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Seroprevalence and correlates of HIV and HCV among injecting drug users in Edmonton, Alberta.

Injection drug users (IDUs) are at risk for acquiring blood-borne pathogens (BBP), such as human immunodefiency virus (HIV) and hepatitis C virus (HCV), through the use of contaminated drug equipment. HIV (and to a far lesser extent, HCV) may also be acquired through sexual transmission routes, which place IDUs at additional risk for infection. Illicit drug use is associated with high-risk sexual behaviours, such as the exchange of sex for drugs or money, (1-3) and a greater likelihood of exposure to social and sexual networks with high HIV (and HCV) prevalence.

In 2006, the rate of positive HIV test reports among Canadian adults was 9.4/100,000 and IDUs represented 19.1% of all such reports. In the province of Alberta, the rate of new adult HIV case reports was 7.2/100,000 with 21.8% of all cases being identified as IDU. (4) Nationally, the rate of newly reported HCV cases in 2004 was 44.7/100,000. (5) In Alberta, the rate of newly reported HCV cases in 2006 was 41.7/100,000 of which approximately 68% were attributed to IDU (Alberta Health and Wellness, 2008).

The objective of this research was to determine the seroprevalence and correlates of HIV and HCV and associated risk behaviours for a cohort of IDUs recruited in Edmonton, Alberta.

METHODS

Edmonton was selected as one of multiple sites for a national, cross-sectional survey (I-Track Study) developed by the Public Health Agency of Canada (PHAC) to describe drug and sexual risk behaviours, and HIV/HCV prevalence among IDUs. (6) This study was approved by the University of Alberta Health Research Ethics Board.

From April to June 2005, recruitment was performed at sites known to have IDUs as clients. Inclusion criteria were: 1) 15 years of age or older, 2) appeared capable of giving informed consent, 3) understood English, and 4) had injected drugs for non-therapeutic purposes in the preceding six months. A single community health representative helped identify and recruit individuals to the study and assessed study eligibility through prescreening questions related to injection drug use practices. Research nurses received informed consent, administered the study questionnaire and collected a finger-prick blood sample on a cotton-fibre-based filter paper to create a dried blood spot (DBS). HIV and HCV testing of the DBS was conducted at the National HIV and Retrovirology laboratory. HIV testing was performed using an enzyme immunoassay (EIA; Bio-Rad GS HIV-1 rLAV) and reactive samples were confirmed by Western Blot (Bio-Rad GS HIV-1 WB). HCV testing was performed by EIA (Ortho HCV version 3). Participants received $20 as compensation for their time. All testing was anonymous and unlinked, therefore participants did not receive test results. Simultaneous testing (following usual regional testing procedures) was offered; this was not linked to study participation.

Sex-specific comparisons of demographics and risk behaviours were determined by Chi-square or Fisher's exact test for proportions and by the Mann-Whitney test for continuous variables. Transgender participants were not included in gender-specific analyses and their data are not shown due to their small number (n=3). A 95% binomial confidence interval (CI) was calculated for each seroprevalence. Univariate and multivariate logistic regression models were used to determine correlates of HIV and HCV seropositivity, and to estimate odds ratios (OR), adjusted odds ratios (AORs) and 95% CIs. Data were analyzed using Stata version 10.0 (Stata Corp, College Station, TX, USA).

RESULTS

Of the 275 participants, 68% (n=187) were male (Table 1). Males were significantly older than females (median: 39 years vs. 36 years, p=0.002). The majority of participants (70.6%) were Aboriginal (i.e., First Nations, Metis, or Inuit), with a higher proportion among females than males (83.5% vs. 64.2%; p=0.001).

