Supervised injection sites (SISs) have been effective in
reducing health risks among people who inject drugs (PWID), including those who
face issues of homelessness, mental health illness, interactions with local
policing practices, and HIV infection. We investigate the risk behaviours and
risk environments currently faced by potential users of an SIS in Ottawa to
establish the need for such a service and to contribute to the design of an SIS
that can address current health risks and reduce harm.
The PROUD cohort is a community-based participatory research
(CBPR) project that examines the HIV risk environment among people who use
drugs in Ottawa. From March to October 2013, 593 people who reported using
injection drugs or smoking crack cocaine were enrolled through street-based
recruitment in the ByWard Market neighbourhood, an area of the city with a high
concentration of public drug use and homelessness. Participants completed a
demographic, behavioural, and risk environment questionnaire and were offered
HIV point-of-care testing. We undertook descriptive and univariate analyses to
estimate potential use of an SIS by PWID in Ottawa and to explore risk
behaviours and features of the risk environment faced by potential users of the
service.
Of those participants who reported injecting drugs in the
previous 12 months (n = 270),
75.2 % (203) reported a
willingness to use an SIS in Ottawa. Among potential SIS users, 24.6 % had
recently injected with a used needle, 19.0 % had trouble accessing new
needles, 60.6 % were unstably housed, 49.8 % had been redzoned by the
police, and 12.8 % were HIV positive. Participants willing to use an SIS
more frequently injected in public (OR = 1.98, 95 % CI = 1.06–3.70), required assistance to inject (OR = 1.84,
95 % CI = 1.00–3.38), were hepatitis C positive
(OR = 2.13, 95 % CI = 1.16–3.91), had overdosed in the previous year (OR = 2.00,
95 % CI = 1.02–3.92), and identified as LGBTQ (OR = 5.61,
95 % CI = 1.30–24.19).
An SIS in Ottawa would be well-positioned to reach its
target group of highly marginalized PWID and reduce drug-related harms. The
application of CBPR methods to a large-scale quantitative survey supported the
mobilization of communities of PWID to identify and advocate for their own
service needs, creating an enabling environment for harm reduction action.
Table 2 | |||
| Risk environment comparison by willingness to use a supervised injection service in Ottawa a | |||
| Intention to use an SIS in Ottawa; no. (and %) of participant b | |||
| Characteristic c | Yes | No | OR (and 95 %CI) d |
| n = 205 | n = 67 | ||
| Age | 42.0 | 44.0 | p value = 0.04 |
| Sexual identity | |||
| LGBTQ | 29 (93.5) | 2 (6.5) | 5.61 (1.30–24.19) |
| Straight | 168 (72.1) | 65 (27.9) | |
| Injects with other people | |||
| Yes | 176 (80.0) | 44 (20.0) | 3.23 (1.66–6.27) |
| No | 26 (55.3) | 21 (44.7) | |
| Injects in public | |||
| Yes | 81 (82.7) | 17 (17.3) | 1.98 (1.06–3.70) |
| No | 113 (70.6) | 47 (29.4) | |
| Assistance to inject | |||
| Yes | 81 (81.8) | 18 (18.2) | 1.84 (1.00–3.38) |
| No | 120 (71.0) | 49 (29.0) | |
| Last hep C test | |||
| Positive | 129 (80.1) | 32 (19.9) | 2.13 (1.16–3.91) |
| Negative | 51 (65.4) | 27 (34.6) | |
| Overdosed | |||
| Yes | 66 (83.5) | 13 (16.5) | 2.00 (1.02–3.92) |
| No | 137 (71.7) | 54 (28.3) | |
Full article at:
By:
1Ottawa Hospital Research Institute, 725
Parkdale Ave., Ottawa K1Y 4E9, Ontario, Canada
2PROUD Committee, 85 Primrose Ave., Ottawa
K1R 6M1, Ontario, Canada
3Drug Users Advocacy League, 216 Murray St.,
Ottawa K1N 5N1, ON, Canada
4Department of Medicine, University of
Ottawa, 451 Smyth Rd., Ottawa K1H 8M5, Ontario, Canada
5University of Ottawa at The Ottawa
Hospital, Division of Infectious Disease, 501 Smyth Rd., Ottawa K1H 8L6, ON,
Canada
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