RAPID ASSESSMENT, RESPONSE AND EVALUATION PROJECT: THE CONTEXT OF INJECTION DRUG USE IN VICTORIA, BC

Recent epidemiologic evidence indicates that the prevalence of HIV infection among injection drug users in Victoria increased from approximately 5% in 1993 to 21% in 1999. A rapid assessment, response and evaluation project was undertaken in 2000 to assess the context of injection drug use, to identify the risk behaviours of those injecting drugs, and to ascertain the effectiveness of harm reduction activities. Key informant interviews and focus groups were conducted with IDU, service providers and community leaders/policy makers. Observations were undertaken in drug use ‘hot spots’ along with mapping of risk activity and service locations, needle disposal sites and locations of drug overdoses in the preceding year. A survey questionnaire was used to describe the IDU study participants. Among IDU study participants, the majority had injected both cocaine and heroin in the preceding month; over 30% had travelled to or lived elsewhere in the preceding six months, most often to Vancouver; over 80% were obtaining some or all their income through drug dealing, panhandling or working in the sex trade. Most had shared equipment. Fifty per cent self-identified as hepatitis C-positive; and 25% as HIV-positive. Study participants identified gaps in harm reduction services (eg, limited hours for the single fixed site needle exchange; no mobile harm reduction service) and limited access to addiction treatment. The negative attitudes of health care providers and their lack of underrstanding of addiction issues limited access to care for IDU. A growing number of youth, expecially females, are injecting heroin, and there is a lack of prevention and harm reduction services for them. The ethnographic data from RARE were supplemented with available epidemiologic and surveillance data to create a composite picture of injection drug use and transmission of HIV in the community. This information is the basis for developing the community response to injection drug use.

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