Overall, 36.9% of participants reported cocaine as the drug they had injected most often in the previous six months, followed by morphine (non-prescription) at 24.9%. Crack was reported as being the non-injection drug used most often by 22.2% of participants. Males initiated injection drug use at a younger age than did females (median: 18 vs. 21 years, p=0.04). Of participants, 21.5% were daily injectors and they reported injecting 2 to 5.5 times per day. Three quarters of participants (74.2%) reported most frequently injecting with someone else. Females were significantly more likely to report injecting with their regular sexual partner than were males (34.1% vs. 13.9%, p=0.002). Only 8.7% of participants reported sharing needles in the previous 6 months, with females being significantly more likely to share needles than males (20% vs. 3.7%, p<0.001). The vast majority of participants (81.8%) had used a needle-exchange program (NEP); 4.7% reported using NEPs on a daily basis in the previous 6 months, compared to 29.8% who used them weekly and 20.4% who had not used one at all in that time period.

The majority of participants reported having a sex partner in the previous six months (84.7%), with more reporting a regular partner than a casual one (70.8% vs. 44.6%). Females were significantly more likely than males to report being paid for sex (34.2% vs. 2.6%, p=0.03), while males were significantly more likely to report having paid for sex (5.8% vs. 0%, p<0.001). Females were significantly less likely to have used a condom during their last sexual encounter as compared to males (40% vs. 58.1%, p=0.04).

Nearly one quarter of participants (23.6%, 95% CI 18.7%-29.1%) tested positive for HIV (Table 2), with a higher proportion being females compared to males (29.4% vs. 21.2%, p=0.14). Of participants, 91.6% reported HIV testing in the past. Among respondents who reported previously testing negative (n=171), 6 new HIV cases (3.5%) were detected; conversely, 7 participants who reported being HIV positive were found to be negative upon testing. Of the 65 self reported HIV-positive participants, 87.7% reported being under medical care and 40% were on treatment for HIV.

Among females, being paid for sex was the only factor found to be significantly associated with HIV seroprevalence (OR 2.9, 95% CI 1.0-8.3)) (Table 3). For males, factors positively associated with HIV seroprevalence were older age (OR 1.1, 95% CI 1.0-1.2), having ever used a NEP (OR 5.7, 95% CI 1.3-24.7) and daily use of a NEP in the previous six months (OR 8.6, 95% CI 2.1-36.2). All three factors remained significant in multivariable analyses: age (AOR 1.1, 95% CI 1.0-1.1), having ever used a NEP (AOR 6.8, 95% CI 1.4-33.6) and daily use of a NEP in the previous six months (AOR 7.4, 95% CI 1.7-33.0).

Two thirds of participants (66.1%, 95% CI 60.1%-71.6%) tested positive for HCV with 88.4% reporting HCV testing in the past (Table 2). Of the 181 HCV-positive participants, 15 self-reported testing negative at their last test, while 12 who self-reported as positive at their last test currently tested negative. Among the HCV-positive participants, 54.3% reported being under medical care and 2.5% were on treatment for HCV.

Having a casual sex partner in the previous six months was protective for being HCV seropositive among females (OR 0.28, 95% CI 0.10-0.78) (Table 4). For males, younger age of first injection (OR 0.95, 95% CI 0.91-0.99), older age (OR 1.15, 95% CI 1.1-1.2), daily injection (OR 2.5, 95% CI 1.1-5.8), ever use of a NEP (OR 2.7, 95% CI 1.3-5.8) and using a condom at the time of the last sexual encounter (OR 2.5, 95% CI 1.1-5.3) were positively associated with being HCV positive, while having a recent sex partner (OR 0.27, 95% CI 0.10-0.75) was protective. In multivariate analyses, older age (AOR 1.2, 95% CI 1.1-1.3) and younger age of first injection (AOR 0.92, 95% CI 0.87-0.96) remained significantly associated with being HCV positive for males.

DISCUSSION

Among this sample of IDUs in Edmonton, one quarter (23.9%) tested HIV positive, two thirds (66.1%) tested HCV positive and one quarter (22.8%) of the population was co-infected with HCV and HIV. The majority of this cohort had previously been tested for HIV and HCV, and a majority of infected persons were already aware of their positive status. More people were aware of their HIV compared to their HCV infection status. Among HCV-infected persons, only half were currently under medical care, emphasizing the need for initiatives to improve access to HCV treatment and care.

