Hepatitis C (HCV) is a blood borne virus that can lead to chronic liver disease and liver failure. In Canada, nearly 250,000 people have an active Hepatitis C infection (Strike, Leonard, Millson, Anstice, Berkeley, & Medd, 2006). People who inject drugs (PWID) are disproportionately represented in this statistic accounting for over 66% of those infected (Strike et al., 2006). Needle sharing among PWID is oft cited as one of the leading causes of HCV transmission (Strike et al. 2006). The objective of this paper is to explore the factors that influence the high prevalence of HCV among PWID, as well as, explore successful interventions and how they can be applied to a community health nursing practice. Firstly, using population statistics I will define the population of “people who inject drugs”. Next, I will provide comprehensive information about the Hepatitis C virus and modes of transmission. I will also analyze the behavioral, structural and attitudinal factors that increase the prevalence of HCV among PWIDs. I will then present research on an effective primary prevention intervention, the needle exchange program. In this section I will also explore how the development of trust with PWID clients and healthcare staff can increase health care utilization and reduce needle sharing. I will then discuss two community health nursing standards (Standards 1 and 3) will guide my work in Parkdale CHC’s NEP. Lastly, I will outline how the I will apply my knowledge of HCV
Human immunodeficiency virus (HIV) and Hepatitis C (HCV) are blood borne diseases transmitted through coming in direct contact with an infected person 's blood. Canadians who are intravenous drug users (IDUs) have a higher than normal risk for coming into contact with both diseases.
An increase in drug use, specifically opiates, has overwhelmed the United States. This behavior has led to a rise in the transmission of HIV/Hepatitis C which would be otherwise preventable. The needle exchange programs in Moorhead, Milwaukee, and Scott County are working to lower the transmission rate and increase participation in treatment programs.
As the number of intravenous drug users continues to rise, so does the risk of dangerous and potentially fatal complications that are associated with illicit drug use. In this population, death rates are higher due to overdose, AIDs-related mortality, and other blood-borne viruses (Mathers et al., 2013). Mortality rates remain high even though precautions have been taken to reduce them. According to Lavender & McCarron (2013), “Mortality in injecting drug users is up to 22 times higher than for the age-adjusted population, despite increased provision of needle and syringe programs, reduced needle and syringe sharing, and higher uptake of hepatitis B vaccination” (p. 511).
Several studies have shown that injection drug users lower their risk of transmitting infectious diseases when there is a needle exchange program available. There has not been a valid study of whether or not the amounts of time needles are returned to the exchange programs are harmful to communities. The Journal of Public Health, conducted surveys, evidence from needle exchange sites, jails, and institutions that needle exchange programs are effective in reducing illnesses such as HIV and AIDS (Burt & Theide, 2016). Furthermore, Reepalu, Blome, Bjork, Widell, & Bjorkman (2012), researched the same individuals for 20 years, with no breaks. Their studies concluded that injection drug use, not only heightens the risk for HIV and AID’s, there is also an increase in Hepatitis B and Hepatitis C. However, there studies showed that there is not an increase rate of cancer diagnoses due to injection drug use. In a study conducted by Bonar and Rosenberg (2014), they wanted to see if self-initiated harm strategies, such as: proper needle sterilization techniques, proper disposal of needles, and cleaning of the pre injected skin, could help improve the health of those that use drugs intravenously. Their study was conducted over an eight-month period, results showed that their
Imagine for a moment being able to walk down the street without seeing used needles or other drug equipment. Although it will not completely eradicate the problem, safe injection sites will allow users to have a safe and clean environment that they do not have access to now; not just to inject their drugs, but also to dispose of their used syringes. When given a 3-year trial at the first facility in Canada, it was found that fatal overdoses within 500 metres of the facility were reduced by 35 percent, and a 9 percent decrease in the rest of the city (Stueck, 2011). Thus proving the effectiveness of injection facilities not only in Vancouver, but nationwide. Giving access to support can significantly increase the quality of life for intravenous drug users. By providing sterile equipment the
Sharing of needles used by injection drug users contributes heavily to the spread of blood-borne diseases, accounting for almost one third of new HIV infections outside sub-Saharan Africa (Ball, 2007). Various studies support that blood-borne disease transmission and contraction are strongly linked to injection drug use. A study conducted by Semaan et al. that analyzed data of 10,301 persons who inject drugs in revealed that 32% had shared syringes during the 12 months prior (Semaan et al., 2011). A second study involving 309 injection drug users found HIV, hepatitis B and hepatitis C prevalence of 42.4%, 80.9%, and 74.1%, respectively. The study also revealed that 63.8% of the participants engaged in indirect sharing practices within six months prior.
