Profile of Hepatitis C & Injection Drug Use in Canada

Introduction

During the mid-1980s the sharing of needles and syringes became recognized as a major route of human immunodeficiency virus (HIV) transmission among persons who inject drugs. More recently, there has been growing international concern about the spread and prevalence of other blood-borne viruses among those who inject drugs, in particular the hepatitis C virus (HCV). Worldwide prevalence estimates range from 50% to 100% infection rate among drug injecting populations (Finch, 1998). Currently, injection drug use (IDU) is the most important mode of transmission of HCV in Canada, accounting for approximately 70% of all prevalent infections (LCDC, 1999). Statistics generally show that between 75% and 85% of individuals infected with HCV will become chronically infected (LCDC, 1999; MRC, 1999). Of these, approximately one-third will develop cirrhosis followed by end stage liver disease, and a small proportion (1% to 5%) will subsequently develop liver cancer (MRC, 1999).

The high rates of HCV infection among populations that inject drugs, the highly efficient transmission associated with the sharing of syringes and other drug equipment, and a steady addition of initiates into IDU have resulted in continued high rates of HCV infection (Crofts et al., 1997). For these reasons people who inject drugs are a key group, and centrally important to the persistence of this virus in Canada. For the most part, interventions designed to prevent HCV infections have been add-ons to existing HIV or sexually transmitted disease (STD) initiatives, and have not had a measurable impact on HCV rates in Canada (LCDC, 1999). To effectively address this issue, it is necessary to understand the unique relationship between HCV and IDU, as differentiated from other blood-borne viruses.

This document summarizes available information regarding the prevalence of HCV and IDU in Canada, demographic characteristics of those who inject drugs in Canada, and the identification of high-risk behaviors. The information contained in this profile will raise awareness and understanding of the nature of HCV infection among IDU populations in Canada, thereby providing direction for future initiatives and programming in this area.

Methodology

This report represents a synopsis of the draft report "A Socio-Demographic Profile of Drug Users in Canada", that was prepared for the HIV/AIDS Division by Dr. Eric Single, as well as a summary of research pertinent to the relationship between IDU and HCV. Although the focus is the Canadian context, research from other jurisdictions is included to further validate observations made by Canadian researchers.

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