Unsafe injecting practices among attendees of syringe exchange programmes in France (2001)

FRANÇAIS :
Etude transversale menée durant une semaine en 1998 dans 60 programmes d'échange de seringues (PES) auprès de 1004 usagers (réponse à un questionnaire sur les pratiques d'injection, les comportements sexuels et le statut sérologique VIH, VHB, VHC). La prévalence VIH est de 19,2%, celle du VHC de 20,8% et celle du VHB de 20,8%. La durée moyenne de consommation est de 11 ans, 85% sont polytoxicomanes et la buprénorphine haut dosage est la substance la plus consommée (73%). Dans le mois précédent, 45% d'entre eux ont réutilisé une seringue, 93% ont pratiqué au moins une injection quotidienne, 18% ont partagé une seringue et 71% ont partagé du matériel d'injection.
ENGLISH :
Aims. To describe syringe exchange programme attendees and their injection practices. Design. Gross-sectional study (one week in 1998). Data were collected through a standardized questionnaire. Setting. 60174 syringe exchange programmes (SEPs) in France. Participants. Clients requesting syringes in 60 SEPs. Measurements. Self-reports of drug use, injecting behaviour, sexual behaviour, serological status (HIV, HBV, HCV). Prevalence of unsafe injecting practices in the previous month such as: syringe sharing; and sharing other injection paraphernalia. Findings. 1004 questionnaires were collected (response rate: 50%). The mean age of respondents was 30 years, and 70% were males. Among individuals tested, HIV reported prevalence was 19.2%, HCV 58.4% and HBV 20.8%. The mean duration of drug use was 11 years. Eighty-five percent were polydrug users and Imprenorphine high-dosage was the substance most used (73%). In the previous month, 45 % of the participants had re-used a syringe, 93% injected at least daily (mean 3.6 injections per day), 18% shared a syringe and 71% shared injection paraphernalia. In multivariate analyses, unsafe injecting practices were associated, with heroin and cocaine use and with living in a couple. The cluster analysis identified five categories of IDUs: users of buprenorphine-HD (45% of the responders), morphine-sulphate (17%), benzodiazepines and other legal drugs (13 Yo), methadone associated with other legal drugs (13%) and crack-cocaine (13%). The buprenorphine-HD group had better social status and safer injection practices. Conclusions. In France, despite an increase in the accessibility to syringes and substitution treatments, unsafe injecting practices persist among SEP attendees. Interventions should stress the importance of using sterile material for each injection, even with a steady sex partner. (Author' s abstract)