Aims. In the UK, 33%-56% of people who inject drugs (PWID) have Hepatitis C. HIV (0-1%) and Hepatitis B (6-18%) rates are lower. As part of a larger study to develop and test the feasibility of an evidence-based psychosocial intervention to prevent blood borne virus (BBV) infection among PWID in the UK, a sub-study was conducted exploring the influences on injection- and sexual- risk behaviour among PWID and the type of psychosocial interventions they would find useful.
Design. Qualitative interview study.
Setting. Sexual health services, needle exchanges, drug treatment/harm reduction services and homeless hostels in London, Yorkshire, Glasgow and North Wales.
Participants. Convenience sample of 60 ‘current injectors’ purposively sampled based on gender, length of time injecting, and drugs injected.
Measurements. In-depth interviews analysed using Framework Analysis.
Findings and conclusions. Individual, situational, and structural factors influenced BBV risks. Participants usually ascribed risk behaviour to the pressures of withdrawal, craving and intoxication. Lack of knowledge, injecting inexperience, and poor vascular access also promoted unsafe practices. Interpersonal relationships based on trust, intimacy and/or dominance, and group norms and dynamics, also influenced risk. Unstable housing and sex work diminished participants’ agency to manage risk. Opiate substitution treatment, stable housing, and a BBV diagnosis were some of the factors promoting behaviour change. Participants also pointed to the importance of access to clean injecting equipment and condoms. Individual, situational and structural factors drive vulnerability to BBV infection among PWID and multi-faceted interventions are necessary.
Ms April Shaw, Research Assistant, School of Media, Culture & Society, University of the West of Scotland Ms Sarah Towers, Blood Borne Virus Nurse, Betsi Cadwaladr University Health Board, NHS Wales Ms Noreen Mdege, Research Fellow, Department of Health Sciences, Faculty of Science, University of York Dr Noel Craine, Research Scientist, Microbiology Department, Public Health Wales Ms Kideshini Widyaratna, Research Assistant, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London Dr Alison Munro, Research Fellow, School of Media, Culture and Society, University of the West of Scotland Professor Liz Hughes, Professor of Applied Mental Health Research, University of Huddersfield Professor John Strang, Head of Department, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London Professor Avril Taylor, Professor of Public Health, School of Media, Culture & Society, University of the West of Scotland Dr Gail Gilchrist, Senior Healthcare Researcher in the Addictions, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London
Conflicts of interest:
National Institute for Health Research (NIHR), Health Technology Assessment (HTA) Programme