The need for BBP prevalence data among IDU in Edmonton has been highlighted by local researchers. (7) A phone survey in the mid-1990s estimated the IDU population of Edmonton to be approximately 4,000 (Canada's Alcohol and Other Drugs Survey, 1996). The first HIV prevalence data collected among IDUs in Edmonton was completed in 1992 as part of an evaluation of the local needle exchange program. This evaluation reported 3 positive HIV results from 616 saliva samples tested over a two-year period. (8) In Wild et al.'s 2000-2002 study of 30 IDU in Edmonton, 17% self-reported as being HIV positive and 72% self-reported as being HCV positive, (7) which is similar to the prevalence data reported in this study.

In comparison to other national sites involved in the I-Track study, Edmonton had the highest HIV prevalence at 23.9%. The average HIV prevalence across sites participating in I-Track was 13.2% (range: 2.9% to 23.9%). The Edmonton I-Track HCV prevalence of 66.1% was similar to the national I-Track HCV prevalence of 65.7% (range 61.8% to 68.5%). (9) It is possible that selection bias may have led to an overestimation of the true HIV prevalence among IDUs in Edmonton as recruitment was done via community-based organizations, some of which were fixed needle exchange sites and one of which catered to HIV-positive individuals. However, a site-by-site analysis (data not shown) showed no statistically significant difference in HIV (or HCV) prevalence.

Previously reported HIV and HCV prevalence among Canadian IDU cohorts has been varied. A 2002 multi-site Canadian cohort study of illicit opioid users (OPICAN) reported that among current IDUs, the HIV prevalence was 16.9% and the HCV prevalence was 59.0%. (10) Prevalence data from other Canadian cities include HIV 23% and HCV 88% among Vancouver IDUs, (11) HIV 10.1% among IDUs attending a needle-exchange program in Quebec City, (12) and HIV 7.2% and HCV 54.2% among Winnipeg IDUs. (13)

Correlates for HIV infection were few. For females, being involved in the sex trade was positively associated with being HIV positive. Sex trade has often been identified as an important risk factor for HIV and STIs among female drug users. (11,14,15) This emphasizes the strong overlap of drug use and sexual relationships among female IDUs (16-18) and the need for targeted programming to prevent infection and transmission of HIV for IDUs involved in commercial sex work.

HIV-positive males were more likely to use NEP services than men testing negative. Ever having used and daily use of NEP services were significantly associated with HIV seroprevalence for males. It has been well documented that NEPs are most frequently used by higher-risk individuals, such as those involved in the sex trade, (19,20) those with unstable housing, (19) those with daily drug use, (21) and those who attend "shooting galleries". (21) In the current study, NEP use was statistically associated with daily injection (p=0.04) and involvement in the sex trade (p=0.02; data not shown). By attracting higher-risk IDUs, NEPs provide an important opportunity to prevent HIV and HCV infection and transmission. It is unclear from our data why the availability of NEPs in the city have not kept HIV rates lower but it may be explained by links between IDU, sex trade and the sexual transmission of HIV. Sexual transmission has been the predominant mode of transmission of HIV in Alberta since 2002 (Alberta Health and Wellness, 2008).

Supervised injection sites have the potential to positively impact injecting practices and thereby reduce the acquisition of HIV and HCV through injection drug use. (22) In this current research, correlates for HCV infection among males included injection-related factors, such as earlier age of first injection and daily injection, emphasizing the importance of safe injecting habits among IDUs. The impact of supervised injection sites has not been explored in the city of Edmonton. In addition, given that nearly one quarter (22.2%) of study participants indicated that crack cocaine was their most commonly used non-injection drug, and that 84% of participants had reported using non-injection crack at some time in the previous six months, the impact of crack distribution kits on HCV and HIV incidence would also be worth exploring. Smoking crack cocaine has been linked to transmission of blood-borne infections and high-risk sexual practices including involvement in sex trade. (23)

