Information exchange among injecting drug users: a role for an expanded peer education workforce

https://doi.org/10.1016/j.drugpo.2004.07.004Get rights and content

Abstract

Hepatitis C incidence continues to be high among people who use injecting drugs (IDUs), particularly those in late teenage years, which corresponds with the typical age of initiation of injecting. Initiates are rarely, if ever, in touch with services supplying safe injecting information. Alternative ways of providing this information are needed. This study included a quantitative survey of 336 young IDUs (<25 years) from three sites in Australia. A sample of 24 young IDUs also participated in in-depth qualitative interviews. Quantitative results indicated that the majority of participants acquired information from formal sources such as pamphlets and NSPs. However, interview data suggest that information acquisition occurred well after initiation: initiates possessed at best “common sense” knowledge about injecting. The majority of survey participants passed on information to their peers. However, the qualitative data show that many issues were discussed among injectors, not only safe injecting, and that inaccuracy of information from some IDUs could result in perpetuation of myths and misinformation. These findings suggest a need to expand the scope and content of peer education activities by building on the demonstrated culture of information exchange between IDUs. Particularly useful may be a workforce model of peer education managed by non-government organisations.

Introduction

Recent reports indicate a doubling of hepatitis C incidence among 15–19 year olds in Australia (Dore et al., 2003). This age bracket corresponds with the age at which initiation to injecting drug use typically occurs (Swift, Maher, & Sunjic, 1999). People new to injecting drug use, or near-initiates, need information about safe injecting relevant to prevention of hepatitis C transmission. This includes information about possibilities of transmission through sharing of needles and syringes as well as other equipment and injecting paraphernalia (Crofts, Aitken, & Kaldor, 1999). However, initiates are unlikely to be in contact with services which provide this information. This scenario suggests a need to examine alternative ways to deliver information about safe injecting practice to this high risk age group.

New injectors often know little about injecting, what to expect during injection, or how to engage in it safely (Claire, 1995). New users are less likely than more experienced users to have knowledge that might motivate them to protect themselves from drug-related harm. There may be a tendency on the part of new injectors to reject messages from official sources as ‘scare tactics’ (Kleinman, Goldsmith, Friedman, Hopkins, & Des Jarlais, 1990).

However, in some cases, novice injectors may have witnessed previous injections, and therefore have gained some vicarious knowledge, or explicit tuition, in injecting technique and the consequences of injecting, both good and bad (Claire, 1995; Swift, Maher, & Sunjic, 1999). If initiates possess any other types of knowledge about health issues around injecting, use of particular drugs, amounts, combinations, and the basic survival skills needed to be a safe drug injector, these are also likely to have been obtained from more experienced injectors (Claire, 1995; Power, Jones, Kearns, Ward, & Perera, 1995).

It is unusual for the first injection to be taken alone. Claire (1995) reported that initiation of injection usually takes place in the presence of a more experienced injector who oversees the injection process and teaches the novice injector how to prepare a safe drug mixture. Most studies reveal that injectors were initiated by a sexual partner (Pierce, 1999, Power, 1989; Powis, Griffiths, Gossop, & Strang, 1996; Rhodes & Quirk, 1998), friend (Louie, Krouslos, Gonzalez, & Crofts, 1998; Pierce, 1999, Power, 1989, Stephens, 1991), or acquaintance (Stephens, 1991): it is rare to be initiated by a stranger. Most people who inject drugs (IDUs) report that their first injection occurred in social circumstances and, for many, their first injection appears to have been largely spontaneous in nature (Stephens, 1991). The novice injector may be quite unprepared for injecting (Claire, 1995). Crofts, Louie, Rosenthal, and Jolley (1996) suggest that the way in which a person is first initiated into injecting is likely to influence that person's future injecting practice and risk-taking behaviour.

Access to safer injecting information is vital for the prevention of hepatitis C transmission among people who inject drugs. As initiation to injecting drug use typically occurs in a social setting and as the initiation experience is likely to influence subsequent injecting practices, the networks formed around injecting may have significant impact on information exchange within these networks. This paper examines knowledge levels and information exchange among young injectors in relation to key variables such as location, drug of choice, age of initiation, HCV status and risk practice. Quantitative survey data are used to report patterns of information exchange and qualitative interview data to illustrate and extend understanding of information access and exchange at initiation and later in injecting drug use.

