At-risk youth who live in neighbourhoods where injection drug use is prevalent are significantly more likely to start injecting drugs themselves, lending support to the idea that prevention and intervention measures are most effective when targeted at high-risk areas.
The finding is the takeaway message from a new six-year study by B.C.'s Centre of Excellence in HIV/AIDS. The study, which focused on Vancouver, found "street-involved youth" who lived in the Downtown Eastside were more than twice as likely to start injecting intravenous drugs than those who lived elsewhere in the city.
Evan Wood, senior author of the study and Canada Research Chair in Inner City Medicine at the University of British Columbia, says it supports the idea that prevention and intervention strategies that target the general population simply don't work.
"[It shows] the shotgun approach to having someone come into high schools, or having advertisements on television, really, that those things have been proven ineffective," he said. "We need to start looking at high-risk populations and evidence-based interventions that can be employed to try and prevent this type of really problematic behaviour."
The study included 422 participants between the ages of 14 and 26, who spent a significant amount of time on the street but were not necessarily homeless, Dr. Wood said. At the start of the study, in September, 2005, all of these participants were using drugs other than marijuana and alcohol – but none had injected drugs. (More than 500 other youths who were recruited were ultimately excluded either because they had previously injected or failed to return for follow-up visits.) Of the 422 participants, 98 reported living in the Downtown Eastside, while the remaining 324 lived elsewhere in the city.
By the end of the study period, in November, 2011, investigators found 43.8 per cent of participants living in the Downtown Eastside had injected drugs, compared to 19.7 per cent of those living elsewhere in the city.
"The takeaway message from this is, clearly, that youth that are living in the Downtown Eastside are transitioning into drug injecting at a much higher rate, despite the overall high-risk profile and, to be frank, the very high-risk environments that exist on the street outside of the Downtown Eastside," said Dr. Wood, noting the need for physicians with specialized training in such areas.
The study results also suggest there is value in not clustering supportive housing in high-risk neighbourhoods.
"I think you need to be strategic with housing and where you're placing people that are vulnerable as a result of their addiction," Dr. Wood said. "Certainly, for people who are early in their careers as being addicted to drugs or alcohol, getting them away from environments where drugs are so freely and easily available just makes sense."
Injection drug use is a major risk factor in the transmission of hepatitis C and HIV. While there remains a considerable problem with the smoking of crack cocaine in Vancouver's Downtown Eastside, Dr. Wood said new cases of HIV have dropped by more than 90 per cent since the late 1990s due to various interventions, including the distribution of clean needles.
Last week, three injection drug users filed a lawsuit over an Abbotsford bylaw that forbids harm-reduction measures including needle exchange programs and supervised injection sites. Councillors had agreed in 2010 to review the bylaw, approved five years earlier, and in March, directed staff to prepare a draft bylaw. It is not known when that might return to council.