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The article presents a study on factors associated with dental care access among population with low socio-economic status in Victoria. A cross-sectional study was conducted with 673 people who inject drugs (PWID) in Melbourne, eight percent of participants reported of attending dentist once in the four weeks and affordability was reported as most common barrier to dental access in Australia.

Importance: Concerns that take-home naloxone (THN) training may lead to riskier drug use (as a form of overdose risk compensation) remain a substantial barrier to training implementation. However, there was limited good-quality evidence in a systematic review of the association between THN access and subsequent risk compensation behaviors., Objective: To assess whether THN training is associated with changes in overdose risk behaviors, indexed through injecting frequency, in a cohort of people who inject drugs., Design, Setting, and Participants: This cohort study used prospectively collected self-reported behavioral data before and after THN training of participants in The Melbourne Injecting Drug User Cohort Study (SuperMIX). Annual interviews were conducted in and around Melbourne, Victoria, Australia, from 2008 to 2021. SuperMIX participants were adults who regularly injected heroin or methamphetamine in the 6 months preceding their baseline interview. The current study included only people who inject drugs who reported THN training and had participated in at least 1 interview before THN training., Exposure: In 2017, the SuperMIX baseline or follow-up survey began asking participants if and when they had received THN training. The first THN training date that was recorded was included as the exposure variable. Subsequent participant interviews were excluded from analysis., Main Outcomes and Measures: Injecting frequency was the primary outcome and was used as an indicator of overdose risk. Secondary outcomes were opioid injecting frequency, benzodiazepine use frequency, and the proportion of the time drugs were used alone. Fixed-effects generalized linear (Poisson) multilevel modeling was used to estimate the association between THN training and the primary and secondary outcomes. Time-varying covariates included housing status, income, time in study, recent opioid overdose, recent drug treatment, and needle and syringe coverage. Findings were expressed as incidence rate ratios (IRRs) with 95% CIs., Results: There were 1328 participants (mean [SD] age, 32.4 [9.0] years; 893 men [67.2%]) who completed a baseline interview in the SuperMIX cohort, and 965 participants completed either a baseline or follow-up interview in or after 2017. Of these 965 participants, 390 (40.4%) reported THN training. A total of 189 people who inject drugs had pretraining participant interviews with data on injecting frequency and were included in the final analysis (mean [SD] number of interviews over the study period, 6.2 [2.2]). In fixed-effects regression analyses adjusted for covariates, there was no change in the frequency of injecting (IRR, 0.91; 95% CI, 0.69-1.20; P = .51), opioid injecting (IRR, 0.95; 95% CI, 0.74-1.23; P = .71), benzodiazepine use (IRR, 0.96; 95% CI, 0.69-1.33; P = .80), or the proportion of reported time of using drugs alone (IRR, 1.04; 95% CI, 0.86-1.26; P = .67) before and after THN training., Conclusions and Relevance: This cohort study of people who inject drugs found no evidence of an increase in injecting frequency, along with other markers of overdose risk, after THN training and supply. The findings suggest that THN training should not be withheld because of concerns about risk compensation and that advocacy for availability and uptake of THN is required to address unprecedented opioid-associated mortality.

