Kirsten Trayner

I am a PhD student at Glasgow Caledonian University (GCU) and Honorary Epidemiologist at Health Protection Scotland (HPS). My PhD is focused on understanding harms, mainly BBVs, associated with injecting drug use (IDU) and interventions which can be implemented to improve health and social outcomes among people who inject drugs (PWID). A large proportion of my PhD is dedicated to understanding the epidemiology and the response to the largest documented outbreak of HIV in over 30 years among PWID, concentrated in Glasgow city centre.

Increased risk of HIV infection and other drug-related harms associated with injecting in public places

Background: Injecting drugs in public places is regarded as a proxy for high risk behaviour among people who inject drugs (PWID), studies quantifying the risk of multiple drug-related harms associated with this practice are lacking and none have examined this in the context of a major HIV outbreak.

Aims: 1) Estimate the prevalence of public injecting in Scotland and associated individual and environmental risk factors; and 2) estimate the association between public injecting and related harms (HIV, chronic Hepatitis C (HCV), overdose and skin and soft tissue infection (SSTI)).

Design: National cross-sectional, bio-behavioural survey. Logistic regression was undertaken.

Setting: Participants were recruited from 139 harm reduction services in Scotland during 2017-18.

Participants: 1478 PWID (injected in the last 6 months).

Measurements: Self-report of recent public injecting, overdose and SSTI. Dried blood spot testing was used to determine HIV and HCV status.

Findings: Prevalence of public injecting was 16% overall and 47% in Glasgow city centre. Factors associated with public injecting were being recruited in Glasgow city centre (aOR=6.27, 95% CI 3.92-10.02, P<0.001), recent homelessness (aOR=3.71, 95% CI 2.59-5.31, <0.001), excessive alcohol consumption (aOR=2.56, 95% CI 1.78-3.70, <0.001), high injection frequency (aOR 3.06, 95% CI 1.82-5.15, <0.001) and cocaine injecting (aOR=1.47, 95% CI 1.00 to 2.17, p=0.048). Public injecting was associated with an increased risk of being HIV positive (aOR 2.11, 95% CI 1.13-3.92, p=0.019), chronic HCV (aOR 2.54, 95% CI 1.81-3.58, <0.001) overdose (aOR 1.71, 95% CI 1.37-2.13, <0.001) and SSTI (aOR 1.54, 95% CI 1.26-1.89, <0.001).

Conclusions: These findings highlight the need to address the additional harms observed among people who inject in public places and provide evidence to inform proposals in the UK and elsewhere to introduce facilities that offer safer drug consumption environments.

Poster link: Increased risk of HIV infection and other drug-related harms associated with injecting in public places