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Vancouver, British Columbia, Canada

Vancouver, British Columbia, Canada. Risk factors for HIV infection among Aboriginal clients of a Supervised Injection Facility in Vancouver, Canada. M-J Milloy 1,2 T Kerr 1,3 M Tyndall 1,3 J Montaner 1,3 E Wood 1,3 British Columbia Centre for Excellence in HIV/AIDS

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Vancouver, British Columbia, Canada

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  1. Vancouver, British Columbia, Canada

  2. Risk factors for HIV infection among Aboriginal clients of a Supervised Injection Facility in Vancouver, Canada M-J Milloy1,2 T Kerr1,3 M Tyndall1,3 J Montaner1,3 E Wood1,3 British Columbia Centre for Excellence in HIV/AIDS School of Population and Public Health, University of British Columbia Department of Medicine, University of British Columbia

  3. Introduction • Study setting: • Explosive HIV outbreak in Vancouver, 1996- • Outbreak focused on injection drug users (IDU) in Downtown Eastside (DTES) • DTES: Urban area marked by poverty, homelessness & open drug market • Approx 20% of residents are Aboriginal

  4. Introduction • Aboriginal IDU in Vancouver: • Significantly elevated burden of HIV

  5. Figure 1. Cumulative HIV incidence rates by ethnicity in two prospective cohorts of IDU in Vancouver, Canada. (From Wood et al., 2008. American Journal of Public Health.)

  6. Introduction • Aboriginal IDU in Vancouver: • Significantly elevated burden of HIV • Less likely to access methadone maintenance therapy (MMT)

  7. Figure 2. Cumulative incidence of initiation of MMT in the Vancouver Injection Drug User Study (From Wood et al., 2007. CMAJ)

  8. Introduction • Aboriginal IDU in Vancouver: • Significantly elevated burden of HIV • Less likely to access methadone maintenance therapy (MMT) • Less likely to access antiretroviral therapy (ART)

  9. Figure 3. Cumulative probability of ART initiation among HIV+ IDU (from Wood et al., 2005. J of Infect.)

  10. Introduction • 2003: Supervised Injection Facility (SIF) pilot opened in DTES • SIF objectives: • To reduce HIV risk behaviours; • To reduce incidence of fatal overdose; • To increase uptake to drug treatment.

  11. Introduction • SIF evaluation findings: • 30% increase in recruitment to detox; • Consistent SIF use associated with improved injecting practices; • No increase in crime or degradation in public order; • Thousands of referrals to health & social services; • Over 800 onsite overdoses, no deaths.

  12. Objectives • To estimate the prevalence and factors associated with Aboriginal ethnicity in a representative sample of clients of a Supervised Injection Facility in Vancouver, Canada

  13. Methods • Scientific Evaluation of Supervised Injecting (SEOSI) prospective cohort • Interviewer-administered questionnaire • Dependent variable: Self-reported Aboriginal, First Nations, Métis or Inuit ethnicity • Univariate analyses (Chi-square & Wilcoxon) • Multivariate logistic regression

  14. Results • SEOSI cohort: • 1090 individuals recruited at random from SIF • 317 (29.1%) are female; • 211 (19.4%) reported Aboriginal, First Nations, Inuit or Métis ethnicity • Of those, 102 (48.3%) are female

  15. Discussion • Aboriginal SIF clients are more likely: • to be female (AOR 0.38); • to be HIV-positive (AOR 2.24); • to not be in drug treatment (AOR 0.56); • to report inconsistent condom use with regular partners (AOR 2.46)

  16. Discussion • SIF has attracted high-risk Aboriginal clientele • Aboriginal clients more likely to have several risk factors for HIV infection • Findings reinforce need for culturally-appropriate treatment services

  17. Acknowledgements • SEOSI participants • Staff of Insite, Vancouver Coastal Health and Portland Hotel Society • Study staff, specifically Deborah Graham, Leslie Rae, Tricia Collingham, Caitlin Johnson, Steve Kain and Calvin Lai • SIF evaluation originally made possible by financial contribution from Health Canada; the views expressed herein do not represent their official policies. • SIF evaluation currently supported by Canadian Institutes of Health Research and Vancouver Coastal Health • Thomas Kerr and Mark Tyndall are supported by the Michael Smith Foundation for Health Research

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