Introduction: Opioid agonist treatment (OAT) is associated with a reduced likelihood of hepatitis C incidence, nonfatal overdose, and (re)incarceration among people who inject drugs (PWID), yet factors underpinning decisions to access OAT in prison and postrelease are not well understood. The aim of the qualitative study was to explore the perspectives of OAT access while in prison among PWID recently released from prison in Australia., Methods: Eligible participants enrolled in the SuperMix cohort (n = 1303) were invited to take part in a semi-structured interview in Victoria, Australia. Inclusion criteria were informed consent, aged ≥18 years, history of injection drug use, incarcerated for ≥3 months, and released from custody <12 months. The study team analysed data via a candidacy framework to account for macro-structural influences., Results: Among 48 participants (33 male; ten Aboriginal), most injected drugs in the prior month (n = 41) with heroin the most frequently injected (n = 33) and nearly half (n = 23) were currently on OAT (primarily methadone). Most participants described the navigation and permeability of OAT services in prison as convoluted. If not on OAT pre-entry, prison policies often restricted access, leaving participants to withdraw in cells. In turn, some participants commenced OAT postrelease to ensure OAT continuity of care if reincarcerated. Other participants who experienced delayed access to OAT in prison stated no need to initiate while in prison or postrelease as they were now "clean". Last, implementation of OAT delivery in prison (e.g., lack of confidentiality) frequently led to changes in OAT type to avoid peer violence (pressure to divert OAT)., Conclusion: Findings draw attention to simplistic notions of OAT accessibility in prisons, illuminating how structural determinants influence choice in PWID decision-making. Suboptimal access and acceptability of OAT delivery in prisons will continue to place PWID at risk of harm postrelease (e.g., overdose)., Competing Interests: Declaration of competing interest ADM, SS, KD, and EB have nothing to declare. LL has received speaker fees from AbbVie. PH has received investigator-initiated research funding from Gilead Sciences and AbbVie. PD is funded by the National Health and Medical Research Council (NHMRC) Senior Research Fellowship and has received investigator-driven research from Gilead Sciences, and has served as an unpaid member of an Advisory Board for an intranasal naloxone product. MS is the recipient of a NHMRC Senior Research Fellowship (Commonwealth Government) and has received investigator-initiated funding from Gilead Sciences, AbbVie and Bristol Myers Squibb. CT has received speaker fees from Abbvie and Gilead and grant funding from Merck., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: Compounding histories of injecting drug use and incarceration can marginalise people engaging with services, making it difficult for them to address their health and social welfare needs, particularly when they navigate community re-entry service supports. Drawing on Hall and colleagues' five components of trust, this paper seeks to understand how trust in service providers fosters (or inhibits) effective service engagement from the perspective of people who inject drugs during the prison post-release period., Methods: Between September 2018 and May 2020, qualitative in-depth interviews were completed with 48 adults (33 men, 15 women) recruited from SuperMIX (a longitudinal cohort study of people with a history of injection drug use in Victoria, Australia). Data relating to service engagement were coded against the five components of trust: competence, fidelity, honesty, global trust, and confidence., Results: Reflections of post-release service engagement frequently focused on interactions with community corrections (parole) officers. Depictions of trust were consistently portrayed within the context of negative experiences and deficits, whereby trusting provider relationships and interactions were rarely described. Most participants recounted a stark absence of fidelity (that is, "pursuing a [client's] best interests"), with some participants detailing circumstances in which their vulnerability was purposefully, almost strategically, exploited. These encounters nearly always had the consequence of impeding the participant's positive progression in the post-release integration period., Conclusion: There is an urgent need to prioritise the client in health and social service delivery in the post-release transition-to-community period and recognise the importance of trust in delivering effective services to people whose life histories make them highly vulnerable to marginalisation., Competing Interests: Declarations of Interest SS, ADM, KD, and EB have nothing to declare. LL has received speaker fees from AbbVie. PH has received investigator-initiated research funding from Gilead Sciences and AbbVie Pharmaceuticals for research not connected to this manuscript. MS is the recipient of a NHMRC Senior Research Fellowship (Commonwealth Government) and has received investigator-initiated funding from Gilead Sciences, AbbVie and Bristol Myers Squibb for research unrelated to this work. PD is funded by National Health and Medical Research Council (NHMRC) Senior Research Fellowship and has received investigator-driven research funding from Gilead Sciences for work on hepatitis C unrelated to this study. PD has served as an unpaid member of an Advisory