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Responding to an Explosive HIV Epidemic Driven by Frequent Cocaine Injection: Is There a Role for Safe Injecting Facilities?

NCJ Number
203311
Journal
Journal of Drug Issues Volume: 33 Issue: 3 Dated: Summer 2003 Pages: 579-608
Author(s)
Thomas Kerr; Evan Wood; Anita Palepu; Dean Wilson; Martin T. Schechter; Mark W. Tyndall
Date Published
2003
Length
30 pages
Annotation
This study determined the prevalence of and factors associated with the willingness of cocaine injectors in Vancouver (Canada) to attend safe injection facilities (SIF's), where intravenous drug users (IDU's) can inject preobtained illicit drugs under medical supervision.
Abstract
SIF's have been credited with improving the health and social functioning of their clients, while reducing the risk of a fatal overdose, HIV and hepatitis C risk behavior, improperly discarded syringes, and public drug use; in addition, improved access to medical care and drug treatment has been attributed to SIF attendance. Health authorities, activists, and drug users in Vancouver have made repeated calls for the establishment of SIF's since the early 1990's. Questions remain concerning the feasibility of establishing SIF's in Downtown Eastside, where injection of cocaine is prevalent, cocaine-related toxicity is common, and cocaine purity is consistently higher than is commonly found in Europe. Although the high-risk nature of the population is such that public health interventions are urgently required, the optimal design for SIF's in a cocaine-driven HIV epidemic has yet to be fully characterized. The current study involved an initial analysis that aimed to determine the prevalence among cocaine injectors of the willingness to attend SIF's, as well as to identify factors associated with such willingness to attend SIF's if they were available. Beginning in May 1996, persons who had injected illicit drugs in the previous month were recruited into the Vancouver Injection Drug User Study, a prospective cohort study. The analysis was restricted to cocaine injecting participants who completed a follow-up visit between June 2001 and May 2002. Demographic characteristics were derived from the baseline questionnaire, and a follow-up questionnaire determined current drug-use characteristics and health-related status. In the second phase of the study, a qualitative focus group method and one unstructured interview were undertaken to determine willingness to use SIF's, barriers to and facilitators of SIF use, and methods for optimizing SIF use among subpopulations of cocaine injectors. The study findings suggest that a high proportion of cocaine injectors, including some of those most at risk, would attend an SIF; however, in order to better accommodate cocaine injectors, several changes should be made to conventional SIF service design and delivery. The majority of these changes pertain to facilitating effective responses to cocaine toxicity. The study concluded that a SIF pilot program could result in significant and immediate benefits to public health and community safety in Vancouver. 3 tables and 51 references

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