BackgroundIntravenous drug use has been predominantly practised since illegal heroin use became known in Germany in the early 1970s. The available data suggest that the risk of accidental overdose when smoking heroin is substantially reduced compared to injecting a substance of unknown purity and quality. Moreover, the risk of transmitting HIV, Hepatitis B or C via blood contact is considerably reduced when smoking heroin rather than when injecting it intravenously. In spite of the significant strain on the lungs and the respiratory tract caused by smoking, it can be concluded that inhalative use - measured by the indicators ‘overdose’ and ‘viral infections’ is considerably less dangerous than intravenous use. Despite these harm-reducing effects of inhalative use, there is only very limited scientific survey on this subject. The project ‘SMOKE IT!’ studied to what extent a change of the consumption method can be supported by making new equipment for drug use available.Method‘SMOKE IT!’ was carried out as a multi-centre survey in drug consumption rooms (DCRs) in five German cities. Participants received ‘SMOKE-IT!’ packs that contained new heroin smoking foils, as well as information about inhalative drug use. The quantitative data collection was aided by a written questionnaire filled out at three different stages in 2012.ResultsThe vast majority of the 165 respondents favoured using the foils from the ‘SMOKE-IT!’ packs (82.5%). The survey shows that two-thirds of the sample used the SMOKE-IT foils for inhaling instead of injecting. Almost six out of ten said that smoking was healthier than injecting. Thirty-five percent of the participants named the reduced risk of a hepatitis or HIV infection as a particularly important factor. A third of the respondents used the smoking foils to avoid the danger of an overdose.ConclusionsTargeted media and personal intervention in association with the dispensation of attractive drug use equipment can motivate opiate users to change their method of drug use. The main reason for inhalative use is that it is significantly less dangerous, measured by the indicators ‘overdose’ and ‘viral infections’. All drop-in centres should expand their syringe-exchange services to include the dispensation of smoking foils.

BackgroundPeople who inject drugs are at high risk for hepatitis B, hepatitis C and HIV. HTLV was reported by neighboring countries to be prevalent in this population, but the situation for Germany is unclear. To generate seroprevalence and related behavioural data and to enhance prevention efforts against these infections for drug users in Germany, a multicentre sero- and behavioural survey was initiated. People who inject drugs are not well reached by services for testing and counselling for blood-borne infections in Germany. An interventional part of the study is intended to prove feasibility and acceptance of testing and counselling in low-threshold drop-in settings.Methods/DesignBetween May 2011 and March 2015, eligible participants (persons having injected drugs within the last 12 months, aged 16 years+, and living in the study city) are recruited by respondent driven sampling, using low-threshold drop-in facilities as study-sites in eight German cities with large drug scenes. Calculated sample size is 2,033 participants. Capillary blood samples collected as dried blood spots are anonymously tested for serological and molecular markers of hepatitis B and C, HIV, and HTLV I and II. A detailed face-to-face-interview about hepatitis- and HIV-related knowledge, former testing, imprisonment, sexual and injecting risk behaviour is conducted with participants. Staff is trained to offer pre- and post-test-counselling of blood-borne infections and HIV rapid testing to participants.DiscussionWe chose respondent driven sampling for recruitment of participants to improve representativeness of results. Persons, who are not reached by the facility where the study is conducted, are aimed to be included by recruitment through their personal social network of injecting drug users. To reduce differential biases in the questions on knowledge of transmission and prevention of infections, we present true statements on hepatitis B, C and HIV, their possible routes of transmission and measures of prevention to participants. Participants are told that the statements are true and are asked to answer if they knew this fact already or if it is new to them. In case of knowledge gaps they are offered free targeted counselling as well as free HIV rapid testing and post-test counselling of HIV and hepatitis test results.

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Zusammenfassung Hintergrund Einrichtungen der Aids- und Drogenhilfe bieten einen niedrigschwelligen Zugang für Menschen mit injizierendem und anderen Drogenkonsumformen und spielen somit eine zentrale Rolle für die Eindämmung von Hepatitis C Virus (HCV)-Infektionen in dieser Hochrisikogruppe. Ziel dieser Studie ist es, die Versorgungsleistungen sowie Barrieren von HCV-spezifischen Maßnahmen in Einrichtungen der Aids- und Drogenhilfe mit niedrigschwelligen Angeboten in Deutschland zu beschreiben. Methode Die Querschnittsbefragung adressierte Einrichtungsstrukturen, Verfügbarkeit von HCV-spezifischen Maßnahmen (Prävention, Testung, Diagnostik, Therapie), strukturelle, einrichtungsbezogene und patient:innenbezogene Barrieren. Die Vergabe von Konsumutensilien wurde als Kriterium für die Auswahl von Einrichtungen mit einem niedrigschwelligen Zugang für Menschen mit injizierendem und anderen Drogenkonsumformen herangezogen. Die Datenanalyse erfolgte deskriptiv, indem Einrichtungen anhand ihrer Merkmale zusammengefasst, beschrieben und analysiert wurden. Ergebnisse Von 380 kontaktierten Einrichtungen gingen Antworten von 135 Einrichtungen mit einer Vergabe von Konsumutensilien in die Auswertung ein. Der Großteil der Einrichtungen bot Informationen zu „Safer Use“ (98,5%) und Beratungen zu HCV (87,4%) an. Etwa 28% der Einrichtungen verfügten über HCV-Antikörper bzw. Schnelltestangebote. 40% bzw. 64,4% aller Einrichtungen gaben an, dass Klient:innen mit einem positiven Antikörpertestergebnis bzw. mit einer entsprechenden Diagnose (z. B. chronische HCV-Infektion) in die medizinische Versorgung weitervermittelt werden können. Als Hauptbarrieren für eine verbesserte Umsetzung von HCV-spezifischen Maßnahmen wurden ungenügende Finanzierung und klient:innenbezogene Barrieren (z. B. mangelnde Zuverlässigkeit) genannt. Schlussfolgerungen Während Maßnahmen zur HCV-Prävention integraler Bestandteil der niedrigschwelligen Drogenhilfe sind, ist die Verfügbarkeit und Inanspruchnahme von HCV-Test- und Versorgungsangeboten für Menschen mit injizierendem und anderen Drogenkonsumformen so gering, dass dies nicht ausreicht, um HCV-Infektionen in dieser Hochrisikogruppe signifikant einzudämmen. Neben einer ausreichenden Finanzierung sind klient:innenbezogene Maßnahmen zur Verbesserung der Inanspruchnahme der Angebote notwendig.

People who inject drugs (PWID) and prisoners are considered key populations at risk for human immunodeficiency virus (HIV) and/or Hepatitis C Virus (HCV). In 2016, the Joint United Nations Program on HIV/AIDS (UNAIDS) was implemented to eliminate HIV and AIDS by 2030 and the World Health Organization (WHO) presented the first strategy to eliminate viral hepatitis by 2030 as well. Following the objectives of the WHO and the United Nations, the German Federal Ministry of Health (BMG) presented the first integrated overall strategy for HIV and HCV in 2017. This article discusses the situation of PWID and prisoners in Germany with regard to HIV and HCV five years after the adoption of this strategy, on the basis of available data and against the background of the most recent practice in the field. In order to meet the elimination goals by 2030, Germany will have to improve the situation of PWID and prisoners substantially, mainly through the implementation of evidence-based harm reduction measures as well as the promotion of diagnosis and treatment in prisons and in freedom.