Abstract
Objectives
London, Ontario, is facing an outbreak of HIV among people who inject drugs (PWID), as well as persistently high levels of hepatitis C virus (HCV). Syringe sharing is the primary driver of HIV and HCV transmission risks among PWID, however, little is known about factors contributing to syringe sharing in this setting. Therefore, we sought to characterize syringe sharing and its correlates among London PWID.
Methods
Between March and April, 2016, PWID participated in a survey administered by peer research associates as part of the Ontario Integrated Supervised Injection Services Feasibility Study. Bivariable and multivariable logistic regression models examined associations with syringe sharing (borrowing or lending previously used syringes) over the previous 6 months. A sub-analysis described patterns of borrowing and lending by self-reported HIV and HCV statuses.
Results
Of 198 PWID, 44 (22%) reported syringe sharing in the past 6 months. In the multivariable analysis, selling drugs (adjusted odds ratio; AOR = 1.92, 95% CI = 1.20–3.08), daily crystal methamphetamine injection (AOR = 1.66, 95% CI = 1.07–2.59), and identifying as HIV-positive (AOR = 3.11, 95% CI = 1.61–6.01) were independently associated with increased syringe sharing. While not independently associated with syringe sharing, problems accessing syringes were common (13–50%). Self-reported HIV-positive respondents were more likely to report syringe borrowing (p < 0.001), but not lending (p = 0.26).
Conclusion
We observed a high rate of syringe sharing among London PWID, with sharing being associated with high-intensity injection of crystal methamphetamine, as well as with involvement in drug sales. Considering the current HIV outbreak in London, multi-level prevention efforts are urgently needed.
Résumé
Objectifs
La ville de London (Ontario) est confrontée à une éclosion de VIH chez les personnes qui utilisent des drogues par injection (UDI), ainsi qu’à des niveaux durablement élevés de virus de l’hépatite C (VHC). Le partage de seringues est le principal vecteur des risques de transmission du VIH et du VHC chez les UDI, mais on en sait peu sur les facteurs qui contribuent au partage de seringues dans ce milieu. C’est pourquoi nous avons voulu caractériser le partage de seringues et ses corrélats chez les UDI de London.
Méthode
Entre mars et avril 2016, des UDI ont participé à un sondage administré par des pairs associés de recherche dans le cadre d’une étude de faisabilité d’Ontario Integrated Supervised Injection Services (OISIS). Des modèles de régression logistique bivariés et multivariés ont permis d’examiner les associations avec le partage de seringues (l’emprunt ou le prêt de seringues déjà utilisées) au cours des six mois antérieurs. Une sous-analyse a porté sur les schémas d’emprunt et de prêt selon l’état sérologique autodéclaré relativement au VIH et au VHC.
Résultats
Sur les 198 UDI, 44 (22%) ont dit avoir partagé des seringues au cours des 6 mois antérieurs. Dans l’analyse multivariée, la vente de drogue (rapport de cotes ajusté; RCA = 1,92, IC de 95% = 1,20–3,08), l’injection quotidienne de méthamphétamine (RCA = 1,66, IC de 95% = 1,07–2,59) et la séropositivité VIH autodéclarée (RCA = 3,11, IC de 95% = 1,61–6,01) étaient indépendamment associées au partage de seringues accru. Bien qu’ils ne soient pas indépendamment associés au partage de seringues, les problèmes d’accès aux seringues étaient courants (13–50%). Les répondants s’étant déclarés séropositifs pour le VIH étaient plus susceptibles de dire avoir emprunté des seringues (p < 0,001), mais pas d’en avoir prêté (p = 0,26).
Conclusion
Nous avons observé un taux élevé de partage de seringues chez les UDI de London, ce partage étant associé à l’injection intensive de méthamphétamine et à la participation à la vente de drogue. Étant donné l’éclosion de VIH qui sévit à London actuellement, des efforts de prévention à plusieurs niveaux sont nécessaires de toute urgence.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Bozinoff, N., Wood, E., Dong, H., Richardson, L., Kerr, T., & DeBeck, K. (2017). Syringe sharing among a prospective cohort of street-involved youth: implications for needle distribution programs. AIDS and Behavior, 21(9), 2717–2725.
Campanella, E. (2015). More than 2.5 million needles distributed in London last year. London: Free Press Available at: http://www.lfpress.com/2015/08/13/more-than-25-million-needles-distributed-in-london-last-year. Accessed 1 June 2017.
Darke, S. (1998). Self-report among injecting drug users: a review. Drug Alcohol Depend, 51, 253–263.
