Environmental Scan of Injection Drug Use, Related Infectious Diseases, High-risk Behaviours, and Relevant Programming in Atlantic Canada

San Patten, MSc.

Prepared for
Public Health Agency of Canada
Atlantic Regional Office

March 2006

PDF Format (606 KB)

The opinions expressed in this publication are those of the author and do not necessarily reflect the views of the Public Health Agency of Canada.

Également disponible en français sous le titre : Utilisation de drogues injectables, maladies infectieuses connexes, comportements à risque élevé et programmes pertinents : analyse de l’environnement au Canada atlantique

Contents may not be reproduced for commercial purposes, but any other reproduction, with acknowledgements, is encouraged. Please credit the source as follows:

Environmental Scan of Injection Drug Use, Related Infectious Diseases, High-risk Behaviours, and Relevant Programming in Atlantic Canada, 2006. Produced by San Patten, MSc., for the Public Health Agency of Canada, Atlantic Regional Office.

For more information contact:

Atlantic Regional Office
Public Health Agency of Canada
1525 - 1505 Barrington Street
Halifax NS B3J 3Y6
Tel: (902) 426-2700
Fax: (902) 426-9689
Email: atlantic-atlantique@phac-aspc.gc.ca
Web site: atlantic.phac.gc.ca

© Public Health Agency of Canada 2006

TABLE OF CONTENTS

ACKNOWLEDGEMENTS

LIST OF TABLES

LIST OF CHARTS

EXECUTIVE SUMMARY
Purpose and Background
Summary of Findings
Program and Policy Gaps

INTRODUCTION
Background
Rationale
Purpose
Target Audience
Methodology
Study Limitations

A POPULATION HEALTH APPROACH TO UNDERSTANDING INJECTION DRUG USE
Population Health
The Link Between Social/Economic Exclusion and Health
The Link Between Social Determinants of Health and Injection Drug Use

GENERAL DESCRIPTION OF INJECTION DRUG USE IN ATLANTIC CANADA
Estimated Number of People Who Inject Drugs
Types of Drugs Being Injected
Drugs of Choice
Procurement of Injection Drugs
Social Context of Injection Drug Use

SNAPSHOT OF HIV, HEPATITIS B, AND HEPATITIS C RATES AND RISK BEHAVIOURS IN PEOPLE WHO INJECT DRUGS IN ATLANTIC CANADA
High-risk Injection Behaviours
High-risk Sexual Behaviours
HIV Prevalence and Incidence
Hepatitis B Incidence
Hepatitis C Incidence
HIV and Hepatitis C Co-infection

POPULATION-SPECIFIC ANALYSIS OF INJECTION DRUG USE IN ATLANTIC CANADA
Youth
Women
People Who Live in Urban Versus Rural Areas
Ethno-cultural Minorities
Prison Populations
People Who Inject Anabolic Steroids

PROGRAM AND POLICY ENVIRONMENT IN ATLANTIC CANADA
Introduction
Substance Abuse Prevention Programs
Community Outreach and Needle Exchange Programs
Addiction Treatment Service Providers
Health Care Services for People Who Inject Drugs
Corrections
Policy Makers and Funders
Research

SUMMARY AND ASSESSMENT OF PROGRAM AND POLICY GAPS
Overall Conclusions
Program and Policy Gaps

APPENDIX ONE: DEFINITION OF TERMS AND CONCEPTS

APPENDIX TWO: METHODOLOGY

APPENDIX THREE: DATA COLLECTION TOOLS

APPENDIX FOUR: KEY INFORMANTS

BIBILIOGRAPHY

ENDNOTES

 

LIST OF TABLES

Table 1		Estimated Number of People Who Inject Drugs in Atlantic Canada
Table 2		Proportion of Key Informants Who Believe That at Least Half of People Who Inject Drugs Engage in Risk Injection Behaviour
Table 3		Proportion of Key Informants Who Believe That at Least Half of People Who Inject Drugs Engage in Risk Sexual Behaviour
Table 4		Number of Positive HIV Test Reports by Province and Year
Table 5		Number (and Percentage) of Positive HIV Test Reports for People Who Inject Drugs (as Exposure Category) by Province/Territory and Year
Table 6		Number of Positive HIV Test Reports from November 1, 1985 to December 31, 2004 (all ages)
Table 7		Number of Positive Hepatitis B Test Reports by Province and Year, 1995 1999
Table 8		Number of Positive Hepatitis B Test Reports by Province and Year, 2000 2004
Table 9		Number of Positive Hepatitis C Test Reports by Province and Year
Table 10		Hepatitis C in the Federally Incarcerated Population, 2000-2004
Table A1		Key Informant Interviews: Planned vs. Completed
Table A2		Number of Interviews With People Who Inject Drugs

 

LIST OF CHARTS

Chart 1		Number of Positive HIV Test Reports by Province by Year
Chart 2		Number of Positive HIV Test Reports with IDU as Risk Factor by Province by Year
Chart 3		Number of Positive Hepatitis C Reports by Province and Year
Chart 4		HCV in the CSC Federally Incarcerated Population: National/Atlantic

 

ACKNOWLEDGMENTS

The author wishes to thank Pyra Consulting for the data collection and first draft of this report, as well as all of the individuals who participated in the interviews to support this project.

The Public Health Agency of Canada would like to thank the Advisory Committee which provided valuable input into the design and implementation of the environmental scan. The Advisory Committee met once in person to identify priority questions for the report and three times via teleconference to help identify key informants to participate in the scan, to provide input on data collection tools, and to receive regular progress reports. The Advisory Committee also reviewed and provided comments on several drafts of the report.

The members of the Environmental Scan Advisory Committee were:

Diane Bailey, Mainline Needle Exchange
Carla Burgess, Capital District Health Authority, Nova Scotia
Tracey Butler, John Howard Society of Newfoundland and Labrador
Carolyn Davison, Addiction Services, Nova Scotia Department of Health Promotion and Protection
Julie Dingwell, AIDS Saint John
Haley Faro, AIDS New Brunswick
Barbara Gibson, AIDS PEI
Leila Gillis, First Nations and Inuit Health Branch, Health Canada
Geri Hirsch, Capital District Health Authority, Nova Scotia
Susan Kirkland, Department of Community Health and Epidemiology, Dalhousie University
Odette LeBlanc-Pellerin, Correctional Service of Canada
David Lewis, Correctional Service of Canada
Robin MacArthur, Public Health Agency of Canada
Tracey MacDonald, Public Health Agency of Canada
Cynthia MacIsaac, Direction 180
Frances MacLeod, Sharp Advice Needle Exchange
Wayne McGill, Public Health Agency of Canada
Jeannine McNeil, Public Health Agency of Canada
Marvin McNutt, Newfoundland and Labrador Department of Justice
Joanne Murray, John Howard Society of Greater Moncton
Josephine Muxlow, First Nations and Inuit Health Branch, Health Canada
Kevork Peltekian, Hepatology Services, Queen Elizabeth II Health Sciences Centre
Robert Pike, Her Majesty's Penitentiary, Newfoundland and Labrador
Mary Swan, NCPC, Public Safety
Tree Walsh, AIDS Committee of Newfoundland and Labrador