Injecting drug users (IDUs) are a marginalized population at high risk of sexually transmitted infections (STIs) and blood borne viruses (BBV), yet they infrequently access health services for screening. In the current study, the authors used street outreach and self-collection of samples for STI screening to establish the prevalence of BBVs and STIs and to identify risk behaviors among a cohort of culturally diverse, street-based IDUs.

From 1999 to 2002, a cross-sectional study of 314 IDUs in the central business district of Melbourne, Australia, was conducted. Using street outreach as the recruitment strategy, researchers visited injecting and dealing locations. Self-collected genital sampling was used to increase acceptance of screening for Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis by polymerase chain reaction. Participants were tested for hepatitis A, B and C, syphilis, and HIV, and given the option of a self-collected or clinician-collected blood sample to increase acceptance for BBV screening.

"Street outreach was highly effective and self directed STI sampling was more acceptable than practitioner directed sampling (76% versus 9% acceptance, p<0.001). There was a high prevalence of hepatitis C (74%, 95% CI 69 to 79) STIs (8% (5 to 13)), and chlamydia (6% (3 to 10)), and past exposure to hepatitis A and B was common," wrote the researchers. "High rates of recent sharing of injecting equipment, unprotected sex and casual sex partners, together with low levels of awareness of current hepatitis C infection were identified."

The researchers concluded that street outreach and self-collected genital samples facilitated STI and BBV screening in IDUs, revealing a high prevalence of infections and risk behaviors.

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