Seroprevalence and correlates of HIV and HCV among injecting drug users in Edmonton, Alberta.
Plitt, Sabrina S. ; Gratrix, Jennifer ; Hewitt, Sharyn 等
Injection drug users (IDUs) are at risk for acquiring blood-borne
pathogens (BBP), such as human immunodefiency virus (HIV) and hepatitis
C virus (HCV), through the use of contaminated drug equipment. HIV (and
to a far lesser extent, HCV) may also be acquired through sexual
transmission routes, which place IDUs at additional risk for infection.
Illicit drug use is associated with high-risk sexual behaviours, such as
the exchange of sex for drugs or money, (1-3) and a greater likelihood
of exposure to social and sexual networks with high HIV (and HCV)
prevalence.
In 2006, the rate of positive HIV test reports among Canadian
adults was 9.4/100,000 and IDUs represented 19.1% of all such reports.
In the province of Alberta, the rate of new adult HIV case reports was
7.2/100,000 with 21.8% of all cases being identified as IDU. (4)
Nationally, the rate of newly reported HCV cases in 2004 was
44.7/100,000. (5) In Alberta, the rate of newly reported HCV cases in
2006 was 41.7/100,000 of which approximately 68% were attributed to IDU
(Alberta Health and Wellness, 2008).
The objective of this research was to determine the seroprevalence
and correlates of HIV and HCV and associated risk behaviours for a
cohort of IDUs recruited in Edmonton, Alberta.
METHODS
Edmonton was selected as one of multiple sites for a national,
cross-sectional survey (I-Track Study) developed by the Public Health
Agency of Canada (PHAC) to describe drug and sexual risk behaviours, and
HIV/HCV prevalence among IDUs. (6) This study was approved by the
University of Alberta Health Research Ethics Board.
From April to June 2005, recruitment was performed at sites known
to have IDUs as clients. Inclusion criteria were: 1) 15 years of age or
older, 2) appeared capable of giving informed consent, 3) understood
English, and 4) had injected drugs for non-therapeutic purposes in the
preceding six months. A single community health representative helped
identify and recruit individuals to the study and assessed study
eligibility through prescreening questions related to injection drug use
practices. Research nurses received informed consent, administered the
study questionnaire and collected a finger-prick blood sample on a
cotton-fibre-based filter paper to create a dried blood spot (DBS). HIV
and HCV testing of the DBS was conducted at the National HIV and
Retrovirology laboratory. HIV testing was performed using an enzyme
immunoassay (EIA; Bio-Rad GS HIV-1 rLAV) and reactive samples were
confirmed by Western Blot (Bio-Rad GS HIV-1 WB). HCV testing was
performed by EIA (Ortho HCV version 3). Participants received $20 as
compensation for their time. All testing was anonymous and unlinked,
therefore participants did not receive test results. Simultaneous
testing (following usual regional testing procedures) was offered; this
was not linked to study participation.
Sex-specific comparisons of demographics and risk behaviours were
determined by Chi-square or Fisher's exact test for proportions and
by the Mann-Whitney test for continuous variables. Transgender
participants were not included in gender-specific analyses and their
data are not shown due to their small number (n=3). A 95% binomial
confidence interval (CI) was calculated for each seroprevalence.
Univariate and multivariate logistic regression models were used to
determine correlates of HIV and HCV seropositivity, and to estimate odds
ratios (OR), adjusted odds ratios (AORs) and 95% CIs. Data were analyzed
using Stata version 10.0 (Stata Corp, College Station, TX, USA).
RESULTS
Of the 275 participants, 68% (n=187) were male (Table 1). Males
were significantly older than females (median: 39 years vs. 36 years,
p=0.002). The majority of participants (70.6%) were Aboriginal (i.e.,
First Nations, Metis, or Inuit), with a higher proportion among females
than males (83.5% vs. 64.2%; p=0.001).
