9261 HEPATITIS C REPORT GALLEY - North West Public Health ...

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azors should not be shared and should be made aware of the risk to both staff and prisoners posed by blood shed in the environment. At present, there is no centrally co-ordinated education programme on hepatitis C for prisoners although individual prisons may have arrangements with local services, for example drugs agencies. Type of drug injected had a strong statistical relationship with probability of ever having been hepatitis C infected. It is probable that the injecting or illegal use of certain drugs acts as a proxy for chaotic behaviour and that chaotic behaviour rather than a specific drug of use is directly related to increased chances of infection. Thus, having injected methadone, DF 118, Diconal and morphine all resulted in a higher risk of hepatitis C infection. The greater the number of different drugs used or injected, the more likely the individual was to be positive. Despite the probability of only an indirect link, polydrug use can still be used as a risk factor for hepatitis C and a marker for those most at risk. Other studies find a relationship between types and combinations of drugs used and infection: for example, the use of cocaine in addition to heroin increases the risk of hepatitis C infection (Garfein et al. 1998). In contrast, steroid injectors have been found to have a very low prevalence of hepatitis B and HIV compared to heroin users, which has been attributed to steroid users’ injecting practices being more hygienic and less likely to share (Crampin et al. 1998). Steroid users are also likely to inject relatively infrequently (Lenehan & McVeigh 1998). 5.4 Effects of testing on risk behaviour In this study, subjects' perception of their hepatitis C status was not directly ascertained; instead, their history of previous tests was recorded. Thus, the 17 individuals who were hepatitis C positive but claimed that their previous test was negative may have had an incorrect recollection of their status or could have become infected (or passed through the incubation period) since their previous test. However, both alternatives are causes for concern. Either individuals had forgotten or not understood their result in which case the value of the test was reduced or they have continued with risk behaviour despite a negative test result. In fact, in our sample an individuals' previous test result did not affect current sharing behaviour: regardless of whether a previous test was negative or positive, around 6% had shared needles in the previous four weeks, and up to 40% had shared some form of injecting equipment over the same time period (Table 4). Importantly however, there was some indication that individuals who had taken a test (regardless of the result) may be less likely to be currently sharing. Table 4 shows that, although those who took a previous test were more likely to have shared all forms of equipment in the past (i.e. ever shared), they were less likely to have shared in the previous four weeks (although this just failed to reach significance). Furthermore, when the data were grouped into current (those who admitted sharing in the previous four weeks) and reformed sharers (those who had shared in the past but not in the previous four weeks), reformed H EPATITIS C IN INJECTING DRUG USERS IN THE N ORTH W EST 35
sharers were significantly more likely to be people who had taken a test (P = 0.045). Therefore, taking a test per se but not the result of the test appears to have some relationship with changing behaviour. In the case of sero-negative individuals this may be to retain their negative status. For sero-positives it may act to prevent infection of fellow users, or to prevent multiple infection with different strains or co-infection with hepatitis B or HIV. It is difficult to distinguish cause and effect. Presenting for the test in the first place may mean individuals have already made a decision to improve and protect their health or the test may allow intervention by a drugs worker to encourage behaviour change. Certainly, the test procedure presents an opportunity for the drugs worker to provide holistic appraisal of risk behaviour, for example to counsel about safer injecting behaviour, and encourage uptake of the hepatitis B vaccine and abstinence from alcohol abuse. Further research should address whether changes in risk behaviour identified in the study occur just prior to or just after testing. 5.5 Sharing behaviour This study identified an important link between the size of the group within which an individual injects and sharing behaviour. Sharing of needles and all types of paraphernalia was much more likely to happen if the user was injecting with just one other person present (Figure 4). Of those whose previous injecting occasion was with one other person, 54% had shared some form of injecting equipment in the previous four weeks, compared with 35% of those who injected with a larger group (two or more others). Many of the occasions of sharing with just one other person may be between sexual partners, in which case, sharing equipment may be seen as a sign of trust and intimacy (Rhodes & Quirk 1998). Harm reduction messages already explain the dangers of sharing but such messages on safer injecting practices should reiterate the fact that sharing with anybody else who injects drugs, be it friends or sexual partners, is a high risk activity for hepatitis C infection and other blood borne viruses. Of equal importance was the finding that sharing is more likely among those who have taken up injecting recently (i.e. within previous five years; Figure 5). This supports the importance of intercepting young users at the beginning of their drug taking careers to educate them in safer injecting behaviour. Harm minimisation policies should consider whether those not injecting, but who are progressing towards such drug use, need safer injecting information in order to reduce the increase in hepatitis C that occurs soon after injecting begins (Figure 2; Smythe et al. 1998; Lamden et al. 1998). Consequently, it is especially important that efforts are made to reach vulnerable groups of young drug users. Overall, it appears that while IDUs may have changed their behaviour regarding sharing of needles (in response to the HIV crisis), messages about the danger of other 36 H EPATITIS C IN INJECTING DRUG USERS IN THE N ORTH W EST
Page 1 and 2: Hepatitis C in injecting drug users
Page 3 and 4: S UMMARY Viruses such as HIV, hepat
Page 5 and 6: • Those who are infected with hep
Page 7 and 8: C ONTENTS Summary 2 Aims 2 Key Find
Page 9 and 10: 1. INTRODUCTION 1.1 Background Viru
Page 11 and 12: where sexual partners do get infect
Page 13 and 14: ehaviour at some stage in their dru
Page 15 and 16: likely to use a condom and less lik
Page 17 and 18: 2. AIMS AND O BJECTIVES Reviewing c
Page 19 and 20: 3.3 Testing Subjects gave blood and
Page 21 and 22: Table 1b: Basic results: behaviours
Page 23 and 24: Table 2: Hepatitis C and B status a
Page 25 and 26: Table 3: Effects of risk factors on
Page 27 and 28: Figure 3: Percentage of injecting d
Page 29 and 30: Table 5: Percentage (number) of sub
Page 31 and 32: 4.5 Predicting sharing behaviour Pe
Page 33 and 34: 4.6 Blood donation Of those who had
Page 35: 5.2 Co-infection between hepatitis
Page 39 and 40: 5.8 Conclusions and Recommendations
Page 41 and 42: R EFERENCES Allory Y, Charlotte F,
Page 43 and 44: Hepatitis Information Network (2000
Page 45 and 46: Tagger A, Donato F, Ribero ML, Chie

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