Board for an intranasal naloxone product. CT has received speakers’ fees from AbbVie and Gilead and research funding from Merck for research unrelated to this work., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Background: People who inject drugs (PWID) are overrepresented among prisoner populations worldwide. This qualitative study used the psychological concept of "ego-depletion" as an exploratory framework to better understand the disproportionate rates of reincarceration among people with injecting drug use histories. The aim was to illuminate mechanisms by which prospects for positive post-release outcomes for PWID are enhanced or constricted., Methods: Participants were recruited from a longitudinal cohort study, SuperMIX, in Victoria, Australia. Eligible participants were invited to participate in an in-depth interview. Inclusion criteria were: aged 18+; lifetime history of injecting drug use; incarcerated for >three months and released from custody <12 months previously. Analysis of 48 interviews examined how concepts relevant to the ego-depletion framework (self-regulation; standards; consequences and mitigators of ego-depletion) manifested in participants' narratives., Results: Predominantly, participants aimed to avoid a return to problematic drug use and recidivism, and engaged in effortful self-regulation to pursue their post-release goals. Post-release environments were found to diminish self-regulation resources, leading to states of ego-depletion and compromising the capacity to self-regulate according to their ideals. Fatalism, stress, and fatigue associated with the transition period exacerbated ego-depletion. Strategies that mitigated ego-depletion included avoidance of triggering environments; reducing stress through opioid agonist therapy; and fostering positive affect through supportive relationships., Conclusions: Post-release environments are ego-depleting and inconducive to sustaining behavioural changes for PWID leaving prison. Corrections' behaviourist paradigms take insufficient account of the socio-structural factors impacting on an individual's self-regulation capacities in the context of drug dependence and desistance processes. Breaking the cycles of reincarceration among PWID requires new approaches that moderate ego-depletion and facilitate long-term goal-pursuit., Competing Interests: Declarations of Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Introduction: Access to services is key to successful community (re-)integration following release from prison. But many people experience disengagement from services, including people who inject drugs (PWID). We use a case study approach and the notion of structural competency to examine influences on access to services among a group of PWID recently released from prison., Methods: This qualitative study recruited participants from SuperMIX, (a longitudinal cohort study in Victoria, Australia)., Inclusion Criteria: aged 18+; lifetime history of injecting drug use; incarcerated for > three months and released from custody < 12 months previously. From 48 participants, five case studies were selected as emblematic of the complex and intersecting factors occurring at the time participants missed an appointment at a service., Results: Numerous, concurrent, and interdependent structural influences in participants' lives coincided with their difficulty accessing and maintaining contact with services and resulted in missed appointments. The key factors involved in the cases presented here include policies around opioid agonist treatment, inadequate, unsuitable and unsafe housing, the management of mental health and side effects of treatment, the lack of social support or estrangement from family, and economic hardship. The support available from service workers to navigate these structural issues was inconsistent. One dissenting case is examined in which missing appointments is anticipated and accommodated., Conclusions: A case study approach enabled a holistic and in-depth examination of upstream structural elements that intersect with limited social and economic resources to exacerbate the challenges of community re-entry. These results highlight structural issues that have a disproportionate impact on the choices and opportunities for PWID. The incorporation of a structural competency framework in design of services and in staff training could support person-centred and coordinated service provision that take into account PWID's experiences post-release to overcome structural barriers to service engagement., Competing Interests: Declarations of Interest Carla Treloar has received speakers’ fees from Abbvie and Gilead and research funding from Merck for research unrelated to this work. Peter Higgs declares has received investigator-initiated research funding from Gilead Sciences and Abbvie Pharmaceuticals for research not connected to this manuscript. Mark Stoove is the recipient of a NHMRC Senior Research Fellowship (Commonwealth Government) and has received investigator initiated funding from Gilead Sciences, AbbVie and Bristol Myers Squibb for research unrelated to this work. Paul Dietze is funded by National Health and Medical Research Council (NHMRC) Senior Research Fellowship and has received investigator-driven research funding from Gilead Sciences for work on hepatitis C unrelated to this study. PD has served as an unpaid member of an Advisory Board for an intranasal naloxone product., (Copyright © 2021. Published by Elsevier B.V.)

