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Objective: We sought to establish the extent of repeat participation in a large annual cross-sectional survey of people who inject drugs and assess its implications for analysis., Results: We used "porn star names" (the name of each participant's first pet followed by the name of the first street in which they lived) to identify repeat participation in three Australian Illicit Drug Reporting System surveys. Over 2013-2015, 2468 porn star names (96.2%) appeared only once, 88 (3.4%) twice, and nine (0.4%) in all 3 years. We measured design effects, based on the between-cluster variability for selected estimates, of 1.01-1.07 for seven key variables. These values indicate that the complex sample is (e.g.) 7% less efficient in estimating prevalence of heroin use (ever) than a simple random sample, and 1% less efficient in estimating number of heroin overdoses (ever). Porn star names are a useful means of tracking research participants longitudinally while maintaining their anonymity. Repeat participation in the Australian Illicit Drug Reporting System is low (less than 5% per annum), meaning point-prevalence and effect estimation without correction for the lack of independence in observations is unlikely to seriously affect population inference.

Cross-sectional surveys were conducted annually from 2006 to 2011 at a music festival. Eight thousand one hundred sixty-five young people completed surveys. STI testing rates increased over time, but there was an increase in the prevalence of some sexual risk behaviors and little improvement in STI knowledge between 2006 and 2011.

Introduction and Aims: In order to monitor trends in illicit drug use among youth, surveillance of drug use behaviours among a variety of populations in different settings is required. We monitored drug use among music festival attendees., Design and Methods: Cross-sectional studies of young people's reported drug use were performed at a music festival in Melbourne from 2005 to 2008. Self-administered questionnaires collected information on drug use, demographics and other risk behaviour., Results: From 2005 to 2008, over 5000 questionnaires were completed by people aged 16-29; 2273 men and 3011 women. Overall, use of any illicit drug in the past month was reported by 44%. After adjusting for demographic and behavioural characteristics, the prevalence of recent illicit drug use decreased significantly from 46% in 2005 to 43% in 2008 (OR 0.92, 95% CI 0.87-0.97). After adjusting for age and sex the downwards trend was repeated for amphetamines and cannabis, but a significant increase in prevalence was observed in hallucinogen, ecstasy and inhalant use. Drug use was more common among men, older participants and those engaging in high-risk sexual behaviour., Discussion and Conclusions: Illicit drug use was much more common in this sample than in the National Drug Strategy Household survey, but the direction of trends in drug use were similar; drug use prevalences were much lower than in the Ecstasy and Related Drugs Reporting System, the Illicit Drug Reporting System or National Needle and Syringe Program Survey. Music festival attendees are a potentially useful group for monitoring trends in illicit drug use.

Objective: To explain rising rates of sexually transmitted infections it is necessary to monitor trends among high risk groups, such as youth. Surveillance of risk behaviours and testing among a variety of populations in different settings is required. We monitored self-reported sexual behaviour among music festival attendees., Methods: Cross-sectional studies of young people's behaviour were conducted annually at a music festival between 2005 and 2008 using self-administered questionnaires. Logistic regression, adjusted for age and gender, determined trends in risk behaviours., Results: More than 5,000 questionnaires were completed. The proportion reporting multiple sexual partners in the past year remained stable from 2005 to 2008 and condom use with these partners increased. Reporting a new sexual partner in the past three months decreased, while condom use with new partners increased. Reporting a casual sexual partner increased and condom use with casual partners remained stable. Reporting a recent STI test increased from 23% in 2006 to 32% in 2008., Conclusions and Implications: Despite increases in STI notifications, most risk behaviours are decreasing in this group, possibly as a function of increased STI testing. Music festivals are a useful setting for monitoring behaviour trends within a sub-population of young people at relatively high risk of STIs.

