Theme: Epidemiology & Public Health Research Year: 2019
Background:
The largest outbreak of HIV in 30 years among people who inject drugs (PWID) in the UK has been
identified in Glasgow, Scotland. This was linked anecdotally to public injecting but research is
required to determine the association between public injecting and HIV, hepatitis C (HCV) and other
drug related harms (overdose and skin and soft tissue infections (SSTI)) in Scotland. We aimed to: 1)
estimate the prevalence of public injecting in Scotland and associated risk factors; and 2) estimate
the association between public injecting and related harms (HIV, HCV, overdose and SSTI).
Methods:
Cross-sectional, bio-behavioral survey (including dried-blood spot (DBS) testing to determine HIV
and HCV status) of 1478 PWID in Scotland during 2017-18. Multi-level logistic regression was
undertaken.
Results:
During 2017-18, 16% of participants reported public injecting in the last six months. Factors
associated with public injecting were being recruited in Glasgow city centre (aOR=6.41, 95% CI 3.99
to 10.21, p<0.001), reporting recent homelessness (aOR=3.51, 95% CI 2.44 to 5.04, p<0.001),
excessive alcohol consumption (>14 units per week) (aOR=2.49, 95% CI 1.72 to 3.61, p<0.001) and
high injection frequency (>4 injections per day) (aOR 3.08, 95% CI 1.83 to 5.19, p<0.001). Public
injecting was associated with an increased risk of being HIV positive (aOR 2.11, 95% CI 1.13 to 3.92,
p=0.019), HCV positive (aOR 2.56, 95% CI 1.86 to 3.52, p<0.001), overdose (aOR 1.71, 95% CI 1.37 to
2.13, p<0.001) and SSTI (aOR 1.54, 95% CI 1.26 to 1.89, p<0.001).
Conclusion:
This is the first study to demonstrate an increased risk of multiple harms (HIV, HCV, overdose and
SSTI) associated with public injecting among a national sample of PWID. These findings highlight the
need to address the additional harms evident among people injecting in public places and provide
evidence to inform proposals in Scotland and elsewhere regarding the introduction of drug
consumption rooms.
Disclosure of Interest Statement:
SJH has received honoraria from Gilead, unrelated to this study. All remaining authors have nothing
to disclose.