Gilbert, M. (2015). New HIV diagnoses in Ontario, 2014. Ontario HIV Epidemiology and Surveillance Initiative. Available at: http://ohesi.ca/documents/OHESI-New-HIV-Diagnoses.pdf. Accessed 1 June 2017.
Jenness, S. M., Hagan, H., Liu, K.-L., Wendel, T., & Murrill, C. S. (2011). Continuing HIV risk in New York City injection drug users: the association of syringe source and syringe sharing. Substance Use & Misuse, 46(2–3), 192–200.
Kerr, T., Wood, E., Small, D., Palepu, A., & Tyndall, M. W. (2003). Potential use of safer injecting facilities. Canadian Medical Association Journal, 169(8), 759–763.
Kerr, T., Tyndall, M., Li, K., Montaner, J., & Wood, E. (2005). Safer injection facility use and syringe sharing in injection drug users. Lancet, 366(9482), 316–318.
Kerr, T., Small, W., Johnston, C., Li, K., Montaner, J. S. G., & Wood, E. (2008). Characteristics of injection drug users who participate in drug dealing: implications for drug policy. Journal of Psychoactive Drugs, 40(2), 147–152.
Kerr, T., Small, W., Buchner, C., Zhang, R., Li, K., Montaner, J., et al. (2010). Syringe sharing and HIV incidence among injection drug users and increased access to sterile syringes. American Journal of Public Health, 100(8), 1449–1453.
Kerr, T., Scheim, A. I., Bardwell, G., Mitra, S., Rachlis, B., Bacon, J., et al. (2017). Ontario integrated supervised injection services feasibility study report: London, ON. Toronto: Ontario HIV Treatment Network Available at: http://www.ohtn.on.ca/wp-content/uploads/2017/02/OISIS-London-Report-Online.pdf. Accessed 1 June 2017.
Lee, W., Ti, L., Marshall, B. D. L., Dong, H., Wood, E., & Kerr, T. (2015). Childhood sexual abuse and syringe sharing among people who inject drugs. AIDS and Behavior, 19(8), 1415–1422.
Lloyd-Smith, E., Kerr, T., Zhang, R., Montaner, J. S. G., & Wood, E. (2009). High prevalence of syringe sharing among street involved youth. Addiction Research and Theory, 16(4), 353–358.
Marshall, B., Milloy, M.-J., Wood, E., Montaner, J., & Kerr, T. (2011). Reduction in overdose mortality after the opening of North America’s first medically supervised safer injecting facility: a retrospective population-based study. Lancet, 377(9775), 1429–1437.
Mathers, B. M., Degenhardt, L., Phillips, B., Wiessing, L., Hickman, M., Strathdee, S. A., et al. (2008). Global epidemiology of injecting drug use and HIV among people who inject drugs: a systematic review. Lancet, 372(9651), 1733–1745.
Medical Officer of Health. (2016). Staff report for action on implementing supervised injection services in Toronto. Toronto: City of Toronto Available at: http://www.toronto.ca/legdocs/mmis/2016/hl/bgrd/backgroundfile-94548.pdf. Accessed 1 June 2017.
Middlesex-London Health Unit. (2013). A profile of people who inject drugs in London, Ontario: Report on the Public Health Agency of Canada I-Track Survey, Phase 3, Middlesex-London, 2012. London. Available from: https://www.healthunit.com/uploads/public-health-agency-of-canada-i-track-survey-phase-3.pdf. Accessed 1 June 2017.
Middlesex-London Health Unit. (2014). The impact of prescription and non-prescription drug use in Middlesex-London. London. Available from: https://www.middlesex.ca/council/2014/july/22/C%2012%20-%20CW%20Info%20-%20July%2022%20-%20The%20Impact%20of%20Prescription%20and%20Non-Prescritpion%20Drug%20Use%20in%20Middlesex-London.pdf. Accessed 1 June 2017.
Middlesex-London Health Unit. (2017). Supervised injection services feasibility in Middlesex-London. London. Available at https://www.healthunit.com/uploads/2017-02-16-report-005-17.pdf. Accessed 1 June 2017.
Mitra, S., Rachlis, B., Scheim, A., Bardwell, G., Rourke, S. B., & Kerr, T. (2017). Acceptability and design preferences of supervised injection services among people who inject drugs in a mid-sized Canadian City. Harm Reduction Journal, 14(1), 46.
Nosyk, B., Zang, X., Min, J. E., Krebs, E., Lima, V. D., Milloy, M.-J., et al. (2017). Relative effects of antiretroviral therapy and harm reduction initiatives on HIV incidence in British Columbia, Canada, 1996–2013: a modelling study. Lancet HIV, 4(7), e303–e310.
