Intravenous drug users who attempt to access addiction treatment but are unsuccessful are likely to engage in syringe sharing, according to a Canadian study published in the June 1st edition of the Journal of Acquired Immune Deficiency Syndromes. This leads the authors to call for increased provision of addiction treatment to prevent the spread of HIV.
Reductions in funding for addiction services in Canada in the mid-1990s have led to the demand for addiction treatment exceeding availability. This study was designed to assess whether inability to access treatment programmes is associated with HIV risk behaviours.
The researchers recruited 1157 HIV-negative intravenous drug users between May 1996 and May 2002, as part of the Vancouver Injecting Drug Users Study (VIDUS). The participants were asked to complete a questionnaire every six months, with questions about syringe-borrowing behaviour, drug use, accommodation, attempts to access addiction treatment and HIV status. Follow-up continued for up to six years, until the end of the study or a positive HIV test.
At the start of the study, only 228 (20%) of the participants were enrolled on an addiction treatment programme. During follow-up, a further 255 (22%) reported enrolling in a treatment programme, but 314 (27%) reported attempting to access addiction treatment without success.
One hundred and seventeen participants (10%) became HIV-positive during the study. Of these, 35 (30%) reported borrowing a used syringe in the six months prior to seroconversion, and ten (9%) had sought treatment, but had been unable to access it.
The study found that the participants who had tried unsuccessfully to access addiction treatment were more likely to have borrowed a used syringe than those who had not been denied treatment (adjusted odds ratio 1.29; 95% confidence interval 1.09 – 1.53; p = 0.003). The authors comment that this may be because drug users at highest risk of syringe sharing are more likely to seek help. However, they add, “it is also plausible that failed attempts to access addiction treatment may promote depression, anxiety or other psychological risk factors for syringe sharing.”
The authors used a broad definition of addiction treatment, including using detoxification programmes, recovery houses, alcohol or drug treatment centres, spiritual healers, addiction counsellors, methadone maintenance therapy or peer-based recovery programmes such as Narcotics Anonymous.
“The limited provision of addiction treatment may result in a major missed opportunity to reduce HIV transmission among intravenous drug users,” conclude the authors. “Major medical cost savings and substantial reduction in community harm may accrue from the expansion of addiction treatment services.”
Syringe borrowing was also found to be associated with daily cocaine or heroin injection, difficulty accessing syringes, requiring help injecting and binge drug use. Sociodemographic factors associated with syringe borrowing included male sex, younger age, aboriginal ethnicity, unstable housing and involvement in the sex trade.
The authors acknowledge that use of self-reporting in their study may have led to underestimates of the level of syringe borrowing or overestimation of attempts to access addiction treatment. They also point out that they were unable to determine whether syringe borrowing occurred before or after treatment-seeking behaviour, the HIV status of the drug users from whom syringes were borrowed or how thoroughly borrowed syringes were cleaned prior to use.
Reference:
Wood E et al. Inability to access addiction treatment and risk of HIV infection among injection drug users. J Acquir Immune Defic Syndr 36: 750-754, 2004.