Overall, 36.9% of participants reported cocaine as the drug they
had injected most often in the previous six months, followed by morphine
(non-prescription) at 24.9%. Crack was reported as being the
non-injection drug used most often by 22.2% of participants. Males
initiated injection drug use at a younger age than did females (median:
18 vs. 21 years, p=0.04). Of participants, 21.5% were daily injectors
and they reported injecting 2 to 5.5 times per day. Three quarters of
participants (74.2%) reported most frequently injecting with someone
else. Females were significantly more likely to report injecting with
their regular sexual partner than were males (34.1% vs. 13.9%, p=0.002).
Only 8.7% of participants reported sharing needles in the previous 6
months, with females being significantly more likely to share needles
than males (20% vs. 3.7%, p<0.001). The vast majority of participants
(81.8%) had used a needle-exchange program (NEP); 4.7% reported using
NEPs on a daily basis in the previous 6 months, compared to 29.8% who
used them weekly and 20.4% who had not used one at all in that time
period.
The majority of participants reported having a sex partner in the
previous six months (84.7%), with more reporting a regular partner than
a casual one (70.8% vs. 44.6%). Females were significantly more likely
than males to report being paid for sex (34.2% vs. 2.6%, p=0.03), while
males were significantly more likely to report having paid for sex (5.8%
vs. 0%, p<0.001). Females were significantly less likely to have used
a condom during their last sexual encounter as compared to males (40%
vs. 58.1%, p=0.04).
Nearly one quarter of participants (23.6%, 95% CI 18.7%-29.1%)
tested positive for HIV (Table 2), with a higher proportion being
females compared to males (29.4% vs. 21.2%, p=0.14). Of participants,
91.6% reported HIV testing in the past. Among respondents who reported
previously testing negative (n=171), 6 new HIV cases (3.5%) were
detected; conversely, 7 participants who reported being HIV positive
were found to be negative upon testing. Of the 65 self reported
HIV-positive participants, 87.7% reported being under medical care and
40% were on treatment for HIV.
Among females, being paid for sex was the only factor found to be
significantly associated with HIV seroprevalence (OR 2.9, 95% CI
1.0-8.3)) (Table 3). For males, factors positively associated with HIV
seroprevalence were older age (OR 1.1, 95% CI 1.0-1.2), having ever used
a NEP (OR 5.7, 95% CI 1.3-24.7) and daily use of a NEP in the previous
six months (OR 8.6, 95% CI 2.1-36.2). All three factors remained
significant in multivariable analyses: age (AOR 1.1, 95% CI 1.0-1.1),
having ever used a NEP (AOR 6.8, 95% CI 1.4-33.6) and daily use of a NEP
in the previous six months (AOR 7.4, 95% CI 1.7-33.0).
Two thirds of participants (66.1%, 95% CI 60.1%-71.6%) tested
positive for HCV with 88.4% reporting HCV testing in the past (Table 2).
Of the 181 HCV-positive participants, 15 self-reported testing negative
at their last test, while 12 who self-reported as positive at their last
test currently tested negative. Among the HCV-positive participants,
54.3% reported being under medical care and 2.5% were on treatment for
HCV.
Having a casual sex partner in the previous six months was
protective for being HCV seropositive among females (OR 0.28, 95% CI
0.10-0.78) (Table 4). For males, younger age of first injection (OR
0.95, 95% CI 0.91-0.99), older age (OR 1.15, 95% CI 1.1-1.2), daily
injection (OR 2.5, 95% CI 1.1-5.8), ever use of a NEP (OR 2.7, 95% CI
1.3-5.8) and using a condom at the time of the last sexual encounter (OR
2.5, 95% CI 1.1-5.3) were positively associated with being HCV positive,
while having a recent sex partner (OR 0.27, 95% CI 0.10-0.75) was
protective. In multivariate analyses, older age (AOR 1.2, 95% CI
1.1-1.3) and younger age of first injection (AOR 0.92, 95% CI 0.87-0.96)
remained significantly associated with being HCV positive for males.
DISCUSSION
Among this sample of IDUs in Edmonton, one quarter (23.9%) tested
HIV positive, two thirds (66.1%) tested HCV positive and one quarter
(22.8%) of the population was co-infected with HCV and HIV. The majority
of this cohort had previously been tested for HIV and HCV, and a
majority of infected persons were already aware of their positive
status. More people were aware of their HIV compared to their HCV
infection status. Among HCV-infected persons, only half were currently
under medical care, emphasizing the need for initiatives to improve
access to HCV treatment and care.