Section snippets

Quantitative survey

All participants were required to be between 16 and 25 years of age, to report an injecting history of four years or less and to have injected illicit drugs in the past six months. Data for calculating response rates were not collected.

Participants were recruited between December 2000 and February 2002 by convenience sampling from three sites on east coast Australia: urban Sydney, urban Brisbane, and the rural Northern Rivers area of New South Wales (NSW). Recruitment fliers were posted in

Quantitative sample

The sample comprised 336 participants: 165 (49%) in Sydney, 119 (35%) in Brisbane and 52 (15%) in Northern Rivers. Participants were 16–25 years of age, with a mean age of 21.2 years. Forty-one percent of the sample was female, and 58 percent male. Three participants described themselves as ‘transgender’. Most participants were born in Australia (86%) and identified as heterosexual (73%) (Table 1). Most participants had completed up to and including year 10 schooling (64%) and relied on

Discussion

This quantitative and qualitative study with young IDUs shows that the majority of participants had passed on some information to other injectors concerning safe injecting, prevention of blood-borne viruses and related issues. However, this information was rarely discussed or made available at the time of initiation or prior to initiation. Instead, it was accumulated gradually by participants after initiation and with subsequent exposure to injecting networks. Typically initiates possessed at

Acknowledgements

This study was funded by grants from the National Health and Medical Research Council (NHMRC) of Australia and NSW Health Department. Thanks to the advisory group for the project and NCHSR researchers: Jan Copeland, Ingrid van Beek, John Howard, Annie Madden, Anne Maree Weatherall, Susan Kippax, June Crawford, Tamo Nakamura, Erica Southgate, Loren Brener, Lucy Zinkiewicz.

References (28)

  • N. Crofts et al.

    Blood-borne virus infections among Australian injecting drug users: Implications for spread of HIV

    European Journal of Epidemiology

    (1994)
  • N. Crofts et al.

    A history of peer-based drug-user groups in Australia

    The Journal of Drug Issues

    (1995)
  • N. Crofts et al.

    The first hit: Circumstances surrounding initiation into injecting

    Addiction

    (1996)
  • Davis, M., Rhodes, T., & Martin, A. (2004). Preventing hepatitis C: ‘Common sense’, ‘the bug’ and other perspectives...
  • Cited by (38)

    • Development, validation, and potential applications of the hepatitis C virus injection-risk knowledge scale (HCV-IRKS) among young opioid users in New York City

      2019, Drug and Alcohol Dependence
      Citation Excerpt :

      Another analysis that included data from this NYC sample as well as from PWID in Russia and Columbia demonstrated the willingness of PWID to spread knowledge to prevent the spread of infections (Mateu-Gelabert et al., 2018). Other research has shown information exchange among PWID to be common, though accuracy is a concern (Ellard, 2007; Treloar and Abelson, 2005). A widespread effort to increase HCV knowledge among PWID in regions where drug injection is expanding could lead to more effective prevention efforts as PWID essentially serve in the unofficial role of harm reductionists as they share knowledge with members of their drug-using networks.

    • Circumstances and contexts of heroin initiation following non-medical opioid analgesic use in New York City

      2016, International Journal of Drug Policy
      Citation Excerpt :

      Although we did not explore in-depth why this disconnect existed, in New York City, harm reduction programs are often located in high-poverty neighborhoods and serve clients who are predominantly male, older than 35 years, and Hispanic (New York State AIDS Institute, nd). New heroin initiates are unlikely to utilize these services (Treloar & Abelson, 2005), which provide education and counseling to participants. Alternative approaches to reaching new heroin initiates with prevention and risk reduction messaging targeting transitions, overdose, blood-borne infection (such as HIV and HCV), and treatment access are needed.

    • Peer helpers' struggles to care for "others" who inject drugs

      2015, International Journal of Drug Policy
      Citation Excerpt :

      Natural helpers considered educating new users to be a particularly important part of their harm reduction role. In keeping with other research (Harocopos, Goldsamt, Kobrak, Jost, & Clatts, 2009; Treloar & Abelson, 2005), the natural helpers in this study indicated that the hidden nature of injecting left them responsible for “how to” training. First-time users wouldn’t know.

    View all citing articles on Scopus
    View full text