Advance care planning is increasingly common practice in contemporary health care for individuals living with a chronic condition. Currently, limited research has been conducted into how newly adopted legislation in Victoria, Australia, facilitates advance care planning. The purpose of this study was to explore the uptake of the Medical Treatment Planning and Decisions Act 2016 in the primary care setting. The study also aimed to explore barriers that allied health professionals encounter when practicing advance care planning with patients. Four interdisciplinary focus groups and two in-depth interviews with participants were conducted and thematically analysed using an interpretivist inquiry paradigm. Analysis revealed two key themes: promoting client wellbeing and scope of practice. The data suggest that advance care planning by allied health professionals in the primary care setting is limited. Focussing on enhancing clients' wellbeing was more important than the development of advanced care directives. Attempting to promote the wellbeing of patients may foster hesitation to commence advance care planning in primary care. This study demonstrated that knowledge of the fundamental legislative changes are evident among allied health professionals which provides a foundation for successful development of advance care planning post implementation of the new Act.

Background: Australian young male prisoners with histories of injecting drug use are more likely to report injecting in prison, to do so more frequently, and to be involved in more un-safe injecting-related practices than their older counterparts. Despite international evidence that prison needle and syringe programs are both feasible and effective in reducing the harms associated with injecting drug use in prison, these young men do not have access to such equipment., Methods: We critically analyse the interview transcripts of 28 young men with histories of injecting drug use who were recently released from adult prisons in Victoria, Australia, and prison drug policy text. We use Bacchi's 'What's the problem represented to be?' approach to examine how the 'problem' of injecting drug use in prison is represented in prison drug policy, including the assumptions that underpin these problematisations, and the subjectification and lived effects that are produced for the young men in our study., Results: Our analysis reveals how prison drug policy enables the creation and re-use of homemade injecting equipment crafted from unsterile items found in prison, and that in doing so the policy produces a range of stigmatising subjectification effects and other harmful material effects (such as hepatitis C virus transmission and injecting related injury and harms). Findings highlight, how injecting drug use is represented in policy silences other ways of understanding the 'problem' that may have less harmful effects for incarcerated young men who inject drugs., Conclusion: We argue that somewhat paradoxically, the approach of prohibiting access to sterile injecting equipment in prison-which is constituted as a solution for addressing such harms-in fact helps to produce them., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Young men are overrepresented among people detained in police custody in Victoria, Australia, a closed institution that has mostly escaped public scrutiny. Our study sheds light on this underexamined place from the perspective of 28 marginalized young men (aged 19-24) detained there prior to adult prison. Drawing on Bacchi's "What's the problem represented to be?" approach and the subdiscipline of carceral geography, we disrupt the assumed purpose of police custody as a place to simply detain people while awaiting court and/or transfer to prison. We illustrate how police custody, although ostensibly for ensuring the safety and protection of the community, privileges that of some over others, with detrimental effects for marginalized groups. We highlight how harsh, degrading, hostile environments intersected with lived experiences and exacerbated psychological, social, and physical health harms; made possible young men's constitution as dirty, violent, and subhuman; and worked to legitimize breaches of human rights.

Objectives: Investigate patterns of methamphetamine use over time, specifically factors associated with remission from dependent and harmful patterns of use; and examine drug treatment and health/support service utilization pathways among people who use methamphetamine., Methods: People who regularly use methamphetamine were recruited from nontreatment settings in Melbourne, Australia, in 2010, and followed up twice over 5 years. Trajectories of past-month methamphetamine use and methamphetamine dependence were mapped. Random-effects logistic regression modeling identified factors associated with these outcomes., Results: Overall, past-month methamphetamine use and methamphetamine dependence decreased among the cohort over the study period. Variability in methamphetamine use and dependence trajectories was observed; 56% of participants achieved past-month abstinence; however, 14% subsequently relapsed and 44% reported past-month use at every time-point. During the study period, 27% of participants were never classified methamphetamine-dependent, 30% remitted from dependence, and 23% were consistently classified dependent. Factors independently associated with past-month methamphetamine use included male sex and poor physical health. Factors independently associated with methamphetamine dependence included poor physical health, low self-perceived social support, current mental health medication prescription, and current engagement with drug treatment services for methamphetamine use. Engagement with treatment and health/support services remained low (12%-22%) over the study period., Conclusions: Our findings indicate people who remit from methamphetamine dependence, reduce their frequency of use or cease entirely can maintain this over long periods. Initiatives addressing social determinants of health could be optimal for combating methamphetamine dependence. Community-based frontline service providers should be educated in relation to appropriately addressing methamphetamine use.

