Trends in drug consumption and risk of transmission of HIV and hepatitis C virus among injecting drug users in Switzerland, 1993-2006

Abstract

among attenders of all low threshold facilities (LTFs) with needle exchange programmes and/or supervised drug consumption rooms for injection or inhalation in Switzerland. Data were collected in each LTF over five consecutive days, using a questionnaire that was partly completed by an interviewer and partly self administered. The questionnaire was structured around three topics: socio-demographic characteristics, drug consumption, health and risk/preventive behaviour. Analysis was restricted to attenders who had injected drugs during their lifetime (IDUs). Between 1993 and 2006, the median age of IDUs rose by 10 years. IDUs are severely marginalised and their social situation has improved little. The borrowing of used injection equipment (syringe or needle already used by other person) in the last six months decreased (16.5% in 1993, 8.9% in 2006) but stayed stable at around 10% over the past three surveys. Other risk behaviour, such as sharing spoons, cotton or water, was reported more frequently, although also showed a decreasing trend. The reported prevalence of HIV remained fairly stable at around 10% between 1993 and 2006; reported levels of hepatitis C virus (HCV) prevalence were high (56.4% in 2006). In conclusion, the overall decrease in the practice of injection has reduced the potential for transmission of infections. However as HCV prevalence is high this is of particular concern, as the current behaviour of IDUs indicates a potential for further spreading of the infection. Another noteworthy trend is the significant decrease in condom use in the case of paid sex.

Injection Drug Use Trajectories among Migrant Populations: A Narrative Review

“…In the 1980s, Switzerland implemented nationwide harm reduction services including opioid substitution therapy (OST) (Dubois-Arber et al, 2008; Dubois-Arber, Jeannin, & Spencer, 1999). Afterward, longitudinal studies in Switzerland demonstrated reduced levels of needle sharing and injection practice overall, with a marked decrease in public injection and IDU in Switzerland during and subsequent to this period of harm reduction scale-up (Dubois-Arber et al, 2008).…”

“…Afterward, longitudinal studies in Switzerland demonstrated reduced levels of needle sharing and injection practice overall, with a marked decrease in public injection and IDU in Switzerland during and subsequent to this period of harm reduction scale-up (Dubois-Arber et al, 2008). While additional barriers to accessing services for migrants were not extensively explored in these ecological findings, they seem to suggest that preventative drug policy mitigated the risk environment for injection initiation (Dubois-Arber et al, 2008).…”

“…Afterward, longitudinal studies in Switzerland demonstrated reduced levels of needle sharing and injection practice overall, with a marked decrease in public injection and IDU in Switzerland during and subsequent to this period of harm reduction scale-up (Dubois-Arber et al, 2008). While additional barriers to accessing services for migrants were not extensively explored in these ecological findings, they seem to suggest that preventative drug policy mitigated the risk environment for injection initiation (Dubois-Arber et al, 2008). Therefore, because migrants exposed to IDU are more likely to initiate injecting, vulnerable migrants that enter regions with scaled-up harm reduction and addiction treatment services likely experience a reduced risk for injection initiation compared to regions that have not implemented such policies and, consequently, constitute risk environments conducive to injection initiation.…”

Management of hepatitis C in decentralised versus centralised drug substitution programmes and minimally invasive point-of-care tests to close gaps in the HCV cascade

“…Sehr hoch ist die Prävalenz bei den IDU (bis zu 80 % in Programmen mit kontrollierter Heroinabgabe), allerdings nimmt sie dank den Schadensminderungsmassnahmen ab [10][11][12][13][14] . Der vorliegende Bericht ist wie folgt gegliedert:…”

Post-war prevention: Emerging frameworks to prevent drug use after the War on Drugs

“…As standards for ethical engagement of PWUD are established and formalized in related fields (i.e., harm reduction intervention development and disease prevention trials), failing to establish similar standards for drug prevention would likely expand the already substantial gap in effectiveness between prevention work (shown to be largely ineffective 59 ) and other modes of responding to problematic drug use, which have yielded a range of tangible improvements in health and social outcomes among PWUD. 74–79 A secondary challenge is that, unlike the development of interventions to reduce drug-related harms, which can provide tangible health or social benefits for PWUD participating in such research (i.e., access to treatment for infectious disease, implementation of supervised injection facilities), few obvious advantages for PWUD involvement in drug prevention work exist. By contrast, if the history of drug prevention intervention development is taken as a guide, prevention research carries the non-trivial risk that any individuals who participate may inadvertently further stigmatizing PWUD as ‘social vectors’ of problematic substance use.…”