The need for BBP prevalence data among IDU in Edmonton has been
highlighted by local researchers. (7) A phone survey in the mid-1990s
estimated the IDU population of Edmonton to be approximately 4,000
(Canada's Alcohol and Other Drugs Survey, 1996). The first HIV
prevalence data collected among IDUs in Edmonton was completed in 1992
as part of an evaluation of the local needle exchange program. This
evaluation reported 3 positive HIV results from 616 saliva samples
tested over a two-year period. (8) In Wild et al.'s 2000-2002 study
of 30 IDU in Edmonton, 17% self-reported as being HIV positive and 72%
self-reported as being HCV positive, (7) which is similar to the
prevalence data reported in this study.
In comparison to other national sites involved in the I-Track
study, Edmonton had the highest HIV prevalence at 23.9%. The average HIV
prevalence across sites participating in I-Track was 13.2% (range: 2.9%
to 23.9%). The Edmonton I-Track HCV prevalence of 66.1% was similar to
the national I-Track HCV prevalence of 65.7% (range 61.8% to 68.5%). (9)
It is possible that selection bias may have led to an overestimation of
the true HIV prevalence among IDUs in Edmonton as recruitment was done
via community-based organizations, some of which were fixed needle
exchange sites and one of which catered to HIV-positive individuals.
However, a site-by-site analysis (data not shown) showed no
statistically significant difference in HIV (or HCV) prevalence.
Previously reported HIV and HCV prevalence among Canadian IDU
cohorts has been varied. A 2002 multi-site Canadian cohort study of
illicit opioid users (OPICAN) reported that among current IDUs, the HIV
prevalence was 16.9% and the HCV prevalence was 59.0%. (10) Prevalence
data from other Canadian cities include HIV 23% and HCV 88% among
Vancouver IDUs, (11) HIV 10.1% among IDUs attending a needle-exchange
program in Quebec City, (12) and HIV 7.2% and HCV 54.2% among Winnipeg
IDUs. (13)
Correlates for HIV infection were few. For females, being involved
in the sex trade was positively associated with being HIV positive. Sex
trade has often been identified as an important risk factor for HIV and
STIs among female drug users. (11,14,15) This emphasizes the strong
overlap of drug use and sexual relationships among female IDUs (16-18)
and the need for targeted programming to prevent infection and
transmission of HIV for IDUs involved in commercial sex work.
HIV-positive males were more likely to use NEP services than men
testing negative. Ever having used and daily use of NEP services were
significantly associated with HIV seroprevalence for males. It has been
well documented that NEPs are most frequently used by higher-risk
individuals, such as those involved in the sex trade, (19,20) those with
unstable housing, (19) those with daily drug use, (21) and those who
attend "shooting galleries". (21) In the current study, NEP
use was statistically associated with daily injection (p=0.04) and
involvement in the sex trade (p=0.02; data not shown). By attracting
higher-risk IDUs, NEPs provide an important opportunity to prevent HIV
and HCV infection and transmission. It is unclear from our data why the
availability of NEPs in the city have not kept HIV rates lower but it
may be explained by links between IDU, sex trade and the sexual
transmission of HIV. Sexual transmission has been the predominant mode
of transmission of HIV in Alberta since 2002 (Alberta Health and
Wellness, 2008).