Social network characteristics of people who inject drugs (PWID) have previously been flagged as potential risk factors for HCV transmission such as increased injection frequency. To understand the role of the injecting network on injection frequency, we investigated how changes in an injecting network over time can modulate injecting risk behaviour. PWID were sourced from the Networks 2 Study, a longitudinal cohort study of PWID recruited from illicit drug street markets across Melbourne, Australia. Network-related correlates of injection frequency and the change in frequency over time were analysed using adjusted Cox Proportional Hazards and Generalised Estimating Equations modelling. Two-hundred and eighteen PWID followed up for a mean (s.d.) of 2.8 (1.7) years were included in the analysis. A greater number of injecting partners, network closeness centrality and eigenvector centrality over time were associated with an increased rate of infection frequency. Every additional injection drug partner was associated with an increase in monthly injection frequency. Similarly, increased network connectivity and centrality over time was also associated with an increase in injection frequency. This study observed that baseline network measures of connectivity and centrality may be associated with changes in injection frequency and, by extension, may predict subsequent HCV transmission risk. Longitudinal changes in network position were observed to correlate with changes in injection frequency, with PWID who migrate from the densely-connected network centre out to the less-connected periphery were associated with a decreased rate of injection frequency.

Introduction and Aims: Indigenous people seeking residential alcohol and other drug (AOD) rehabilitation in Victoria are most frequently referred to the Ngwala Willumbong Co-operative (Ngwala). This study aimed to describe socio-demographic changes in clients of Ngwala's residential rehabilitation services between 2015 and 2016., Design and Methods: Self-assessment surveys completed upon screening for rehabilitation between May 2015 and November 2016 (n = 117) were analysed for socio-demographic data, AOD use and mental health status. Ngwala's monthly summary reports from January 2015 to December 2016 were analysed to compare primary drugs of concern, proportion of forensic clients assessed and admitted across 2015-2016. Independent t-tests and tests of two proportions were used to compare variables between years, with differences considered significant when P < 0.05., Results: Clients were predominantly Indigenous (n = 100, 91%), male (n = 92, 71%) and unemployed (n = 106, 93%). Most clients (n = 92, 88%) were at high risk of serious mental illness (by Kessler Psychological Distress Scale). A significantly higher proportion of forensic clients were admitted in 2016 (n = 221, 60%) compared to 2015 (n = 158, 43%; P < 0.001; 95% confidence interval -0.24, -0.10). The mean monthly number of clients listing amphetamines as their primary drug of concern upon assessment was greater in 2016 (21 ± 7.19 people) compared to 2015 (12 ± 2.78 people; P = 0.01; 95% confidence interval 3.13, 15.37)., Discussion and Conclusions: These findings suggest the proportion of Indigenous people in AOD treatment with amphetamine use problems or forensic involvement is increasing. These trends should be considered in service design and funding decisions., (© 2018 Australasian Professional Society on Alcohol and other Drugs.)

