Élise Roy

Drug injection among street youths in montreal: Predictors of initiation

In North America, street youths are generally considered at very high risk of injection drug use. To estimate the incidence rate of injection drug use in this population and to identify predictors of injection drug use, we conducted the present analysis. Among participants to a cohort study initiated in January 1995, we selected subjects who had never injected at study entry and had completed at least one follow-up questionnaire. Predictors of initiation were identified using Cox proportional bazard regression models. Among the 415 never injectors (mean age at entry 19.5 years), 74 had initiated injection by January 2000 (incidence rate 8.2 per 100 person-years). Independent predictors of initiation were recent episode of homelessness; age younger than 18 years; being tattooed; recently using hallucinogens, beroin, and cocainelcrack/freebase; having a friend who injects drugs; and having ever experienced extrafamilial sexual abuse. This study showed that injection drug use is frequent among street youths, but prevention appears possible.

HIV risk profile of male street youth involved in survival sex

Objectives: To compare HIV risk factors of male street youth involved in survival sex with those of their never involved peers and to describe the sexual activities of the involved youths. Methods: From 2001 to 2003, street youth aged 14–23 years were recruited from street youth agencies in Montreal, Canada. Information was collected on sociodemographic characteristics, substance use, and sexual behaviours. Involvement in survival sex was defined as having ever exchanged sex for money, gifts, drugs, shelter, or other needs. Logistic regression was used to identify HIV risk factors associated with involvement in survival sex. Results: Among the 542 male participants recruited, 27.7% reported involvement in survival sex. HIV risk factors independently associated with such involvement were injection drug using partners (modulated by length of homelessness), unprotected oral sex with male partners, steroid injection, history of sexual abuse, and drug injection. Among involved youths, 32.0% had only female clients, 41.3% only male clients, and 26.7% had clients of both sexes. Unprotected sexual activities were common with clients. However, even more risks were taken with non-commercial sexual partners. Conclusions: Male street youth involved in survival sex are at higher risk for HIV than their non-involved peers not only because of their unprotected commercial sexual activities. They have multiple other HIV risks related to non-commercial sexual activities, drug injection, and sexual abuse. All these risks need to be addressed when providing sexual health interventions for this population.

The rising prevalence of prescription opioid injection and its association with hepatitis C incidence among street-drug users

AIMS   To examine trends in prescription opioid (PO) injection and to assess its association with hepatitis C virus (HCV) seroconversion among injection drug users (IDUs). DESIGN   Prospective cohort study. SETTING   Montreal, Canada. PARTICIPANTS   HCV-negative IDUs at baseline, reporting injection in the past month. MEASUREMENTS   Semi-annual visits included HCV antibody testing and an interview-administered questionnaire assessing risk behaviours. HCV incidence rate was calculated using the person-time method. Time-updated Cox regression models were conducted to examine predictors of HCV incidence. FINDINGS   The proportion of IDUs reporting PO injection increased from 21% to 75% between 2004 and 2009 (P < 0.001). Of the 246 participants (81.6% male; mean age 34.5 years; mean follow-up time 23 months), 83 seroconverted to HCV [incidence rate: 17.9 per 100 person-years; 95% confidence interval (CI) 14.3, 22.1]. Compared to non-PO injectors, PO injectors were more likely to become infected [adjusted hazard ratio (AHR): 1.87; 95%CI:1.16, 3.03]. An effect modification was also found: PO injectors who did not inject heroin were more likely to become infected (AHR: 2.88; 95%CI: 1.52, 5.45) whereas no association was found for participants using both drugs (AHR: 1.19; 95% CI: 0.61, 2.30). Other independent predictors of HCV incidence were: cocaine injection, recent incarceration and >30 injections per month. CONCLUSIONS   Prescription opioid injectors who do not inject heroin are at greater risk for HCV seroconversion than are those injecting both heroin and prescription opioids. Important differences in age, behaviour and social context suggest a need for targeted outreach strategies to this population.

Prevalence of HIV infection and risk behaviours among Montreal street youth.