Supervised injection sites have the potential to positively impact
injecting practices and thereby reduce the acquisition of HIV and HCV
through injection drug use. (22) In this current research, correlates
for HCV infection among males included injection-related factors, such
as earlier age of first injection and daily injection, emphasizing the
importance of safe injecting habits among IDUs. The impact of supervised
injection sites has not been explored in the city of Edmonton. In
addition, given that nearly one quarter (22.2%) of study participants
indicated that crack cocaine was their most commonly used non-injection
drug, and that 84% of participants had reported using non-injection
crack at some time in the previous six months, the impact of crack
distribution kits on HCV and HIV incidence would also be worth
exploring. Smoking crack cocaine has been linked to transmission of
blood-borne infections and high-risk sexual practices including
involvement in sex trade. (23)
The majority of individuals in this IDU cohort were Aboriginal
(70.6%), although Aboriginals make up approximately 5% of the Alberta
population. (24) This disproportionate representation of Aboriginals
among IDU cohorts was reported for many of the other I-Track recruitment
sites, including Regina (87.2% Aboriginal) and Winnipeg (69.6%). This is
reflective of socio-economic disparities among Aboriginal persons in
Canada. For example, in Canada, Aboriginals represent the largest ethnic
group after Whites to be infected with HIV. (4) In 2006 in Alberta,
23.9% of the 222 HIV cases were classified as Aboriginal. Among these
Aboriginal cases, 47.2% were IDU while only 11.8% of the non-Aboriginal
cases were classified as IDU (Alberta Health and Wellness, 2008). In
total, 13.5% of all HCV cases in 2006 were among Aboriginal persons
(Alberta Health and Wellness, 2008). The high mobility of Aboriginal
people between inner cities and rural areas has the potential to
increase the risk of infectious disease transmission to remote
Aboriginal communities. (25) This highlights the need for commitment to
and support for the development and implementation of prevention and
control strategies among Aboriginal persons in Canada.
There are several limitations to this research. The cross-sectional
study design did not allow the determination of temporal relationships
between behaviours and HIV/HCV infection. Given the older age and long
length of time that these IDUs have been injecting, it is likely that
they were infected years ago, making the association of recent/current
behaviours with infection status less meaningful. Most of the data
collected in the study used self-report via an interviewer-administered
questionnaire, therefore the possibility of social desirability bias
does exist. However, this bias may have been reduced by using
interviewers who were trained and familiar with the IDU population in
Edmonton. Sample size may have limited our ability to find statistically
significant results, this being especially true for female participants.
Finally, this sample may not be representative of IDU populations in
other cities in Canada and may not be representative of the IDU
population in Edmonton. It is hoped that by using a variety of
recruitment sites, we have improved the representativeness of this
population.
The high HIV and HCV prevalence found in this study among IDUs in
Edmonton highlights the complex needs of the IDU community as well as
the continued need for targeted programming. Although a small proportion
of the study participants reported sharing needles, nearly half of them
admitted to having unprotected sex the last time they had sex, putting
them at risk for HIV and other STIs. To better meet the health needs of
the IDU community, continued surveillance of their communicable diseases
risk and behaviours together with targeted interventions should be a
high priority for policy-makers.
Acknowledgements: We acknowledge the I-Track participants for their
time and participation. We are also grateful to the many staff at the
Public Health Agency of Canada for their time and effort with regard to
study design, laboratory testing and data management for the I-Track
study. Finally, we acknowledge the staff of the following agencies in
Edmonton for their time and participation: the Bissell Centre, Boyle
McCauley Health Centre, Kindred House, HIV Edmonton, and the STD Centre.
Conflict of Interest: None to declare.
