les comportements à risque et les nouveaux besoins de services à l’intérieur de programmes d’échange de seringues de tout l’Ontario, afin d’établir des comparaisons régionales. Des utilisateurs de drogues injectables (UDI) recrutés grâce aux efforts du personnel des programmes d’échange de seringues (PES) de neuf villes ontariennes en 1997–1998 ont rempli des questionnaires sur leur consommation de drogues et leurs comportements et fourni des échantillons de salive et/ou de sang séché aux fins de tests anonymes et non reliés de sérodiagnostic du VIH. Le profil démographique et les habitudes de consommation de drogues des participants présentaient d’importants écarts régionaux. La prévalence du VIH variait de 1,4 % à 14,7 % selon la région. En plus du facteur régional, la séropositivité pour le VIH était associée à une habitude d’injection de plus de cinq ans, à la consommation de cocaïne (en poudre), à la consommation de crack, à l’injection excessive (au moins un épisode d’injection 10 fois par jour ou plus au cours des six mois précédents) et au fait d’être un utilisateur à long terme du PES. Le partage des accessoires d’injection, et surtout des accessoires autres que les seringues, comme l’eau et les réchauds, est encore un important problème, bien que dans la plupart des cas, l’accessoire en question n’ait été partagé qu’avec une seule personne. Les résultats font état d’un besoin non satisfait de traitement à la méthadone — malgré les changements à la réglementation de l’offre de méthadone qui visaient à la rendre plus accessible. L’étude met en lumière le grand besoin d’améliorer la prévention du VIH chez les utilisateurs de drogues injectables, partout en Ontario. Elle indique aussi la possibilité de fournir d’autres services, comme le traitement à la méthadone, dans le cadre des PES si l’on y investit les ressources nécessaires. Les PES qui ont réussi à gagner la confiance des UDI très vulnérables pourraient leur donner accès aux services dont ils ont besoin.

Objective:Examine the challenges of four service delivery models (i.e., fixed, mobile, satellite and home visits) and how service delivery may impact on NEP HIV prevention efforts. Methods:Using a modified ethnographic approach, semi-structured interviews concerning policies and procedures were conducted with staff (n=59) of NEPs (n=15) in Ontario. An iterative, inductive analytic process was used. Results:According to workers and managers, effectiveness of NEP prevention efforts depend on client development and retention and service design. Fixed and satellite sites, home visits and mobile services provide varied levels of temporal and spatial accessibility. Combining modes of delivery can offset the disadvantages of individual modes. Discussion:NEP evaluations that do not consider service and resource factors run the risk of concluding that NEPs are ineffective when it may be that the program works for a small proportion of IDUs whom the NEP has the resources to serve. Objectif:Nous avons examiné les défis de quatre modes de prestation de services (service fixe, mobile et par satellite et visites à domicile) et leurs incidences possibles sur les efforts de prévention du VIH des programmes d’échange de seringues (PES). Méthode:Selon une démarche ethnographique modifiée, nous avons mené des entretiens semidirectifs avec 59 employés de 15 PES ontariens à propos des politiques et méthodes de ces PES, puis effectué une analyse itérative et inductive. Résultats:Aux dires du personnel et des cadres, l’efficacité des efforts de prévention des PES dépend de l’élargissement et du maintien de leur clientèle et du mode de prestation choisi. L’accessibilité aux services, dans l’espace et dans le temps, varie selon qu’ils sont offerts au moyen d’installations fixes, mobiles ou par satellite ou lors de visites à domicile. En combinant plusieurs modes de prestation, on peut compenser leurs inconvénients respectifs. Discussion:Les évaluations des PES qui font abstraction des différences dans les services et les ressources risquent de conclure à l’inefficacité de certains programmes, alors qu’ils peuvent donner des résultats pour la faible proportion d’utilisateurs de drogues injectables que le PES a les moyens de desservir.

Objective: To examine the contribution of patterns of sexual partnering to the spread of HIV/STD infection between communities. Methods: 651 randomly selected Aboriginals from 11 reserve communities in Ontario were interviewed. This analysis included those who had sex in the previous 12 months. Descriptive statistics and multivariate analyses identified associations with patterns of sexual partnering. Results: 22% reported having partners from both within and outside the community, 51% from within only, and 27% from outside only. Those with partners from both within and out-side were more likely to be male, unmarried, from a remote community, have more sexual partners and perceive that their behaviour placed them at higher risk of HIV/STD infection. They were least likely to perceive their community to be at risk from their behaviour. Conclusions: Findings suggest that Aboriginal communities are not insulated and that HIV could spread rapidly if introduced. Objectif: examiner la contribution des types de partenariat sexuel à la propagation du VIH et des MTS entre les communautés. Méthodes: 651 Autochtones choisis au hasard dans 11 communautés des réserves de l’Ontario ont été interviewés. L’analyse comprenait les individus ayant eu des relations sexuelles au cours des 12 mois précédents. Les statistiques descriptives et les analyses multi-variées ont identifié des associations selon les types de partenariat sexuel. Résultats: 22% ont déclaré avoir eu des partenaires tant au sein qu’à l’extérieur de la communauté, 51% au sein de la communauté seulement, et 27% à l’extérieur de la communauté seulement. Les individus ayant eu des partenaires tant à l’intérieur qu’à l’extérieur de la communauté étaient plus souvent des hommes, célibataires, venant d’une communauté éloignée, qui étaient plus susceptibles d’avoir davantage de partenaires sexuels et de penser que leur comportement leur faisait courir des risques plus élevés d’être infectés par des MTS et le VIH. Ils étaient aussi les moins susceptibles de percevoir le risque qu’ils faisaient courir à leur communauté par leur comportement. Conclusions: les résultats suggèrent que les communautés autochtones ne sont pas isolées contre le risque et que le VIH pourrait rapidement se propager s’il était introduit.

The objective of this study was to assess the effectiveness of two different kinds of AIDS risk reduction programs for gay and bisexual men practicing sexual behavior at all ranges of risk for transmission of HIV: Six hundred and twelve gay and bisexual men were recruited and randomly assigned to either: (a) singlesession groups led by trained volunteer peers, (b) four-session groups led by paid counselors, or (c) waiting-list control groups. Self-administered questionnaires measured knowledge of AIDS risk, attitudes toward AIDS and sexual practices, and sexual behavior prior to randomization and three months postintervention. Dropouts (18%o) included subjects who did not complete the follow-up data collection. There was an overall shift toward safer sex over time which was strongest for the single-session group, but the effect was not related to group assignments. The changes in knowledge of AIDS risk and the attitude Condom Efficacy were significantly higherfor individuals in the two treatment groups than for the controls.