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Abstract
This study assessed risk behavior and preventive measures for hepatitis C among injecting drug users in Rotterdam, the Netherlands (452 participants, 2002–2003) and Stockholm, Sweden (310 participants, 2004–2006), two cities with contrasting drug policies. Uni- and multivariate logistic regression models were used. We found that the prevalence of hepatitis C was almost two times higher in participants from Stockholm than in participants from Rotterdam, even after adjustment for sex sharing paraphernalia (adjusted relative risk: 1.92, 95% confidence interval: 1.60–2.29). Follow-up comparative studies are needed to determine if policies with structured health programs can decrease transmission of hepatitis C.
RÉSUMÉ
L'hépatite C parmi les toxicomanes par injection est 2 fois supérieure à Stockholm, en Suède, qu’à Rotherdam, aux Pays-Bas
Cette étude évalue le comportement à risque et les mesures préventives de l'hépatite C parmi des toxicomanes par injection à Rotherdam, (452, 2002) et à Stockholm, (310, 2004), politiques opposées en matière de drogues. Les modèles de multivarié ont été utilisés. Nous avons constaté que la prévalence de l'hépatite C était presque 2 fois plus élevée chez les participants de Stockholm que chez ceux de Rotterdam, même après ajustement pour partage d'accessoires sexuels (1.92;1.60–2.29). Des analyses comparatives de suivi sont nécessaires pour définir si les poliques incluant des programmes de santé structurés peuvent réduire la transmission de l'hépatite C.
Mots-clés: toxicomanes par injection, partage d'aiguilles, seringues ou autre attirail, programmes d’échanges d'aiguilles et seringues, traitement de substitution aux opiacés.
RESUMEN
La hepatitis C entre usuarios de drogas inyectables es dos veces más alta en Estocolmo, Suecia, que en Rotterdam, Países Bajos
Este estudio evalúa el comportamiento de riesgo y las medidas preventivas para la hepatitis C entre los consumidores de drogas ilegales administradas por via intravenosas en Rotterdam (452) y en Estocolmo (310); dos ciudades con contrastantes políticas hacia la drogodependencia. Hemos encontrado que la prevalencia de hepatitis C era casi dos veces mayor en los participantes de Estocolmo que en los participantes de Rotterdam, incluso después de ajustar para el uso compartido de parafernalia sexual. Seguimiento de los estudios comparativos son necesarios para determinar si las políticas de los programas estructurados de salud disminuye la transmisión de hepatitis C.
Palabras clave: usuarios de drogas inyectables, uso compartido de agujas o jeringas y otra parafernalia, programas de intercambio de jeringuillas y agujas, tratamiento de sustitución de opiáceos.
THE AUTHORS
Lillebil Norden, PhD, is a behavioral scientist at Stockholm Addiction Centre, Karolinska University Hospital, Huddinge and the Department of Clinical Neuroscience, Karolinska Institutet, Sweden. Her main areas of interest are prevention of blood borne infections among injecting drug users and risk interventions out of motivational interviewing.
Maaike van Veen, PhD, is an epidemiologist and currently working as program manager Sexual Health at the Public Health Service in Amsterdam, The Netherlands. Her main areas of interest are infectious disease epidemiology, sexually transmitted infections, and sexual health.
Christer Ldman, MD, is an Assistant Professor in infectious diseases at the Karolinska University Hospital, Stockholm, and the Department of Infectious Diseases, Karolinska Institutet, Sweden. His main areas of interest are infections, particularly blood borne diseases among IDUs.
Ivo Todorov is a behavioral scientist and doctoral student at the Department of Psychology, Stockholm University, Sweden. His main areas of interest are higher cognitive functions, metacognition, and multitasking.
Bruno Guarita is a scientific assistant and PG Dip, European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal. His main areas of interest are monitoring systems of drug use and addiction, epidemiological reporting methods.
Mirjam Kretzschmar is a Chief Science Officer Mathematical Disease Modelling, National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands, and Associate Professor at the University Medical Center Utrecht, The Netherlands. Main interests include mathematical modeling of infectious diseases, in particular sexually transmitted infections and blood borne infections.
Lucas Wiessing is an epidemiologist and Principal Scientist Infectious Diseases at the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) in Lisbon. He coordinates international projects with the aim to monitor, analyze, and improve data on drug use and drug-related infectious diseases—mainly HIV and viral hepatitis in injecting drug users in the European Union. He is a national from the Netherlands, and previously worked at the National Institute of Public Health and the Environment (RIVM) in the Netherlands where he performed multiple serobehavioral HIV studies in different risk groups and in particular among injecting drug users. He has published extensively and works with many relevant organizations and colleagues in his field, including participation in key international expert and advisory groups and scientific conferences.