Received: February 5, 2009 Accepted: October 8, 2009
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Sabrina S. Plitt, PhD, [1] Jennifer Gratrix, BScN, MSc, [2] Sharyn
Hewitt, RN, [2] Patsy Conroy, RN, [2] Tracy Parnell, [2] Beverly Lucki,
BScN, [2] Vicki Pilling, BScN, [2] Barbara Anderson, BScN, MSc, [2]
Yogesh Choudri, MD, [1] Chris P. Archibald, MD, [1] Ameeta E. Singh,
BMBS, MSc [2]
Author Affiliations
[1.] Surveillance and Risk Assessment Division, Centre for
Communicable Disease and Infection Control, Public Health Agency of
Canada, Ottawa, ON
[2.] Alberta Health Services - Edmonton STD Centre, Edmonton, AB
Correspondence: Dr. Ameeta Singh, Alberta Health Services-Edmonton
STD Centre, 3B20-11111 Jasper Ave, Edmonton, AB T5K 0L4, Tel:
780-342-2300, Fax: 780-4252194, E-mail: ameeta@ualberta.ca
Table 1. Gender-specific Demographics, Drug-using Behaviours and
Sex Behaviours, Edmonton, Alberta, 2005, %(n)*
Total Males
Factor (n = 275) (n = 187)
([dagger]) ([dagger])
Median age (IQR) 38 (33-44) 39 (34-46)
Ethnicity ([section])
Aboriginal 70.6 (194) 64.2 (120)
Non-Aboriginal 29.4 (81) 35.8 (67)
Completed high school 41.5 (114) 46.5 (87)
Drug-injecting Behaviours
Median age of injection 19 (16-25) 18 (16-25)
initiation
Frequency of injection
([parallel])
Never 12.7 (35) 11.8 (22)
Not regularly 32.4 (89) 32.6 (61)
1-2 x/week 16.7 (46) 18.2 (34)
>3 x/week 16.7 (46) 17.1 (32)
Daily 21.5 (59) 20.3 (38)
Median injections/day 3 (2-5.5) 3 (2-6)
Most frequently injected
with ([paragraph]:
Sex partner 20.2 (55) 13.9 (26)
Close friend 42.9 (117) 47.6 (88)
Family 5.9 (16) 6 (11)
Acquaintance 4.8 (13) 6 (11)
Stranger 0.4 (1) 0.5 (1)
No one 26 (71) 26 (48)
Shared needles ([paragraph]) 8.7 (24) 3.7 (7)
Most frequently shared used
needles with ([paragraph]):
Sex partner 29.2 (7) 16.7 (1)
Close friend 37.5 (9) 66.7 (4)
Family 12.5 (3) 16.7 (1)
Acquaintance 8.3 (2) 0 (0)
Stranger 8.3 (2) 0 (0)
Frequency of sharing
used needles
Always 4.3 (1) 0 (0)
Occasionally 78.3 (18) 100 (6)
Sometimes 17.4 (4) 0 (0)
Shared other injection
equipment
Cookers 28.4 (78) 23.5 (44)
Water 24 (66) 21.4 (40)
Filters 20 (55) 16.6 (31)
Ever used a needle 81.8 (225) 80.8 (151)
exchange program
Daily use of a needle 4.7 (13) 4.8 (9)
exchange program
([paragraph])
Sexual Risk Behaviours
([paragraph])
Had a sex partner 84.7 (233) 82.4 (154)
Regular ** 70.8 (165) 68.2 (105)
Casual ([dagger][dagger]) 44.6 (104) 50 (77)
Paid for sex 3.9 (9) 5.8 (9)
Was paid for sex 13.7 (32) 2.6 (4)
Had sex with a person 5.9 (16) 4.3 (8)
of same sex
Used a condom in last 51.9 (96) 58.1 (68)
sexual encounter
Females
Factor (n = 85) P-value
([dagger]) ([double
dagger])
Median age (IQR) 36 (33-41) 0.002
Ethnicity ([section])
Aboriginal 83.5 (71) 0.001
Non-Aboriginal 16.5 (14)
Completed high school 29.4 (25) 0.008
Drug-injecting Behaviours
Median age of injection 21 (17-28) 0.04
initiation
Frequency of injection
([parallel])
Never 15.3 (13) 0.71
Not regularly 30.6 (26)
1-2 x/week 12.9 (11)
>3 x/week 16.5 (14)
Daily 24.7 (21)
Median injections/day 3 (2-5) 0.91
Most frequently injected
with ([paragraph]:
Sex partner 34.1 (29) 0.002
Close friend 31.8 (27)
Family 5.9 (5)
Acquaintance 1.2 (1)
Stranger 0 (0)
No one 27.1 (23)
Shared needles ([paragraph]) 20 (17) <0.001
Most frequently shared used
needles with ([paragraph]):
Sex partner 35.3 (6) 0.57
Close friend 29.4 (5)