The majority of individuals in this IDU cohort were Aboriginal (70.6%), although Aboriginals make up approximately 5% of the Alberta population. (24) This disproportionate representation of Aboriginals among IDU cohorts was reported for many of the other I-Track recruitment sites, including Regina (87.2% Aboriginal) and Winnipeg (69.6%). This is reflective of socio-economic disparities among Aboriginal persons in Canada. For example, in Canada, Aboriginals represent the largest ethnic group after Whites to be infected with HIV. (4) In 2006 in Alberta, 23.9% of the 222 HIV cases were classified as Aboriginal. Among these Aboriginal cases, 47.2% were IDU while only 11.8% of the non-Aboriginal cases were classified as IDU (Alberta Health and Wellness, 2008). In total, 13.5% of all HCV cases in 2006 were among Aboriginal persons (Alberta Health and Wellness, 2008). The high mobility of Aboriginal people between inner cities and rural areas has the potential to increase the risk of infectious disease transmission to remote Aboriginal communities. (25) This highlights the need for commitment to and support for the development and implementation of prevention and control strategies among Aboriginal persons in Canada.

There are several limitations to this research. The cross-sectional study design did not allow the determination of temporal relationships between behaviours and HIV/HCV infection. Given the older age and long length of time that these IDUs have been injecting, it is likely that they were infected years ago, making the association of recent/current behaviours with infection status less meaningful. Most of the data collected in the study used self-report via an interviewer-administered questionnaire, therefore the possibility of social desirability bias does exist. However, this bias may have been reduced by using interviewers who were trained and familiar with the IDU population in Edmonton. Sample size may have limited our ability to find statistically significant results, this being especially true for female participants. Finally, this sample may not be representative of IDU populations in other cities in Canada and may not be representative of the IDU population in Edmonton. It is hoped that by using a variety of recruitment sites, we have improved the representativeness of this population.

The high HIV and HCV prevalence found in this study among IDUs in Edmonton highlights the complex needs of the IDU community as well as the continued need for targeted programming. Although a small proportion of the study participants reported sharing needles, nearly half of them admitted to having unprotected sex the last time they had sex, putting them at risk for HIV and other STIs. To better meet the health needs of the IDU community, continued surveillance of their communicable diseases risk and behaviours together with targeted interventions should be a high priority for policy-makers.

Acknowledgements: We acknowledge the I-Track participants for their time and participation. We are also grateful to the many staff at the Public Health Agency of Canada for their time and effort with regard to study design, laboratory testing and data management for the I-Track study. Finally, we acknowledge the staff of the following agencies in Edmonton for their time and participation: the Bissell Centre, Boyle McCauley Health Centre, Kindred House, HIV Edmonton, and the STD Centre.

Conflict of Interest: None to declare.

Received: February 5, 2009 Accepted: October 8, 2009

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(12.) Poulin C, Alary M, Bernier F, Ringuet J, Joly JR. Prevalence of Chlamydia trachomatis, Neisseria gonorrhoeae, and HIV infection among drug users attending an STD/HIV prevention and needle-exchange program in Quebec City, Canada. Sex Transm Dis 1999;26(7):410-20.

(13.) Wylie JL, Shah L, Jolly AM. Demographic, risk behaviour and personal network variables associated with prevalent hepatitis C, hepatitis B, and HIV infection in injection drug users in Winnipeg, Canada. BMC Public Health 2006;6:229.

(14.) Kral AH, Bluthenthal RN, Lorvick J, Gee L, Bacchetti P, Edlin BR. Sexual transmission of HIV-1 among injection drug users in San Francisco, USA: Risk-factor analysis. Lancet 2001;357(9266):1397-401.

(15.) Plitt SS, Sherman SG, Strathdee SA, Taha TE. Herpes simplex virus 2 and syphilis among young drug users in Baltimore, Maryland. Sex Transm Infect 2005;81(3):248-53.

(16.) Evans JL, Hahn JA, Page-Shafer K, Lum PJ, Stein ES, Davidson PJ, et al. Gender differences in sexual and injection risk behavior among active young injection drug users in San Francisco (the UFO Study). J Urban Health 2003;80(1):137-46.

