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Injecting risk behaviours amongst people who inject drugs

Lucy Tran
image - Lucy Tran Square

It is estimated that between 10.2 and 23.7 million people worldwide inject illicit drugs. Among people who inject drugs (PWID), those who engage in injecting risk behaviours are at increased of blood-borne viruses, such as HIV, hepatitis C virus (HCV) and hepatitis B virus (HBV), as well as bacterial infections. Injecting risk behaviours can include sharing injecting equipment such as needles/syringes, filters and spoons, and reusing one’s own equipment for multiple injections.

There are a range of factors that are associated with why an individual might engage in injecting risk behaviours. These factors could be individual-specific (e.g., age, gender, housing) or community-specific (e.g., region, availability of needle-syringe programmes and opioid agonist treatment). Country-specific factors could potentially be associated with engagement in injecting risk behaviours by affecting attitudes towards and marginalisation of PWID. However, studies about the prevalence of injecting risk behaviours and the factors associated with this have mostly focused on an individual country.

Our recent systematic review looked to estimate global, region and country prevalence of different injecting risk behaviours and individual and country factors associated with these behaviours. From 464 studies focusing on 88 countries, we estimated that globally 17.9% (95%CI: 16.2 - 19.6%) of PWID at last injection, used a needle/syringe after someone else has used it (receptive needle sharing). Furthermore, 32.8% (95%CI: 28.6–37.0%) PWID reported receptive needle sharing in the past 6-12 months.

Additionally, we also found that:

Injecting risk behaviours varies greatly country to country, region to region.

Though data was not available for all countries who reported PWID, we found that country estimates ranged from 8.5% (95%CI: 8.0 – 9.0%) in Ukraine to 80.6% (95%CI: 71.3 – 90.0%) in Azerbaijan for receptive needle sharing in the past month. This was also reflected in the regional estimates of past month receptive needle sharing with Western Europe estimated 9.8% (95%CI: 7.1 – 12.5%) compared to Middle East and North Africa with an estimated 33.5% (95%CI: 5.4 – 61.7%) of PWID reporting the behaviour.

There are both individual and country level factors that are associated with higher receptive needle sharing in the past month

Our analyses found that studies reporting more males, shorter mean injecting durations, and injecting daily or more was associated with greater past month receptive needle sharing. Studies that were conducted more recently was associated with lower past month receptive sharing.

On a country or regional level, studies conducted in Western Europe, Australasia and East/South east Asia were associated with lower engagement in receptive needle sharing. It was also found that countries who had greater NSP coverage (i.e., more needles/syringes were distributed per PWID per year) was associated with lower reporting of receptive needle sharing.

This review presents a small piece of the greater complex issue about how to better reduce the harms associated with injecting drugs. It is encouraging to see that increased NSP coverage is associated with lower receptive sharing among PWID. However, data about injecting risk behaviours was only reported for 88/179 countries with evidence of PWID. Therefore, to gain a more complete view of the prevalence of injecting risk behaviours, we need to gain a better understanding of those countries where no data was reported.