Information exchange among injecting drug users: a role for an expanded peer education workforce
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.
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2015, International Journal of Drug PolicyCitation 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.