Background: The hepatitis C virus (HCV) epidemic is a major health issue; in most developed countries it is driven by people who inject drugs (PWID). Injecting networks powerfully influence HCV transmission. In this paper we provide an overview of 10 years of research into injecting networks and HCV, culminating in a network-based approach to provision of direct-acting antiviral therapy., Methods: Between 2005 and 2010 we followed a cohort of 413 PWID, measuring HCV incidence, prevalence and injecting risk, including network-related factors. We developed an individual-based HCV transmission model, using it to simulate the spread of HCV through the empirical social network of PWID. In addition, we created an empirically grounded network model of injecting relationships using exponential random graph models (ERGMs), allowing simulation of realistic networks for investigating HCV treatment and intervention strategies. Our empirical work and modelling underpins the TAP Study, which is examining the feasibility of community-based treatment of PWID with DAAs., Results: We observed incidence rates of HCV primary infection and reinfection of 12.8 per 100 person-years (PY) (95%CI: 7.7-20.0) and 28.8 per 100 PY (95%CI: 15.0-55.4), respectively, and determined that HCV transmission clusters correlated with reported injecting relationships. Transmission modelling showed that the empirical network provided some protective effect, slowing HCV transmission compared to a fully connected, homogenous PWID population. Our ERGMs revealed that treating PWID and all their contacts was the most effective strategy and targeting treatment to infected PWID with the most contacts the least effective., Conclusion: Networks-based approaches greatly increase understanding of HCV transmission and will inform the implementation of treatment as prevention using DAAs., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Unlabelled: With the development of new highly efficacious direct-acting antiviral (DAA) treatments for hepatitis C virus (HCV), the concept of treatment as prevention is gaining credence. To date, the majority of mathematical models assume perfect mixing, with injectors having equal contact with all other injectors. This article explores how using a networks-based approach to treat people who inject drugs (PWID) with DAAs affects HCV prevalence. Using observational data, we parameterized an exponential random graph model containing 524 nodes. We simulated transmission of HCV through this network using a discrete time, stochastic transmission model. The effect of five treatment strategies on the prevalence of HCV was investigated; two of these strategies were (1) treat randomly selected nodes and (2) "treat your friends," where an individual is chosen at random for treatment and all their infected neighbors are treated. As treatment coverage increases, HCV prevalence at 10 years reduces for both the high- and low-efficacy treatment. Within each set of parameters, the treat your friends strategy performed better than the random strategy being most marked for higher-efficacy treatment. For example, over 10 years of treating 25 per 1,000 PWID, the prevalence drops from 50% to 40% for the random strategy and to 33% for the treat your friends strategy (6.5% difference; 95% confidence interval: 5.1-8.1)., Conclusion: Treat your friends is a feasible means of utilizing network strategies to improve treatment efficiency. In an era of highly efficacious and highly tolerable treatment, such an approach will benefit not just the individual, but also the community more broadly by reducing the prevalence of HCV among PWID., (© 2014 by the American Association for the Study of Liver Diseases.)

Background: Cohort studies provide an excellent opportunity to monitor changes in behaviour and disease transmission over time. In Australia, cohort studies of people who inject drugs (PWID) have generally focused on older, in-treatment injectors, with only limited outcome measure data collected. In this study we specifically sought to recruit a sample of younger, largely out-of-treatment PWID, in order to study the trajectories of their drug use over time., Methods: Respondent driven sampling, traditional snowball sampling and street outreach methods were used to recruit heroin and amphetamine injectors from one outer-urban and two inner-urban regions of Melbourne, Australia. Information was collected on participants' demographic and social characteristics, drug use characteristics, drug market access patterns, health and social functioning, and health service utilisation. Participants are followed-up on an annual basis., Results: 688 PWID were recruited into the study. At baseline, the median age of participants was 27.6 years (IQR: 24.4 years - 29.6 years) and two-thirds (67%) were male. Participants reported injecting for a median of 10.2 years (range: 1.5 months - 21.2 years), with 11% having injected for three years or less. Limited education, unemployment and previous incarceration were common. The majority of participants (82%) reported recent heroin injection, and one third reported being enrolled in Opioid Substitution Therapy (OST) at recruitment. At 12 months follow-up 458 participants (71% of eligible participants) were retained in the study. There were few differences in demographic and drug-use characteristics of those lost to follow-up compared with those retained in the study, with attrition significantly associated with recruitment at an inner-urban location, male gender, and providing incomplete contact information at baseline., Conclusions: Our efforts to recruit a sample of largely out-of-treatment PWID were limited by drug market characteristics at the time, where fluctuating heroin availability has led to large numbers of PWID accessing low-threshold OST. Nevertheless, this study of Australian injectors will provide valuable data on the natural history of drug use, along with risk and protective factors for adverse health outcomes associated with injecting drug use. Comprehensive follow-up procedures have led to good participant retention and limited attrition bias.