Family 11.8 (2)
Acquaintance 11.8 (2)
Stranger 11.8 (2)
Frequency of sharing
used needles
Always 5.9 (1) 0.66
Occasionally 70.6 (12)
Sometimes 23.5 (4)
Shared other injection
equipment
Cookers 37.7 (32) 0.05
Water 28.3 (24) 0.37
Filters 25.9 (22) 0.16
Ever used a needle 84.7 (72) 0.43
exchange program
Daily use of a needle 4.7 (4) 0.97
exchange program
([paragraph])
Sexual Risk Behaviours
([paragraph])
Had a sex partner 89.4 (76) 0.14
Regular ** 77.6 (59) 0.14
Casual ([dagger][dagger]) 34.2 (26) 0.02
Paid for sex 0 (0) 0.03
Was paid for sex 34.2 (26) <0.001
Had sex with a person 9.4 (8) 0.095
of same sex
Used a condom in last 40.0 (26) 0.04
sexual encounter
* except for continuous variables which are expressed as median
(IQR:inter-quartile range)
([dagger]) denominator totals may not represent column totals
due to missing data
([double dagger]) p-values represent only male and female
comparisons; p-values were calculated using Chi-square test or
Fisher's exact test for categorical variables and Mann-Whitney
test for continuous variables
([section]) all non-Aboriginal participants were Caucasian except
for one African-Canadian male
([parallel]) in previous month
([paragraph]) in previous 6 months
** defined as someone with whom you have had a relationship and
with whom you are emotionally involved
([dagger][dagger]) defined as someone with whom you have had a
sexual relationship one or a few times, but with whom you have
no emotional involvement
Note: three transgendered individuals are not included in this
table or analysis
Table 2. HIV and HCV Current Test Results, Past Testing Results
and Medical Care and Treatment, Edmonton, Alberta, 2005, %(n)
Total Males
Factor % (n = 275)* % (n = 187)*
Study results
HIV positive 23.9 (65) 21.2 (39)
HCV positive 66.1 (181) 64.0 (119)
Co-infection 22.8 (62) 20.7 (38)
Past HIV testing results
Positive 25.8 (65) 24.0 (40)
Negative 68.3 (172) 72.5 (121)
Indeterminate 0.4 (1) 0 (0)
Don't know 5.2 (13) 0 (0)
Refused 0.4 (1) 0 (0)
Total tested in 91.6 (252) 89.3 (167)
lifetime
Total tested within 64.7 (163) 65.9 (110)
past 2 years
Self-reported
HIV-positive participants
Under medical care for HIV 87.7 (57) 85 (34)
On treatment for HIV 40 (26) 37.5 (15)
Past HCV testing results
Positive 67.1 (163) 65.8 (104)
Negative 2.8 (70) 31.7 (50)
Don't know 3.7 (9) 2.5 (4)
Refused 0.4 (1) 0 (0)
Total tested in lifetime 88.4 (243) 84.5 (158)
Self-reported HCV-positive
participants
Under medical care for HCV 54.3 (88) 56.7 (59)
On treatment for HCV 2.5 (4) 1.9 (2)
Females p-value
Factor % (n = 85)* ([dagger])
Study results
HIV positive 29.4 (25) 0.14
HCV positive 70.6 (60) 0.29
Co-infection 27.1 (23) 0.24
Past HIV testing results
Positive 29.3 (24) 0.045
Negative 59.8 (49)
Indeterminate 1.2 (1)
Don't know 8.5 (7)
Refused 1.2 (1)
Total tested in 96.5 (82) 0.14
lifetime
Total tested within 62.2 (51) 0.60
past 2 years
Self-reported
HIV-positive participants
Under medical care for HIV 91.7 (22) 0.44
On treatment for HIV 41.7 (10) 0.74
Past HCV testing results
Positive 68.7 (57) 0.19
Negative 24.1 (20)
Don't know 6 (5)
Refused 1.2 (1)
Total tested in lifetime 97.7 (83) 0.006
Self-reported HCV-positive
participants
Under medical care for HCV 50 (28) 0.42
On treatment for HCV 3.6 (2) 0.52
* denominator will not equal column total as three males were not
tested for HIV and one male was not tested for HCV