(17.) Powis B, Griffiths P, Gossop M, Strang J. The differences between male and female drug users: Community samples of heroin and cocaine users compared. Subst Use Misuse 1996;31(5):529-43.

(18.) Henderson DJ, Boyd C, Mieczkowski T. Gender, relationships, and crack cocaine: A content analysis. Res Nurs Health 1994;17(4):265-72.

(19.) Schechter MT, Strathdee SA, Cornelisse PG, Currie S, Patrick DM, Rekart ML, et al. Do needle exchange programmes increase the spread of HIV among injection drug users?: An investigation of the Vancouver outbreak. AIDS 1999;13(6):F45-F51.

(20.) Cao W, Treloar C. Comparison of needle and syringe programme attendees and non-attendees from a high drug-using area in Sydney, New South Wales. Drug Alcohol Rev 2006;25(5):439-44.

(21.) Wood E, Lloyd-Smith E, Li K, Strathdee S, Small W, Tyndall M, et al. Frequent needle exchange use and HIV incidence in Vancouver, Canada. Am J Med 2007;120(2):172-79.

(22.) Stoltz JA, Wood E, Small W, Li K, Tyndall M, Montaner J, et al. Changes in injecting practices associated with the use of a medically supervised safer injection facility. J Public Health (Oxf) 2007;29(1):35-39.

(23.) Cornish JW, O'Brien CP. Crack cocaine abuse: An epidemic with many public health consequences. Annu Rev Public Health 1996;17:259-73.

(24.) Statistics Canada. 2001 Census Aboriginal Population Profiles. Released June 17, 2003. Last modified: 2005-11-30. Statistics Canada Catalogue no. 93F0043XIE, 2002.

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Sabrina S. Plitt, PhD, [1] Jennifer Gratrix, BScN, MSc, [2] Sharyn Hewitt, RN, [2] Patsy Conroy, RN, [2] Tracy Parnell, [2] Beverly Lucki, BScN, [2] Vicki Pilling, BScN, [2] Barbara Anderson, BScN, MSc, [2] Yogesh Choudri, MD, [1] Chris P. Archibald, MD, [1] Ameeta E. Singh, BMBS, MSc [2]

Author Affiliations

[1.] Surveillance and Risk Assessment Division, Centre for Communicable Disease and Infection Control, Public Health Agency of Canada, Ottawa, ON

[2.] Alberta Health Services - Edmonton STD Centre, Edmonton, AB

Correspondence: Dr. Ameeta Singh, Alberta Health Services-Edmonton STD Centre, 3B20-11111 Jasper Ave, Edmonton, AB T5K 0L4, Tel: 780-342-2300, Fax: 780-4252194, E-mail: ameeta@ualberta.ca
Table 1. Gender-specific Demographics, Drug-using Behaviours and
Sex Behaviours, Edmonton, Alberta, 2005, %(n)*

                                  Total        Males
Factor                            (n = 275)    (n = 187)
                                  ([dagger])   ([dagger])

Median age (IQR)                  38 (33-44)   39 (34-46)
Ethnicity ([section])
  Aboriginal                      70.6 (194)   64.2 (120)
  Non-Aboriginal                  29.4 (81)    35.8 (67)
Completed high school             41.5 (114)   46.5 (87)