Sites such as ‘Insight’ were originally opened because of the growing awareness surrounding the high rates of diseases intravenous drug use is known to cause, such as HIV and the Hepatitis C virus. With these sites leveraged as a harm reduction strategy, the purpose is to provide education about safe drug injection practices and the ways to prevent avoidable diseases and health threatening outcomes. SIS provides clean needles which reduce the risk of reusing needles
Needle exchange programs have long been a controversial subject with both the general population and government lawmakers. The primary objective for needle exchange programs (NEPs) is to prevent the spread of blood-borne disease and is very successful in doing so. But, issues of morality due to the perception of drug enablement and the stigma of intravenous drug users (IDUs) and their potential effects on the decline of society are continually used as arguments for those against NEPs. It has been proven through many studies that these programs not only reduce harms associated with intravenous drug use, they are also cost effective and reduce the circulation of used syringes to the general population. Beyond epidemiological efforts, NEPs also provide a de-stigmatized center for gathering and offers health services such as HIV testing, counselling and referrals to treatment for drug addiction. This paper aims to highlight the efficacy of needle exchange programs, safe injection sites and address the social and political issues associated with them.
Vancouver is a city with multiple “claims to fame”. Known to be one of the worlds most livable, expensive, and beautiful cities, it is also well known for its large population of drug users, and the detrimental effects intravenous drugs have had on the Downtown East Side community. One of the major concerns connected to intravenous drug use is the large proportion of users who report a history of needle sharing, greatly increasing their chances of contracting HIV, Hepatitis B or C, and other injection related infections (Strike, Myers & Millson, 2004). With an estimated 15000 intravenous drug users (IDUs) currently residing in Vancouver, and up to an estimated 125000 nationally, the Canadian government has taken a proactive “Harm Reduction” stance allowing the implementation of controversial Needle Exchange Programs (NEPs) throughout most of the country (Weekes & Cumberland). Canada’s first NEP opened in Toronto in 1987, with Vancouver following suit in 1989. While it was still considered an offence to possess drugs under the Canadian Criminal Code, section S.462.2 stated that it was “not an offence […] to distribute needles to prevent the spread of HIV infection” (Weekes & Cumberland). The goal of these early NEPs was to supply IDUs with injection equipment to eliminate the necessity for needle sharing between users, operating on a strict “one for one” model. For each used needle returned, it would be replaced with a new, sterile
The primary goal of needle exchange programs, which increase the availability of sterile syringes, are an important means of reducing the transmission of HIV infection and other blood-borne diseases such as Hepatitis B and C among injection drug users and their often unsuspecting sexual partners and children in which is the most rapidly growing population of people with HIV. These programs operate on a one-for-one basis, so they reduce the presence of infected needles in playgrounds, streets, and trash receptacles, which protects children, sanitation workers, and others from accidental needle sticks (Needle
Needle exchange programs are considered in the public’s eye as controversial topic. The major public fears involve that these needle exchange programs will propagate the drug problem even more. Another fear is the spread of diseases such as HIV that will spread more rapidly than before among users. These two issues unify where the use of intravenous drugs not only creates disease risk from injection with tainted needles, but also increases risk of contracting HIV and other sexually transmitted diseases through promiscuous sex, possibly related to drug use. However, with the local health departments allowed to offer needle exchange programs give access to drug users to prevent contaminating the major population. "A
“The Centers for Disease Control and Prevention (CDC) has reported that syringe exchange programs can be effective in linking hard-to-reach individuals to health services, and that the programs do not serve to encourage drug use or initiate.” (Needle exchange, 2009) Kidorf states that the community based programs increased motivation to participate in substance abuse programs and treatments.
Hepatitis C is a prevalent health care problem. According to the Centers of Disease Control and Prevention (CDC, 2016), approximately 2.7-3.9 million of the adult population in the United States is infected with hepatitis C virus (HCV). Some groups of people are at risk for Hepatitis C infection, including current injection drug users, people who received the blood transfusion before 1992, organ recipients from a donor who tested positive for hepatitis C virus, hemodialysis patients, and children born to a hepatitis C mother (CDC, 2016). Hepatitis C causes embarrassment and isolation from the society. Self-esteem and understanding of the
yringe exchange programs are a very necessary service within Canada for which we should advocated. Syringe exchange programs help to reduce HIV infection rates among injection drug users while at the same time do not facilitate an increase in drug use (Wodak, A., 2006, p. 837). Syringe exchange programs provide injection drug users with sterile syringes for little to no cost (Zhang, S., Yan, P., Archibald, C., 2004). Contracting blood-borne diseases from sharing and using infected needles contributes to the overall epidemic and can spread to populations outside of injection drug users (Zhang, et al. 2004).
Hepatitis is inflammation of the liver. There are currently five known viruses that cause can hepatitis (Microbiology, 10e). The hepatitis C virus (HCV) is transmitted through contact with the blood of an infected person; however, it is now more commonly spread among IV drug users that share needles. Healthcare workers are also at risk for contracting HCV, but with standard precautions, the risk is low. “Prior to 1992, some people acquired the HCV infection from transfusions of blood or blood products. Since 1992, all blood products have been screened for HCV, and cases of HCV due to blood transfusion now are extremely rare. HCV can be passed from mother to unborn child. Approximately 4 out of every 100 infants born to HCV-positive mothers