Richardson, L., Sherman, S. G., & Kerr, T. (2012). Employment amongst people who use drugs: a new arena for research and intervention? The International Journal on Drug Policy, 23(1), 3–5.
Richmond, R. (2016). Decrease in London’s overdose deaths obscures a growing, longer-term threat from crystal meth. London Free Press [Internet]. 2016 Mar 17. Available from: http://www.lfpress.com/2016/03/17/decrease-in-londons-overdose-deaths-obscures-a-growing-longer-term-threat-from-crystal-meth.
Richmond, R. (2017). Health officials plan to add London pharmacies to program that gives clean needles to drug users. London: Free Press Available from: http://www.lfpress.com/2017/05/22/health-officials-plan-to-add-london-pharmacies-to-program-that-gives-clean-needles-to-drug-users. Accessed 1 June 2017.
SAS Institute Inc. (2013). SAS version 9.4. Cary, NC.
Scheim, A., Rachlis, B., Bardwell, G., Mitra, S., & Kerr, T. (2017). Public drug injecting in London, Ontario: a cross-sectional survey. CMAJ Open, 5(2), E290–E294.
Shaw, S. Y., Shah, L., Jolly, A. M., & Wylie, J. L. (2007). Determinants of injection drug user (IDU) syringe sharing: the relationship between availability of syringes and risk network member characteristics in Winnipeg, Canada. Addiction, 102(10), 1626–1635.
Shaw, A., Lazarus, L., Pantalone, T., LeBlanc, S., Lin, D., Stanley, D., Chepesiuk, C., Patel, S., Tyndall, M., & and The PROUD advisory committee. (2015). Risk environments facing potential users of a supervised injection site in Ottawa, Canada. Harm Reduction Journal, 12, 49.
Statistics Canada. (2013). Health regions and peer groups. Ottawa. Available at http://www.statcan.gc.ca/pub/82-402-x/2013003/regions/hrpg-eng.htm. Accessed 17 January 2017.
Statistics Canada. (2017). Income highlight tables, 2016 census. Ottawa. Available at http://www12.statcan.gc.ca/census-recensement/2016/dp-pd/hlt-fst/inc-rev/Table.cfm?Lang=Eng&T=307&S=123&O=D&RPP=25. Accessed 17 January 2017.
Tyndall, M. W., Currie, S., Spittal, P., Li, K., Wood, E., O'Shaughnessy, M. V., et al. (2003). Intensive injection cocaine use as the primary risk factor in the Vancouver HIV-1 epidemic. AIDS, 17(6), 887–893.
van Buuren, S. (2007). Multiple imputation of discrete and continuous data by fully conditional specification. Statistical Methods in Medical Research, 16(3), 219–242.
Wood, E., Tyndall, M. W., Spittal, P. M., Li, K., Hogg, R. S., Montaner, J. S., et al. (2002). Factors associated with persistent high-risk syringe sharing in the presence of an established needle exchange programme. AIDS, 16(6), 941–943.
Wood, E., Kerr, T., Spittal, P. M., Small, W., Tyndall, M. W., O'Shaughnessy, V., et al. (2003). An external evaluation of a peer-run “unsanctioned” syringe exchange program. Journal of Urban Health, 80(3), 455–464.
Wood, E., Kerr, T., Small, W., Li, K., Marsh, D. C., Montaner, J. S. G., et al. (2004). Changes in public order after the opening of a medically supervised safer injecting facility for illicit injection drug users. Canadian Medical Association Journal, 171(7), 731–734.
Wood, E., Li, K., Small, W., Montaner, J. S., Schechter, M. T., & Kerr, T. (2005). Recent incarceration independently associated with syringe sharing by injection drug users. Public Health Reports, 120(2), 150–156.
Acknowledgements
The authors thank the study participants, research team, and staff, and the study Advisory Committee for their contributions.
Funding
The study was supported by the CIHR Centre for REACH in HIV/AIDS and the Ontario HIV Treatment Network, and Thomas Kerr’s CIHR Foundation Grant (20R74326). Ayden Scheim is supported by the Pierre Elliott Trudeau Foundation and a CIHR Fellowship. Geoff Bardwell is supported by a Mitacs Elevate Postdoctoral Fellowship from Mitacs Canada.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Participants provided written informed consent and were provided a $25 honorarium. Ethics approval was obtained from research ethics boards at the University of Toronto and the University of British Columbia.
Conflict of interest
The authors declare that they have no conflict of interest.
Rights and permissions
About this article
Cite this article
Scheim, A.I., Bardwell, G., Rachlis, B. et al. Syringe sharing among people who inject drugs in London, Canada. Can J Public Health 109, 174–182 (2018). https://doi.org/10.17269/s41997-018-0058-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.17269/s41997-018-0058-1