Drug-injecting Behaviours

Median age of injection           19 (16-25)   18 (16-25)
    initiation
Frequency of injection
    ([parallel])
  Never                           12.7 (35)    11.8 (22)
  Not regularly                   32.4 (89)    32.6 (61)
  1-2 x/week                      16.7 (46)    18.2 (34)
  >3 x/week                       16.7 (46)    17.1 (32)
  Daily                           21.5 (59)    20.3 (38)
Median injections/day             3 (2-5.5)    3 (2-6)
Most frequently injected
    with ([paragraph]:
  Sex partner                     20.2 (55)    13.9 (26)
  Close friend                    42.9 (117)   47.6 (88)
  Family                          5.9 (16)     6 (11)
  Acquaintance                    4.8 (13)     6 (11)
  Stranger                        0.4 (1)      0.5 (1)
  No one                          26 (71)      26 (48)
Shared needles ([paragraph])      8.7 (24)     3.7 (7)
Most frequently shared used
   needles with ([paragraph]):
  Sex partner                     29.2 (7)     16.7 (1)
  Close friend                    37.5 (9)     66.7 (4)
  Family                          12.5 (3)     16.7 (1)
  Acquaintance                    8.3 (2)      0 (0)
  Stranger                        8.3 (2)      0 (0)
Frequency of sharing
    used needles
  Always                          4.3 (1)      0 (0)
  Occasionally                    78.3 (18)    100 (6)
  Sometimes                       17.4 (4)     0 (0)
Shared other injection
    equipment
  Cookers                         28.4 (78)    23.5 (44)
  Water                           24 (66)      21.4 (40)
  Filters                         20 (55)      16.6 (31)
Ever used a needle                81.8 (225)   80.8 (151)
    exchange program
Daily use of a needle             4.7 (13)     4.8 (9)
    exchange program
    ([paragraph])

Sexual Risk Behaviours
    ([paragraph])

Had a sex partner                 84.7 (233)   82.4 (154)
  Regular **                      70.8 (165)   68.2 (105)
  Casual ([dagger][dagger])       44.6 (104)   50 (77)
Paid for sex                      3.9 (9)      5.8 (9)
Was paid for sex                  13.7 (32)    2.6 (4)
Had sex with a person             5.9 (16)     4.3 (8)
    of same sex
Used a condom in last             51.9 (96)    58.1 (68)
   sexual encounter

                                  Females
Factor                            (n = 85)     P-value
                                  ([dagger])   ([double
                                               dagger])

Median age (IQR)                  36 (33-41)   0.002
Ethnicity ([section])
  Aboriginal                      83.5 (71)    0.001
  Non-Aboriginal                  16.5 (14)
Completed high school             29.4 (25)    0.008

Drug-injecting Behaviours

Median age of injection           21 (17-28)   0.04
    initiation
Frequency of injection
    ([parallel])
  Never                           15.3 (13)    0.71
  Not regularly                   30.6 (26)
  1-2 x/week                      12.9 (11)
  >3 x/week                       16.5 (14)
  Daily                           24.7 (21)
Median injections/day             3 (2-5)      0.91
Most frequently injected
    with ([paragraph]:
  Sex partner                     34.1 (29)    0.002
  Close friend                    31.8 (27)
  Family                          5.9 (5)
  Acquaintance                    1.2 (1)
  Stranger                        0 (0)
  No one                          27.1 (23)
Shared needles ([paragraph])      20 (17)      <0.001
Most frequently shared used
   needles with ([paragraph]):
  Sex partner                     35.3 (6)     0.57
  Close friend                    29.4 (5)
  Family                          11.8 (2)
  Acquaintance                    11.8 (2)
  Stranger                        11.8 (2)
Frequency of sharing
    used needles
  Always                          5.9 (1)      0.66
  Occasionally                    70.6 (12)
  Sometimes                       23.5 (4)
Shared other injection
    equipment
  Cookers                         37.7 (32)    0.05
  Water                           28.3 (24)    0.37
  Filters                         25.9 (22)    0.16
Ever used a needle                84.7 (72)    0.43
    exchange program
Daily use of a needle             4.7 (4)      0.97
    exchange program
    ([paragraph])

Sexual Risk Behaviours
    ([paragraph])

Had a sex partner                 89.4 (76)    0.14
  Regular **                      77.6 (59)    0.14
  Casual ([dagger][dagger])       34.2 (26)    0.02
Paid for sex                      0 (0)        0.03
Was paid for sex                  34.2 (26)    <0.001
Had sex with a person             9.4 (8)      0.095
    of same sex
Used a condom in last             40.0 (26)    0.04
   sexual encounter

* except for continuous variables which are expressed as median
(IQR:inter-quartile range)

([dagger]) denominator totals may not represent column totals
due to missing data

([double dagger]) p-values represent only male and female
comparisons; p-values were calculated using Chi-square test or
Fisher's exact test for categorical variables and Mann-Whitney
test for continuous variables

