Many Injection Drug Users Infected With Hepatitis C Continue To Share Needles or Drug Paraphernalia, Study Says
The majority of injection drug users who are infected with hepatitis C continue to share needles and other drug paraphernalia after learning of their diagnosis and receiving information about the disease, suggesting that routine risk reduction counseling may be of "limited benefit," according to a study published in the Oct. 1 issue of Clinical Infectious Diseases. Researchers from Johns Hopkins University, the New York Academy of Medicine and Columbia University analyzed data taken from the Risk Evaluation and Community Health II Study, a study of HIV risk among young injection drug users in Baltimore. Participants were tested for hepatitis C and HIV at baseline and were given their test results and post-test counseling two weeks after the baseline visit. Follow-up evaluations were conducted six months after the baseline visit. Counseling included information on hepatitis C and HIV risk reduction, and participants were told of the location and operating times of the Baltimore City Needle Exchange Program. Additional information about hepatitis C infection and substance abuse treatment was also given, and participants were counseled to avoid sharing needles, syringes and other injection equipment to reduce the risk of hepatitis C transmission. The study compared 46 participants who tested positive for hepatitis C antibodies at baseline and were notified of their diagnosis at least three months prior to the six-month follow-up visit (hepatitis C group) with 60 participants who either tested negative for hepatitis C or tested positive for hepatitis C but did not receive their diagnosis at least three months prior to the six-month follow-up visit (non-hepatitis C group). The scientists evaluated whether participants had changed their behavior with regard to direct or indirect sharing of needles, cookers, cotton filters and rinse water.
Needle Sharing Steady
The study states that overall only 17% of participants reported decreasing their frequency of sharing needles, while 15.1% of participants reported a decrease in "backloading," a procedure in which drugs are injected from one syringe into the barrel of another syringe. Nearly 35% of participants infected with hepatitis C reported either increasing or not changing their frequency of needle sharing, while 76.1% of hepatitis C-positive participants increased or did not change their frequency of backloading. Overall, between 23% and 29% of participants decreased their frequency of sharing drug paraphernalia, but more than 50% of the hepatitis C group either increased or did not change their frequency of sharing cookers and rinse water. Fifteen percent of the hepatitis C group was also infected with HIV, and coinfected individuals were more likely to decrease their frequency of direct needle sharing and indirect sharing of paraphernalia.
The CDC in 2001 published its National Hepatitis C Prevention Strategy, which emphasizes education, counseling and testing, but a more comprehensive prevention strategy is needed, the study states. The finding that fewer than 20% of participants decreased direct or indirect needle sharing suggests that "risk reduction counseling is of limited benefit," the researchers write. "Young hepatitis C-positive IDUs continue to engage in behaviors that can result in transmission of hepatitis C to others, while hepatitis C-negative IDUs continue to engage in behaviors that place them at risk for hepatitis C acquisition," the study states. Noting that many injection drug users may be unaware of the risks of sharing drug paraphernalia, the researchers suggest that public health officials undertake more efforts to reduce the sharing of injection equipment. The researchers conclude that targeted behavioral interventions and broader hepatitis C treatment is vital to lowering the frequency of high-risk behaviors and suggest that substance abuse treatment, education, counseling and testing be combined with skills training for injection drug users (Ompad et al., Clinical Infectious Diseases, 10/1).