Objective: We estimated the cost to the public health system of treating Injecting-Related Injuries and Diseases (IRIDs) in the three most populous states in Australia in the 12 months over 2005/06., Methods: We conducted a cost of illness analysis from the perspective of the public health system. Costs of treating IRIDs in the community were estimated from health service utilisation surveys of injecting drug users and physicians (yielding data on Government subsidised physician visits, medicines prescribed and emergency department presentations). Data on admitted hospitalisations in public hospitals due to IRIDs were extracted from State Government databases. Appropriate costs were attached to all Government-borne services and prescriptions to estimate the total cost to the public health system of treating IRIDs in 2005/06 in Queensland, NSW and Victoria., Results: Our estimate of the cost to the public health system of treating IRIDs in Queensland, NSW and Victoria in 2005/06 was $20 million., Conclusion: IRIDs are an under-recognised harm resulting from injecting drug use, but the economic burden of IRIDs in Australia are non-negligible. Research is needed to identify cost effective programs to reduce the clinical and economic burden caused by IRIDs, particularly to reduce hospitalisations due to IRIDs., Implications: General practitioners, clinicians and other health workers need to be alert to IRIDs in their injecting drug user clients to prevent progression to more serious disease and consequent elevation of the associated economic costs.

Introduction: The aim of this study was to ascertain whether the health of past and current smokers of illicit tobacco (chop-chop) differs from that of smokers of licit tobacco., Methods: The design was a telephone survey, stratified by state, using computer aided telephone interviewing, with households selected by random digit dialing from the telephone white pages. Setting was all Australian states and territories, 1,621 regular tobacco smokers aged 18+ years. Measures were social and personal characteristics of tobacco smokers, smoking histories and patterns, and health status (SF-8 and disability weights). Binary logistic regression was used to identify variables associated with current and lifetime chop-chop use., Results: Compared with licit-only tobacco smokers, current users of chop-chop had significantly greater odds of beginning smoking aged <16 years (odds ratio [OR] 1.65, 95% CI = 1.09-2.50), of reporting below-average social functioning (OR 1.61, 95% CI = 1.06-2.44), and of a measurable disability (OR 1.95, 95% CI = 1.08-3.51). Lifetime chop-chop users were relatively likely to be less than 45 years of age (OR 1.82, 95% CI = 1.38-2.39), report below-average mental health (OR 1.61, 95% CI = 1.22-2.13) and above-average bodily pain (OR 1.40, 95% CI = 1.06-1.85), smoke more than 120 cigarettes/week (OR 1.39, 95% CI = 1.06-1.83), and to have begun smoking aged <16 years (OR 1.33, 95% CI = 1.01-1.75)., Discussion: Current and lifetime users of chop-chop report significantly worse health than smokers of licit tobacco. Investigation of how to communicate this finding to current and potential chop-chop smokers is warranted.

Background and Aims: Current injecting drug users (IDU) in major street drug markets within greater Melbourne were recruited to a longitudinal study on blood borne viruses. Here we investigated risk factors for hepatitis C virus (HCV), hepatitis B virus (HBV) and HIV infection in these IDU at the time of their recruitment., Methods: Three hundred and eighty-two IDU completed detailed questionnaires on their drug use and risk behaviours, and provided blood samples for serology testing. These data were analysed using univariate and multivariate techniques., Results: The overall prevalence of exposure to HCV, HBV and HIV was estimated at 70%, 34% and <1%, respectively. Independent predictors of HCV exposure were history of imprisonment (RR 1.34, 95% CI 1.19-1.52), use of someone else's needle or syringe (RR 1.23, 95% CI 1.07-1.42), >7.6years length of time injecting (RR 1.21, 95% CI 1.07-1.37), and originating from Vietnam (RR 1.12, 95% CI 1.07-1.18). Independent predictors of HBV exposure were HCV exposure (RR 2.15, 95% CI 1.35-3.43), >7.6years length of time injecting (RR 1.57, 95% CI 1.17-2.13) and originating from outside Australia (RR 1.60, 95% CI 1.22-2.10). Neither prison- nor community-applied tattoos predicted HCV or HBV exposure. Up to 31% of IDU who injected for 1year or less were HCV antibody positive, as were 53% of those who injected for 2years or less., Conclusions: Ongoing engagement with young IDU, through the provision of harm reduction education and resources, is critical if we are to address blood borne viral infections and other health and social harms associated with injecting drug use.