Objectives: To develop a mathematical model to project the potential impact of hepatitis C virus (HCV) treatment on HCV infection prevalence among people who inject drugs (PWID)., Design and Setting: An existing model of HCV transmission among PWID was parameterised using data from Victoria, Australia, including specific parameter estimates of the number of people who are currently active injecting drug users, average duration of injecting, chronic HCV infection prevalence among PWID, annual mortality, and annual HCV treatment rate. We also explored the impact of prevalence uncertainty, program scale-up, and new treatments., Main Outcome Measure: Prevalence of chronic HCV infection among people who are currently active injecting drug users., Results: With annual treatment rates of 13, 17, or 25 per 1000 PWID, the model predicts relative prevalence reductions of 20%, 30%, and 50%, respectively, within 30 years. If new treatments giving higher sustained viral response rates are available in 5 years, estimated impact is increased by 21%–23% at 15 years, and 17%–38% at 30 years, depending on treatment rates., Conclusions: This model suggests that modest rates of current HCV treatment among PWID in Victoria, Australia could halve HCV infection prevalence among PWID in 30 years. This finding suggests that interventions aimed at increasing access to HCV treatment in community clinics will benefit individual PWID and reduce HCV infection prevalence.

Introduction and Aims: Catha Edulis Forsk (khat) is a plant-reported to have a stimulant effect similar to that of amphetamines-grown and used by eastern African communities worldwide. Khat can be legally consumed in many parts of the world, including Victoria, Australia. Recent concerns have been raised about the social and economic impacts of khat consumption among Victoria's East African community members. This study explores khat use and the social impact it has on East African families and communities in Melbourne, Australia., Design and Methods: Focus groups and individual interviews were conducted in 2009 with 29 members of Melbourne's East African community recruited via community leaders and snowball sampling. Fifty-five per cent of the sample reported khat use and the remainder reported only having experience of other people's use of the drug., Results: Participants who did not report chewing khat were mainly concerned with the negative social impacts of its use, such as the extended time men spent away from their families while consuming the drug. These participants (mainly women) expressed their hope that khat would be prohibited in Victoria. Participants who reported the use of khat (mainly men) reported that any social problems existed independently of khat consumption., Discussion and Conclusions: This study found only limited evidence that khat use has been impacting directly on people's health and well-being. Any moves to prohibit khat use may further marginalise already vulnerable groups of people., (© 2011 Australasian Professional Society on Alcohol and other Drugs.)

Introduction and Aims: Following detection of an upward trend in the frequency of fatal heroin overdoses in Victoria between 2001 and 2003, Victoria's Department of Human Services planned a campaign aimed at increasing injecting drug users' (IDU) awareness of overdose risks and prevention strategies. Stickers, wallet cards and posters featuring five key messages were distributed via needle and syringe programs (NSP) and other drug and alcohol services between November 2005 and April 2006. An evaluation of the campaign was commissioned to be conducted in late 2006., Design and Methods: The evaluation consisted of analysis of three independent data sets--quantitative data collected from IDU during the campaign period (n = 855 at baseline; and a range of 146-656 at follow up); qualitative interviews with IDU who were NSP clients during the campaign period (n = 16) and qualitative interviews with NSP staff and other key stakeholders (n = 9)., Results: While key experts felt that the campaign messages had engendered lasting impact for at least some IDU, these positive impressions were not borne out by the NSP client data, with less than one quarter of all campaign messages being mentioned by a significantly higher proportion of clients during the post-campaign period compared with baseline. Key experts perceived the greatest weakness of the campaign to be the delay between issue identification and the introduction of campaign materials., Discussion and Conclusions: While IDU are generally responsive to health promotion campaigns, future initiatives in this domain should be designed and implemented rapidly and in ways that are sufficiently flexible to cope with shifts in drug markets which could influence the reception of key messages.