We aim to estimate HIV prevalence and associated risk factors among street youth in Montreal, Canada. We conducted a one-year cross-sectional anonymous study in 1995. We recruited youth aged 13-25 years meeting specific criteria for itinerancy through the 20 major Montreal street youth agencies. Participation included a structured interview and provision of an oral specimen for HIV testing. Among the 909 subjects studied, 99.3% had been sexually active, 25.9% had exchanged sex for money, gifts, drugs, a place to sleep, or other things; 31.8% reported anal sex; and 36.4% reported having ever injected drugs. Overall, HIV prevalence was 1.9% (1.1% in girls and 2.2% in boys). Multivariate logistic regression showed that being over 20 years of age (adjusted odds ratio (AOR) 7.09), having injected drugs (AOR 4.48), having engaged in prostitution (AOR 3.32), and being born outside Canada (AOR 4.41) were all independently associated with HIV infection.

High hepatitis C virus prevalence and incidence among Canadian intravenous drug users

We used data and leftover samples collected through the SurvUDI network to describe the epidemiology of hepatitis C virus (HCV) infection among injection drug users (IDUs) in Eastern Central Canada. Among the 1380 selected IDUs, having participated twice or more between 1997 and 2003, the overall HCV prevalence rate was 60.4% (95% confidence interval [CI]: 57.7–63.0%). Among the 543 initially uninfected participants, the HCV incidence rate was 27.1 per 100 person-years (95% CI: 23.4–30.9 per 100 person-years). Independent predictors of seroconversion, identified among 359 participants, were age, injecting for a year or less, injecting with a syringe previously used by someone else, injecting most often cocaine, engaging in prostitution, and being recruited in a major urban centre. The HCV epidemic severely affects IDUs in this area. Actions to prevent HCV transmission, such as distribution of sterile injection equipment, have to be reinforced. Special efforts have to be targeted towards starting IDUs.

HIV risk profile and prostitution among female street youths

The objective of this study was to compare human immunodeficiency virus (HIV) risk factors among female street youths involved in prostitution and those with no history of prostitution. Youths aged 14 to 25 years were recruited into the Montreal Street Youth Cohort. Semiannually, youths completed an interviewer-administered questionnaire. Statistical analyses comparing characteristics and HIV risk factors for girls involved in prostitution and those never involved were carried out using parametric and nonparametric methods. Of the girls, 88 (27%) reported involvement in prostitution, and 177 girls reported no history of prostitution at the baseline interview. Girls involved in prostitution were two times and five times more likely to have reported bingeing on alcohol and on drugs, respectively. A history of injection drug use was four times more likely to have been reported by girls involved in prostitution. Further, these girls were 2.5 times more likely to have reported injected cocaine as their drug of choice. Girls involved in prostitution were younger the first time they had consensual sex and were twice as likely to have reported anal sex. Consistent condom use for anal, vaginal, and oral sex was low for all girls. Girls involved in prostitution reported more risky sexual partners. In conclusion, girls involved in prostitution may be at increased risk of HIV infection due to their injection drug use and risky sexual behaviors. Unique intervention strategies are necessary for reducing HIV infection among female street youths involved in prostitution.

The Growing Popularity of Prescription Opioid Injection in Downtown Montréal: New Challenges for Harm Reduction

Starting in 2007, a 2-year study based on ethnographic methodology was carried out downtown Montréal, Canada. A thematic analysis of observational and interview-based notes was conducted. Illicit prescription opioid (PO) use was widespread among street-based participants. Injection was the main mode of PO administration observed among users. Some injection practices such as “doing a wash” could pose new challenges in terms of prevention of infections. More research is needed to examine the role of illicit PO use in the development of opiate addiction and to better understand drug-using contexts that put PO users at risk of infections. The studys limitations are noted.

Predictors of initiation into prostitution among female street youths

Prostitution among female street youths represents an important risk factor for several health problems. Little is known about the incidence and determinants of prostitution in this vulnerable population, and no data have been previously reported based on a longitudinal follow-up study. The objective of this study was to determine predictors of initiation into prostitution among female street youths. Female youths aged 14 to 25 years were enrolled in the Montreal Street Youth Cohort. They completed a baseline and at least one follow-up questionnaire between January 1995 and March 2000. Girls who reported never having engaged in prostitution at baseline were followed prospectively to estimate the incidence and predictors of prostitution. Of the 330 female street youths enrolled as of September 2000 in the cohort, 148 reported no history of involvement in prostitution at baseline and completed at least one follow-up questionnaire. Of these 148 girls, 33 became involved in prostitution over the course of the study (mean follow-up 2.4 years), resulting in an incidence rate of 11.1/100 person-years. Multivariate Cox regression analysis revealed having a female sex partner (adjusted hazard ratio [AHR] 3.8; 95% confidence interval [CI] 1.6–9.1) was an independent predictor of initiation into prostitution after controlling for having been on the street at age 15 years or younger (AHR 1.8, 95% CI 0.9–3.8), using acid or phecyclidine (PCP; AHR 2.0, 95% CI 0.9–4.6), using heroin (AHR 1.9, 95% CI 0.7–5.5), the use of drugs greater than twice perweek (AHR 1.9, 95% CI 0.9–4.2), and injection drug use (AHR 0.8, 95% CI 0.3–2.4). The incidence of prostitution in female street youths was elevated. Having a female sex partner was a strong predictor of initiating involvement in prostitution.

