The REDUCE project is co-ordinated by the Parc de Salut Mar, Barcelona, Spain, with partners from
Scotland (University of the West of Scotland, Paisley), Poland (Institute of Psychiatry and Neurology,
Warsaw), Austria (Medical University of Vienna) and Italy (Regione Marche Health Service, Ancona).
The University of Greenwich (London, England) have been sub-contracted by Parc de Salut Mar,
Barcelona, Spain to manage the REDUCE project. The REDUCE project, co-funded by the European
Union’s Drug Prevention and Information Programme, began on 1 October 2011 and will be
completed by 30 September 2013.
Background
One objective of the EU Drug Strategy 2005-2012 is to prevent and reduce drug use/dependence and the associated inherent risks among vulnerable groups and people living in socially disadvantaged areas, including women. The EU drugs action plan (2009–2012) highlights the need to further improve the effectiveness of measures to reduce drug use and its consequences by improving the quality and effectiveness of harm reduction interventions; by targeting innovative and evidence-based and evaluated prevention and intervention programmes to prevent high risk behaviour among vulnerable groups, including injecting drug users (IDU).
Prevalence and predictors of hepatitis C among female drug users
Worldwide, around 170 million people are infected with HCV; the majority are IDU [1]. Being female is a predictor of HCV among IDU [2]. Sharing injecting equipment poses the greatest risk of transmission among IDU, however, some studies have reported sexual transmission [3]. Female drug users report risk behaviors including sharing needles and injecting paraphernalia, having sex with IDU, exchanging sex for money or drugs and not using condoms [4,5]. Depression among IDUs has been associated with injection-related risk and needle sharing [6]. Research suggests a gap in IDU transmission knowledge that may contribute to the high prevalence [7]. Many female drug users rely on others to inject them, often male sexual partners [8-10], which may reduce their ability to insist on safer injecting behaviours. Female IDUs are more likely than male IDUs to have sexual partners who also inject drugs, to inject with and to have been first injected by a male partner, and to borrow needles and injecting paraphernalia from their sexual partner [5, 9-13]. Female drug users experience high levels of intimate partner violence [14]. HCV risk behaviour therefore, should be understood in the context of their relationships with male partners [15].
Rationale for the REDUCE project
Gender inequalities, negative mood, partner violence and lack of assertiveness may decrease FDU ability to negotiate safer interactions in their personal drug and sex networks/ relationships. Risks could be reduced if FDU were educated about HCV transmission risks and were able to assertively insist on and negotiate safer sex and injecting practices. Behavioural interventions to reduce HIV and HCV risk taking behaviours among IDU report reductions in risk behaviours [16, 17]; however previous studies have failed to consider sex differences or mental health and have failed to account for risks that may occur in intimate relationships.
Aims and Objectives
The REDUCE project aims to determine and understand the knowledge around transmission of HCV and the risk behaviours associated with HCV among female drug users.
1. to develop a toolkit for measuring hepatitis C (HCV) risk behaviours and transmission knowledge among female drug users
2. to examine HCV prevention initiatives throughout Europe
3. to determine and compare the level of HCV risk behaviours and transmission knowledge among female drug users in the partner countries
4. to develop and test an evidence based group intervention to reduce HCV risk taking behaviours and increase HCV transmission knowledge among female drug users
5. to produce and disseminate a manualised therapy to reduce HCV risk taking behaviours and increase HCV transmission knowledge among female drug users
References
1. World Health Organisation (2000) Fact sheet N°164
2. Vescio et al (2008). Correlates of hepatitis C virus seropositivity in prison inmates: a meta-analysis. J. Epidemiol. Community Health 62: 305-313
3. Rooney G and Gilson R J (1998). Sexual transmission of hepatitis C virus infection. Sexually Transmitted Infections 74 (6): 399-404
4. Booth, R.E., et al. (1995) Gender differences in sex-risk behaviors, economic livelihood, and self-concept among drug injectors and crack smokers. Am J Addictions, 4, 313-322
5. Brook, D. W., et al. (2000) Needle sharing: a longitudinal study of female injection drug users. American Journal of Drug and Alcohol Abuse 26 (2): 263-81
6. Stein MD, et al. (2001) Hepatitis C disease among injection drug users: knowledge, perceived risk and willingness to receive treatment. Drug and Alcohol Dependence, 61(3):211-215
7. O'Brien S. et al. (2008) Injecting drug users’ understanding of hepatitis C. Addict Behav, 33;1602–1605
8. Doherty, M.C., et al. (2000) Gender differences in the initiation of injection drug use among young adults, J. Urban Health 77: 396–414.