Unlabelled: An estimated 170 million people worldwide carry the hepatitis C virus (HCV), and in more developed countries the prevalence and incidence of HCV is particularly high among injecting drug users (IDUs). Spontaneous clearance of HCV infection and reinfection is well recognized but the level of protection against further infection conferred by HCV infection and clearance remains uncertain. We conducted a prospective study of HCV infection in IDUs recruited in Melbourne, Australia, using a much shorter median testing interval than in previous studies. Incidences of naive infection and reinfection were calculated by the person-year method and Cox proportional hazards regression used to adjust for covariates. A significantly higher HCV incidence rate was measured in previously infected IDUs (46.8% per year) compared with HCV-naive IDUs (15.5% per year). The hazard ratio for previously infected IDUs compared to HCV-naive IDUs, after adjustment for time-dependent covariates, was 2.54 (95% confidence interval, 1.11-5.78, P > |z| < 0.05). Viral persistence after reinfection appeared similar to that following naive infection., Conclusion: Our data suggest that HCV infection in IDUs is more likely following prior infection and clearance than in HCV-naive individuals, implying no increased immunity against further infection. This result has important implications for the future development of an HCV vaccine.

Multiple factors affect injecting drug-related mortality, many of which will vary over time and between jurisdictions. There are relatively few studies of mortality among injecting drug users (IDU) in Australia. We aimed to provide data comparable to those reported internationally on the rate of mortality among IDU in Australia. We retrospectively examined mortality among participants (N=220) from the first Australian cohort study of IDU by linking coded personal identifier records with a national death register. The overall mortality rate among those followed-up was 0.83 per 100 PY (95% CI, 0.56-1.21 per 100 PY). This rate is lower than those reported internationally but comparable to the limited Australian data from other cohorts of IDU. Mortality was higher among males, most common among those aged in their early thirties and drug-related mortality occurred typically after substantial injecting careers. Extensive experience of incarceration (>or=3 times) was associated with increased risk of mortality. These results suggest that rates of mortality among Australian IDU may be lower than those reported internationally, with low HIV prevalence and Australia's long-held harm reduction framework potentially contributing to this result. Further studies using defined cohorts followed over time are needed to examine long-term outcomes among IDU in Australia.

Introduction and Aims: Drug use is becoming normalised among young Australian people involved in music sub-cultures. We aimed to determine prevalences of illicit drug use in this population and associations between preferences for different music genres and recent use of particular illicit drugs., Design and Methods: A cross-sectional questionnaire of young people (aged 16-29 years) attending a music festival., Results: Of 939 respondents, 46% had used illicit drugs (principally cannabis) in the past month, a significantly higher proportion than among respondents to the 2004 National Drug Strategy Household Survey (18%). Participants who favoured dance/house or rap music were more likely to have used illicit drugs recently than the remainder of the sample, while those who favoured pop or alternative music were less likely to have used drugs in the past month., Discussion and Conclusions: These data suggest that music festival attendees use illicit drugs more commonly than their age-matched cohort in the general community, and that music festivals venues (particularly those that cater for dance/house and rap) would be appropriate places for interventions to promote safer drug use.

Objective: To investigate the prevalence and associations of buprenorphine injection among a field-recruited cohort of injecting drug users., Design: Cross-sectional data from a prospective longitudinal cohort. Setting. Metropolitan Melbourne, Australia., Subjects: Current injecting drug users (IDUs)., Main Outcome Measures: Prevalence of buprenorphine injection, associations with location, buprenorphine as prescribed pharmacotherapy, markers of hepatitis C virus (HCV) exposure and risk behaviours for HCV., Results: More than 10% of our 316 participants reported buprenorphine as the drug they had most often injected, and 32% had injected buprenorphine at least once in the 3 months prior to interview. Primary buprenorphine injection was significantly more likely to be reported by IDUs recruited at one of our three research sites, and by those being prescribed buprenorphine for opioid dependence. Frequency of sharing a used needle was also associated with buprenorphine injection, but HCV exposure was not., Conclusions: Buprenorphine injection has become entrenched among some groups of Victorian IDUs. The practice carries serious risks to health, including some related to microbiological contamination of buprenorphine during diversion. While measures can be taken to reduce the occurrence of buprenorphine diversion and injection and the associated harm, an alternative harm reduction measure would be to provide IDUs with an injectable pharmacotherapy.