Hepatitis C virus incidence among young street-involved IDUs in relation to injection experience

BACKGROUND Young injection drug users (IDUs) are at very high risk of hepatitis C virus (HCV) infection. Using a time scale starting at first injection, we studied the period of HCV susceptibility after initiation into drug injection among street-involved IDUs. METHODS A prospective cohort study was carried out among street youth from 2001 to 2005. Semiannual interviews included completion of an interviewer-administered questionnaire and collection of blood samples for HCV antibody testing. HCV-negative subjects currently injecting drugs (last six months) were included in the analyses. Follow-up started at first questionnaire where current injection was reported and ended at seroconversion or at last questionnaire. Poisson regression was used to assess the predictive power of time elapsed since initiation on incidence rate. Kaplan-Meier technique was used to estimate cumulative infection probabilities. RESULTS Among the 858 cohort participants, 145 were injecting at baseline and 60 were injecting at a subsequent questionnaire (45 youth had started injection and 15 had resumed injection). Mean age was 20 years and 62% were males. In the 395 person-years of follow-up, 61 subjects contracted HCV. The HCV incidence rate increased from 16.1/100 person-years during the first year following first injection to 22.4 in the third year, and then decreased to 7.2 in years 7-13 (p=0.02). Median time to seroconversion after first injection was 3.3 years. CONCLUSION The first years after first injection is the period during which vulnerability to HCV is greatest. Our results show the importance of intervening with new IDUs to optimize the chances to successfully prevent infection.

Cessation of injecting drug use among street-based youth

Young injecting drug users (IDUs) are at high risk for a number of negative health outcomes such as hepatitis B, hepatitis C, and human immunodeficiency virus (HIV) infection. However, very little is known about injecting drug-use patterns among this population, particularly with respect to cessation of injection. We sought to identify the factors associated with cessation of injection in a population of young street-based IDUs. A prospective cohort study design was used to assess long-term (≥1 year) cessation of drug injection. Data was collected between January 1995 and September 2000 in Montreal, Québec, Canada. Subjects were originally recruited from various street-based outreach programs in Montreal and, for this study, had to have reported injecting drugs within the prior 6 months at baseline or during follow-up and had to have completed at least two semiannual follow-up questionnaires. Cessation incidence rates stratified by duration of injection and adjusted hazard ratios (AdjHRs) were calculated. A Cox proportional hazards regression model was used to identify risk factors independently associated with cessation of drug injection. Of 502 young IDUs, 305 subjects met the inclusion criteria. Cessation of injection for approximately 1 year or more occurred in 119 (39%) of the young IDUs. The incidence of cessation was 32.6/100 person-years but consistently declined as duration of time spent injecting increased. Independent predictors of cessation of injection were currently injecting on a less than monthly or less than weekly basis (HR=6.4; 95% confidence interval (CI): 3.0–13.6 and HR=2.4; 95% CI=1.1–5.3, respectively); currently injecting two or fewer different types of drug (HR=2.1; 95% CI=1.1–4.0); currently employed (HR=1.7; 95% CI=1.1–2.7); and having at least one parent born outside of Canada (HR=1.4; 95% CI=1.1–1.7). Independent predictors of not ceasing injection were currently attending a needle-exchange program (HR=0.5; 95% CI=0.3–0.8); and current homelessness (HR=0.6; 95% CI=0.4–1.0). The early sharp decline in cessation of drug injection followed by a consistent decrease in this rate suggest difficulties in breaking the habit later on in the drug injecting career. Intensity of drug use and factors which may help to stabilize the social environment of the young IDU may also influence the ability to stop injecting.