The Potential Public Health and Community Impacts of Safer Injecting Facilities: Evidence From a Cohort of Injection Drug Users
March 6, 2003
Many North American cities are experiencing HIV epidemics due to the use of injection drugs. The Downtown Eastside area of Vancouver, British Columbia, had an 18 percent annual HIV incidence rate documented in 1997, to date the most rapid infection rate ever documented in the developed world. The implementation of medically supervised safer injecting facilities (SIFs) in North America is currently being debated. Outstanding issues surrounding such interventions include the potential community and public health impact, and doubts as to whether or not those at greatest risk of overdose and HIV transmission would attend.Adapted from:
In other cities with similar health crises, SIFs have been shown to improve the health and social functioning of their clients, and to reduce overdose deaths, HIV risk behavior, improperly discarded syringes and public drug use, according to the study. SIFs provide clients with sterile injection equipment, medical attention in case of overdose, and access to health care and other services.
The current study evaluated the proportion of injection drug users willing to attend SIFs, if they were available. Researchers gathered data from participants followed from June 2001 to June 2002 in the Vancouver Injection Drug User Study. Five hundred eighty-seven active IDUs responded to a questionnaire; 215 (36.6 percent) expressed a willingness at attend an SIF. Two hundred eighty-eight IDUs (49.0 percent) said they would not attend, and 84 (14.3 percent) were unsure. Multivariate analyses showed that having difficulty accessing sterile syringes, needing help injecting, frequently injecting heroin, sex trade work, and injecting in public spaces were variables independently associated with willingness to attend an SIF. Such variables have been previously associated with overdose, syringe sharing, HIV and HCV incidence, and community consequences of illicit drug use in Vancouver.
"Together, the data from elsewhere and the findings presented here suggest that the IDU[s] who are responsible for the public order problems that stem from public injection drug use and the IDU[s] who are at high risk of blood-borne disease transmission and fatal overdose may be much more likely to use SIFs," the researchers wrote.
"Although a scientific evaluation of SIFs may be required to fully evaluate the impact of SIF provision in Canada," they concluded, "these data suggest that there is high potential for immediate community and public health benefits were SIFs made available."
Journal of Acquired Immune Deficiency Syndromes
01.01.03; Vol. 32; No. 1: P. 2-8; Evan Wood; Thomas Kerr; Patricia M. Spittal; Kathy Li; Will Small; Mark W. Tyndall; Robert S. Hogg; Michael V. O'Shaughnessy; Martin T. Schechter
This article was provided by CDC National Prevention Information Network. It is a part of the publication CDC HIV/Hepatitis/STD/TB Prevention News Update.