Risk behaviour and prevention of blood borne infections among injecting drug users

Abstract

In Stockholm County the two major injecting drugs are amphetamine and heroin, injected by about 9 000 persons almost every day. There is no access to needle and syringe program and about 1000 patients are in substitution programs, mostly Methadone and Burprenorphine programs.

This work has focused on markers of blood borne infections, as antibodies for HIV, HBV and HCV, on risk behaviour, gender, age, mortality, perception of risks with HCV infection and preventive measures. 407 unique participants were interviewed about risk behaviour and blood tested when visiting treatment settings and a custody in Stockholm County from the year of 2001-2006. Participants were >15 years of age and had injected drugs.

The main way of transmission for acquiring blood borne infections in this work was sharing injecting equipment (syringes, needles, filter, cooker and drug mixture) but the participants have reported various degrees of risk behaviour. Some HIV negative participants shared needles with known HIV infected and other differentiated between HIV, HBV and HCV. HIV diagnosed participants had a higher mortality rate than non HIV infected participants in a 1.5-5 years follow up after study participation.

The prevalence of HCV positive status and of active HCV infection was high and many acquired their HCV infection short after starting to inject drugs. Gender/sex played a role in transmission of HCV. Young women were at higher risk of acquiring HCV infection than men. But women recovered spontaneously more often from HCV infection and had better response to HBV vaccination compared to men. Sero markers for HBV vaccination were in general low. Men and women had similar patterns of HCV genotypes. Sharing injecting equipment was common regardless of reporting HCV positive or HCV unknown status. Further, assessment of health consequences with HCV infection was not enough for changing risky injecting behaviour as sharing injecting equipment.

In this thesis, preventive measures of blood borne infections in IDUs are suggested to focus; on young injectors, especially females. On persons with injecting risk behaviour infected as well as non infected with HIV and HCV. The measures are also suggested to be individualized and differentiated for HIV, HBV and HCV. To change risk behaviour for not acquiring blood borne infections; risk perception is suggested to be analysed and communicated by professionals in a dialogue, structured in the method of Motivational Interviewing. Focus should be on IDUs´ risk assessment, with emphasis on how to identify, quantify and characterize risks.