([dagger]) p-values represent only male and female comparisons;
p-values were calculated using Chi-square test or Fisher's exact
test for ([daggategorical variables and Mann-Whitney test for
continuous variables
Note: three transgendered individuals are not included in this
table or analysis
Table 3. Correlates of HIV Seroprevalence by Gender, Edmonton,
Alberta, 2005
Total n
Females
Been paid for sex 76
Males
Median age (yrs; IQR) 183
Ever used a needle-exchange 184
program
Daily use of a needle-exchange 184
program ([parallel])
HIV Positive HIV Negative
% (n) * % (n) *
Females
Been paid for sex 52.4 (11) 27.3 (15)
Males
Median age (yrs; IQR) 43 (40-47) 38 (33-43)
Ever used a needle-exchange 94.9 (37) 76.6 (111)
program
Daily use of a needle-exchange 15.4 (6) 2.1 (3)
program ([parallel])
OR ([dagger]) AOR ([dagger])
(95% CI (95% CI)
([dagger])
Females
Been paid for sex 2.9 (1.0-8.3) 5.5 (1.4-21.3)
Males ([double dagger])
Median age (yrs; IQR) 1.1 (1.0-1.2) 1.09 (1.04-1.14)
([section])
Ever used a needle-exchange 5.7 (1.3-24.7) 7.4 (1.7-33.0)
program
Daily use of a needle-exchange 8.6 (2.1-36.2) 6.8 (1.4-33.6)
program ([parallel])
* except for continuous variables which are expressed as median and
interquartile range (IQR)
([dagger]) OR: Odds Ratio, 95% CI: 95% confidence interval,
AOR: Adjusted Odds Ratio
([double dagger]) age-adjusted
([section]) OR for age represents an increase in odds associated
with a one-year increase in age
([parallel]) within previous six months
Table 4. Correlates of HCV Seroprevalence by Gender, Edmonton,
Alberta, 2005
Total n
Females
Recent casual sex partner 76
Males
Median age of first 185
injection (yrs; IQR)
Median age (yrs; IQR) 185
Daily injection (within 186
previous month)
Ever used a 186
needle-exchange program
Recent sex partner (within
previous 6 months) 186
Condom use at last sexual 117
encounter
HCV Positive HCV Negative
% (n)* % (n)*
Females
Recent casual sex partner 25.0 (13) 54.2 (13)
Males
Median age of first 18 (38-47) 21 (18-27)
injection (yrs; IQR)
Median age (yrs; IQR) 42 (38-47) 35 (29-39)
Daily injection (within 25.2 (30) 11.9 (8)
previous month)
Ever used a 86.6 (103) 70.2 (47)
needle-exchange program
Recent sex partner (within 77.3 (92) 92.5 (62)
previous 6 months) 186
Condom use at last sexual 66.2 (49) 44.2 (19)
encounter
OR ([dagger]) AOR
(95% CI ([dagger])
([dagger])) (95% CI)
Females
Recent casual sex partner 0.28 (0.10-0.78)
Males
Median age of first 0.95 (0.91-0.99) 0.92 (0.87-0.96)
injection (yrs; IQR)
Median age (yrs; IQR) 1.15 (1.1-1.2) 1.18 ([section])
(1.1-1.3)
Daily injection (within 2.5 (1.1-5.8) 2.3 (0.84-6.3)
previous month)
Ever used a 2.7 (1.3-5.8) 2.5 (0.94-6.8)
needle-exchange program
Recent sex partner (within 0.27 (0.10-0.75) 0.29 (0.74-1.1)
previous 6 months) 186
Condom use at last sexual 2.5 (1.1-5.4) -([parallel])
encounter
* except for continuous variables which are expressed as median
and interquartile range (IQR)
([dagger]) OR: Odds Ratio, 95% CI: 95% confidence interval,
AOR: Adjusted Odds Ratio
([double dagger]) no multivariate analysis performed due to lack
of significant variables in univariate analyses
([section]) OR for age represents an increase in odds associated
with a one-year increase in age
([parallel]) not included in final multivariate model due to
collinearity with recent sex partner variable