Background: Tattooing in prison represents a unique combination of risk factors for blood borne virus (BBV) transmission because it is illicitly performed by untrained operators with homemade, unsterile, and frequently-shared equipment. It occurs in a setting where a high proportion of people are already infected with hepatitis C virus (HCV) and other BBVs., Objectives: This study measured the frequency of tattoo acquisition by prisoners inside and outside prison, and the associations between tattooing, injecting drug use, and HCV infection risk., Methods: A cross-sectional survey was conducted in correctional facilities in Victoria, Australia. Participants completed a questionnaire that asked about injecting drug use and tattooing and provided a finger-prick blood sample that was tested for HCV antibody., Results: Six hundred and forty-two prisoners participated in the study; 449 had ever been tattooed, of whom 182 (41%) had been tattooed in adult or juvenile prison. Of the participants who were not tattooed professionally, 27% reported someone using the same needle, and 42% reported someone had used the ink before them. Prisoners with a history of drug injection were more likely to have a tattoo and to have acquired a tattoo in prison (OR 3.0; CI 1.7-5.4). The HCV antibody-positive prisoners were more likely to have acquired a tattoo in prison compared with HCV antibody-negative prisoners., Conclusions: Acquiring a tattoo in prison was common and the reports of sharing the tattooing needle and ink was high, placing prisoners at risk of acquiring HCV through tattooing in prison. Trials need to be undertaken that evaluate the risk and benefits of legal tattoos in prison.

Multiple genotypes of the hepatitis C virus (HCV) were detected in five of 138 HCV RNA positive injecting drug users (IDUs) recruited in Melbourne, Australia. Two were detected by combined LiPA and core and NS5a region sequencing, and three more (selected for testing due to their high-risk behaviour) by heteroduplex mobility analysis. We conclude that the true prevalence of mixed infection in IDUs is undoubtedly higher than the 3.6% (five of 138) we observed, and is underestimated by LiPA, the most common method of genotyping. As responsiveness to HCV treatment varies significantly with genotype, a high prevalence of mixed HCV infections in IDUs must diminish overall treatment efficacy and lessen our ability to reduce the burden of HCV-related disease.

Background: We aimed to measure the overlap between the social networks of injection drug users (IDUs) and the patterns of related hepatitis C virus (HCV) infections among IDUs., Methods: A cohort of 199 IDUs (138 of whom were HCV RNA positive) was recruited from a local drug scene in Melbourne, Australia, and was studied using social network analysis and molecular phylogenetic analysis of 2 regions of the HCV genome., Results: Eighteen clusters of related infections involving 51 IDUs (37.0% of HCV RNA-positive IDUs) were detected; these clusters could be separated into 66 discrete pairs. Twelve (18.2%) of the 66 IDU pairs with related infections reported having previously injected drugs together; conversely, only 12 (3.8%) of the 313 pairs of HCV RNA-positive IDUs who were injection partners had strong molecular evidence of related infections. The social and genetic distances that separated IDUs with identical genotypes were weakly associated. Significant clusters of phylogenetically related sequences identified from core region analysis persisted in the analysis of the nonstructural 5a protein region. Genotyping and sequence analysis revealed 2 mixed-genotype infections., Conclusions: Static social network methods are likely to gather information about a minority of patterns of HCV transmission, because of the difficulty of determining historical infection pathways in an established social network of IDUs. Nevertheless, molecular epidemiological methods identified clusters of IDUs with related viruses and provided information about mixed-genotype infection status.