([section]) all non-Aboriginal participants were Caucasian except
for one African-Canadian male

([parallel]) in previous month

([paragraph]) in previous 6 months

** defined as someone with whom you have had a relationship and
with whom you are emotionally involved

([dagger][dagger]) defined as someone with whom you have had a
sexual relationship one or a few times, but with whom you have
no emotional involvement

Note: three transgendered individuals are not included in this
table or analysis

Table 2. HIV and HCV Current Test Results, Past Testing Results
and Medical Care and Treatment, Edmonton, Alberta, 2005, %(n)

                                 Total          Males
Factor                           % (n = 275)*   % (n = 187)*

Study results
  HIV positive                   23.9 (65)      21.2 (39)
  HCV positive                   66.1 (181)     64.0 (119)
  Co-infection                   22.8 (62)      20.7 (38)
Past HIV testing results
  Positive                       25.8 (65)      24.0 (40)
  Negative                       68.3 (172)     72.5 (121)
  Indeterminate                  0.4 (1)        0 (0)
  Don't know                     5.2 (13)       0 (0)
  Refused                        0.4 (1)        0 (0)
  Total tested in                91.6 (252)     89.3 (167)
    lifetime
  Total tested within            64.7 (163)     65.9 (110)
    past 2 years
Self-reported
    HIV-positive participants
  Under medical care for HIV     87.7 (57)      85 (34)
  On treatment for HIV           40 (26)        37.5 (15)
Past HCV testing results
  Positive                       67.1 (163)     65.8 (104)
  Negative                       2.8 (70)       31.7 (50)
  Don't know                     3.7 (9)        2.5 (4)
  Refused                        0.4 (1)        0 (0)
  Total tested in lifetime       88.4 (243)     84.5 (158)
Self-reported HCV-positive
    participants
  Under medical care for HCV     54.3 (88)      56.7 (59)
  On treatment for HCV           2.5 (4)        1.9 (2)

                                 Females        p-value
Factor                           % (n = 85)*    ([dagger])

Study results
  HIV positive                   29.4 (25)      0.14
  HCV positive                   70.6 (60)      0.29
  Co-infection                   27.1 (23)      0.24
Past HIV testing results
  Positive                       29.3 (24)      0.045
  Negative                       59.8 (49)
  Indeterminate                  1.2 (1)
  Don't know                     8.5 (7)
  Refused                        1.2 (1)
  Total tested in                96.5 (82)      0.14
    lifetime
  Total tested within            62.2 (51)      0.60
    past 2 years
Self-reported
    HIV-positive participants
  Under medical care for HIV     91.7 (22)      0.44
  On treatment for HIV           41.7 (10)      0.74
Past HCV testing results
  Positive                       68.7 (57)      0.19
  Negative                       24.1 (20)
  Don't know                     6 (5)
  Refused                        1.2 (1)
  Total tested in lifetime       97.7 (83)      0.006
Self-reported HCV-positive
    participants
  Under medical care for HCV     50 (28)        0.42
  On treatment for HCV           3.6 (2)        0.52

* denominator will not equal column total as three males were not
tested for HIV and one male was not tested for HCV

([dagger]) p-values represent only male and female comparisons;
p-values were calculated using Chi-square test or Fisher's exact
test for ([daggategorical variables and Mann-Whitney test for
continuous variables

Note: three transgendered individuals are not included in this
table or analysis

Table 3. Correlates of HIV Seroprevalence by Gender, Edmonton,
Alberta, 2005

                                     Total n

Females
  Been paid for sex                  76
Males
  Median age (yrs; IQR)              183
  Ever used a needle-exchange        184
    program
  Daily use of a needle-exchange     184
    program ([parallel])

                                     HIV Positive     HIV Negative
                                     % (n) *          % (n) *

Females
  Been paid for sex                  52.4 (11)        27.3 (15)
Males
  Median age (yrs; IQR)              43 (40-47)       38 (33-43)
  Ever used a needle-exchange        94.9 (37)        76.6 (111)
    program
  Daily use of a needle-exchange     15.4 (6)         2.1 (3)
    program ([parallel])