9. Wood, E. (2007) Gender and risk factors for initiation into injection drug use. Drug and Alcohol Review, 26(3): 333-334
10. Hahn, J.A., et al. (2002) Hepatitis C virus seroconversion among young injection drug users: relationships and risks, J. Infect. Dis. 186:1558–1564.
11. Evans, J.L., et al. (2003) Gender differences in sexual and injection risk behavior among active young injection drug users in San Francisco (the UFO study). Journal of Urban Health, 80, 137–146.
12. Bennett, G. A., et al. (2000). Gender differences in sharing injecting equipment by drug users in England. AIDS Care, 12(1): 77-87.
13. Montgomery, S.B., et al. (2002) Gender differences in HIV risk behaviors among young injectors and their social network members. Am J Drug Alcohol Abuse, 28, 453–475.
14. Engstrom; M., et al. (2008) Childhood Sexual Abuse and Intimate Partner Violence among Women in Methadone Treatment: A Direct or Mediated Relationship? Journal of Family Violence 23(7); 605-617
15. Hearn, K.D., et al. (2005) Intimate Partner Violence and Monogamy among Women in Methadone Treatment AIDS and Behavior, 9(2), 177-186
16. Copenhaver, M. M., et al. (2006). Behavioral HIV risk reduction among people who inject drugs: Meta-analytic evidence of efficacy. Journal of Substance Abuse Treatment, 31 , 163-171.
17. Garfein RS, et al. (2007) Reduction in injection risk behaviors for HIV and HCV infection among young injection drug users using a peer-education intervention. AIDS 2007; 20:000–000.
Background
One objective of the EU Drug Strategy 2005-2012 is to prevent and reduce drug use/dependence and the associated inherent risks among vulnerable groups and people living in socially disadvantaged areas, including women. The EU drugs action plan (2009–2012) highlights the need to further improve the effectiveness of measures to reduce drug use and its consequences by improving the quality and effectiveness of harm reduction interventions; by targeting innovative and evidence-based and evaluated prevention and intervention programmes to prevent high risk behaviour among vulnerable groups, including injecting drug users (IDU).
Prevalence and predictors of hepatitis C among female drug users
Worldwide, around 170 million people are infected with HCV; the majority are IDU [1]. Being female is a predictor of HCV among IDU [2]. Sharing injecting equipment poses the greatest risk of transmission among IDU, however, some studies have reported sexual transmission [3]. Female drug users report risk behaviors including sharing needles and injecting paraphernalia, having sex with IDU, exchanging sex for money or drugs and not using condoms [4,5]. Depression among IDUs has been associated with injection-related risk and needle sharing [6]. Research suggests a gap in IDU transmission knowledge that may contribute to the high prevalence [7]. Many female drug users rely on others to inject them, often male sexual partners [8-10], which may reduce their ability to insist on safer injecting behaviours. Female IDUs are more likely than male IDUs to have sexual partners who also inject drugs, to inject with and to have been first injected by a male partner, and to borrow needles and injecting paraphernalia from their sexual partner [5, 9-13]. Female drug users experience high levels of intimate partner violence [14]. HCV risk behaviour therefore, should be understood in the context of their relationships with male partners [15].