Successful HIV prevention programs-such as sterile needle and syringe programs-have ensured that incidence and prevalence of HIV among people who inject drugs remains low in Australia. However, between 1999 and 2006, 20 of the 46 injecting-related HIV notifications in Melbourne (Australia's second-largest city) were ethnic Vietnamese heroin users. Through in-depth interviews we explored and documented the coping tactics and strategies of 9 ethnic Vietnamese heroin injectors. We explored their experiences of living with HIV, and in this article identify factors that appear to have contributed to limiting the spread of HIV beyond this cluster of people. The data reveal factors associated with this self-limiting outbreak, including consciously avoiding opioid withdrawal and having closed injecting networks. Early and effective engagement with participants by health care workers also appears to have played an important role in containing the transmission of HIV within this group of ethnic Vietnamese heroin injectors.

Previous quantitative cross sectional studies of ethnic Vietnamese drug users in Melbourne have been overwhelmingly drawn from samples of men. In this qualitative investigation, 24 women aged between 18 and 33 years were interviewed. This exploratory study sought: to identify issues surrounding heroin initiation and drug use career; to examine relationships with family and primary sex partners; and to reveal participants' attitudes to drug treatment. Data reveal that for the women in this study the initiation and continued use of heroin was heavily influenced by men, especially their primary sex partners. The women interviewed reported strategies to minimise their risk taking including enrolling in pharmacotherapy treatment programmes, but they remained particularly vulnerable - especially to blood borne viruses - through both injecting and sexual risk behaviour. The data suggest that interventions which focus on the gendered nature of injecting practices within personal relationships may go some way to both reducing harm and increasing control for the women involved.

Objective: To investigate risk behaviours associated with the transmission of blood borne viruses (BBVs) and sexually transmitted infections (STIs) among transient rural workers in Victoria., Design: Cross-sectional study using a convenience sampling frame., Setting: Between June and August 2006, 89 participants were recruited from sites located in three rural centres in Victoria's Loddon and Mallee regions. Data were collected using a short questionnaire that asked about history of transient work, sexual history, condom use, alcohol and illicit drug use, and BBV history and testing. Finger-prick blood samples were collected in order to determine prevalence of human immunodeficiency virus (HIV) and hepatitis C virus (HCV) exposure., Results: Eighty-nine individuals completed a questionnaire, and 85 (96%) provided a finger-prick blood sample for antibody testing. Twenty-seven participants (30%) were consuming alcohol at levels risky to health. Thirty per cent of participants with new partners reported infrequent condom use. Illicit drug use (mainly marijuana) was widespread with more than 46% of the sample reporting recent use of illicit drugs. An HCV exposure prevalence of 2.4% was measured; no samples tested reactive for HIV antibodies., Conclusions: Compared with nationally representative data, our study sample reported high rates of alcohol consumption at levels risky to health, illicit drug use and infrequent use of condoms. These results suggest that transient workers and their contacts would benefit from the targeted provision of harm-reduction services, with a particular focus on sexual behaviour and alcohol and drug use.

Objective: To investigate patterns of drug use and injection-related risk behaviours among young Indo-Chinese injecting drug users (IDUs)., Method: Cross-sectional survey. A structured questionnaire was administered to 184 Indo-Chinese IDUs aged 15 to 24 in Sydney and Melbourne. Participants were recruited using snowball sampling techniques; measures included patterns of heroin and other drug use, injection-related risk behaviours, perceived susceptibility to HIV and HCV infection and access to services., Results: Despite perceived high availability of sterile injecting equipment, 36% had ever shared a needle and syringe and 22% had done so in the preceding month. Lifetime sharing was significantly associated with duration of injecting, history of incarceration and residence in Sydney. Sharing of injecting paraphernalia other than needles and syringes was also common, with young women and Sydney residents significantly more likely to report sharing equipment in the preceding month., Conclusions: Young Indo-Chinese IDUs are at high risk of infection with hepatitis C and other blood-borne viruses. Results indicate an urgent need for culturally appropriate and sustainable risk reduction programs which specifically target this population., Implications: Health services must respond swiftly to implement effective blood-borne virus prevention programs for young Indo-Chinese IDUs. Failure to do so may sustain the current epidemic of hepatitis C among IDUs.