                                     OR ([dagger])    AOR ([dagger])
                                     (95% CI          (95% CI)
                                     ([dagger])

Females
  Been paid for sex                  2.9 (1.0-8.3)    5.5 (1.4-21.3)
Males                                                 ([double dagger])
  Median age (yrs; IQR)              1.1 (1.0-1.2)    1.09 (1.04-1.14)
                                                      ([section])
  Ever used a needle-exchange        5.7 (1.3-24.7)   7.4 (1.7-33.0)
    program
  Daily use of a needle-exchange     8.6 (2.1-36.2)   6.8 (1.4-33.6)
    program ([parallel])

* except for continuous variables which are expressed as median and
interquartile range (IQR)

([dagger]) OR: Odds Ratio, 95% CI: 95% confidence interval,
AOR: Adjusted Odds Ratio

([double dagger]) age-adjusted

([section]) OR for age represents an increase in odds associated
with a one-year increase in age

([parallel]) within previous six months

Table 4. Correlates of HCV Seroprevalence by Gender, Edmonton,
Alberta, 2005

                              Total n

Females
  Recent casual sex partner   76
Males
  Median age of first         185
    injection (yrs; IQR)
  Median age (yrs; IQR)       185

  Daily injection (within     186
    previous month)
  Ever used a                 186
    needle-exchange program
  Recent sex partner (within
    previous 6 months) 186
  Condom use at last sexual   117
    encounter

                              HCV Positive       HCV Negative
                              % (n)*             % (n)*

Females
  Recent casual sex partner   25.0 (13)          54.2 (13)
Males
  Median age of first         18 (38-47)         21 (18-27)
    injection (yrs; IQR)
  Median age (yrs; IQR)       42 (38-47)         35 (29-39)

  Daily injection (within     25.2 (30)          11.9 (8)
    previous month)
  Ever used a                 86.6 (103)         70.2 (47)
    needle-exchange program
  Recent sex partner (within  77.3 (92)          92.5 (62)
    previous 6 months) 186
  Condom use at last sexual   66.2 (49)          44.2 (19)
    encounter

                              OR ([dagger])      AOR
                              (95% CI            ([dagger])
                              ([dagger]))        (95% CI)
Females
  Recent casual sex partner   0.28 (0.10-0.78)
Males
  Median age of first         0.95 (0.91-0.99)   0.92 (0.87-0.96)
    injection (yrs; IQR)
  Median age (yrs; IQR)       1.15 (1.1-1.2)     1.18 ([section])
                                                 (1.1-1.3)
  Daily injection (within     2.5 (1.1-5.8)      2.3 (0.84-6.3)
    previous month)
  Ever used a                 2.7 (1.3-5.8)      2.5 (0.94-6.8)
    needle-exchange program
  Recent sex partner (within  0.27 (0.10-0.75)   0.29 (0.74-1.1)
    previous 6 months) 186
  Condom use at last sexual   2.5 (1.1-5.4)      -([parallel])
    encounter

* except for continuous variables which are expressed as median
and interquartile range (IQR)

([dagger]) OR: Odds Ratio, 95% CI: 95% confidence interval,
AOR: Adjusted Odds Ratio

([double dagger]) no multivariate analysis performed due to lack
of significant variables in univariate analyses

([section]) OR for age represents an increase in odds associated
with a one-year increase in age

([parallel]) not included in final multivariate model due to
collinearity with recent sex partner variable
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Article Details
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Title Annotation:QUANTITATIVE RESEARCH; hepatitis C virus
Author:Plitt, Sabrina S.; Gratrix, Jennifer; Hewitt, Sharyn; Conroy, Patsy; Parnell, Tracy; Lucki, Beverly;
Publication:Canadian Journal of Public Health
Article Type:Report
Geographic Code:1CANA
Date:Jan 1, 2010
Words:5360
Previous Article:Future challenges to health and public health services in Canada.
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