Rationale for the REDUCE project
Gender inequalities, negative mood, partner violence and lack of assertiveness may decrease FDU ability to negotiate safer interactions in their personal drug and sex networks/ relationships. Risks could be reduced if FDU were educated about HCV transmission risks and were able to assertively insist on and negotiate safer sex and injecting practices. Behavioural interventions to reduce HIV and HCV risk taking behaviours among IDU report reductions in risk behaviours [16, 17]; however previous studies have failed to consider sex differences or mental health and have failed to account for risks that may occur in intimate relationships.
Aims and Objectives
The REDUCE project aims to determine and understand the knowledge around transmission of HCV and the risk behaviours associated with HCV among female drug users.
1. to develop a toolkit for measuring hepatitis C (HCV) risk behaviours and transmission knowledge among female drug users
2. to examine HCV prevention initiatives throughout Europe
3. to determine and compare the level of HCV risk behaviours and transmission knowledge among female drug users in the partner countries
4. to develop and test an evidence based group intervention to reduce HCV risk taking behaviours and increase HCV transmission knowledge among female drug users
5. to produce and disseminate a manualised therapy to reduce HCV risk taking behaviours and increase HCV transmission knowledge among female drug users
References
1. World Health Organisation (2000) Fact sheet N°164
2. Vescio et al (2008). Correlates of hepatitis C virus seropositivity in prison inmates: a meta-analysis. J. Epidemiol. Community Health 62: 305-313
3. Rooney G and Gilson R J (1998). Sexual transmission of hepatitis C virus infection. Sexually Transmitted Infections 74 (6): 399-404
4. Booth, R.E., et al. (1995) Gender differences in sex-risk behaviors, economic livelihood, and self-concept among drug injectors and crack smokers. Am J Addictions, 4, 313-322
5. Brook, D. W., et al. (2000) Needle sharing: a longitudinal study of female injection drug users. American Journal of Drug and Alcohol Abuse 26 (2): 263-81
6. Stein MD, et al. (2001) Hepatitis C disease among injection drug users: knowledge, perceived risk and willingness to receive treatment. Drug and Alcohol Dependence, 61(3):211-215
7. O'Brien S. et al. (2008) Injecting drug users’ understanding of hepatitis C. Addict Behav, 33;1602–1605
8. Doherty, M.C., et al. (2000) Gender differences in the initiation of injection drug use among young adults, J. Urban Health 77: 396–414.
9. Wood, E. (2007) Gender and risk factors for initiation into injection drug use. Drug and Alcohol Review, 26(3): 333-334
10. Hahn, J.A., et al. (2002) Hepatitis C virus seroconversion among young injection drug users: relationships and risks, J. Infect. Dis. 186:1558–1564.
11. Evans, J.L., et al. (2003) Gender differences in sexual and injection risk behavior among active young injection drug users in San Francisco (the UFO study). Journal of Urban Health, 80, 137–146.
12. Bennett, G. A., et al. (2000). Gender differences in sharing injecting equipment by drug users in England. AIDS Care, 12(1): 77-87.
13. Montgomery, S.B., et al. (2002) Gender differences in HIV risk behaviors among young injectors and their social network members. Am J Drug Alcohol Abuse, 28, 453–475.
14. Engstrom; M., et al. (2008) Childhood Sexual Abuse and Intimate Partner Violence among Women in Methadone Treatment: A Direct or Mediated Relationship? Journal of Family Violence 23(7); 605-617
15. Hearn, K.D., et al. (2005) Intimate Partner Violence and Monogamy among Women in Methadone Treatment AIDS and Behavior, 9(2), 177-186
16. Copenhaver, M. M., et al. (2006). Behavioral HIV risk reduction among people who inject drugs: Meta-analytic evidence of efficacy. Journal of Substance Abuse Treatment, 31 , 163-171.
17. Garfein RS, et al. (2007) Reduction in injection risk behaviors for HIV and HCV infection among young injection drug users using a peer-education intervention. AIDS 2007; 20:000–000.