Deconstructing injecting risk of hepatitis C virus transmission: Using strategic positioning to understand "higher risk" practices (2016)

Aims: Currently, efforts to prevent hepatitis C virus (HCV) focus on the message that all sharing of injecting equipment is risky. This obscures the strategies undertaken by people who inject drugs (PWID) to reduce risk of transmission to themselves and others.
Methods: Self-complete survey of clients of Needle and Syringe Programs (NSPs) in a metropolitan area of Sydney, Australia. Among those who reported sharing injecting equipment, two categories of risk were constructed based on self-perceived HCV status and self-reported distributive and receptive sharing of injecting equipment. The "higher risk" category contained participants who reported being either HCV-positive and distributive sharing or HCV-negative and receptive sharing. The "lower risk" category contained participants who reported being either HCV-positive and receptive sharing or HCV-negative and distributive sharing.
Findings: Around a third of the total sample were categorised as "higher risk". In multivariate analysis, being in the higher risk category was associated with perceived difficultly in managing drug use (adjusted odds ratio (AOR) = 2.37; 95% CI 1.34 4.18; p = 0.003) and having less trust in drug and alcohol workers (AOR = 0.68; 95% CI 0.52 0.90; p = 0.007).
Conclusions: This exploratory study highlights gaps in the way that the HCV prevention sector understands and addresses risk. Further research is required to guide prevention efforts that are meaningful and relate to the strategies that PWID undertake to reduce HCV risk.