Hepatitis‐associated knowledge is low and risks are high among HIV‐aware injection drug users in three US cities

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Abstract
Aims Injection drug use is a major risk factor for HIV and hepatitis infections. Whereas programs to prevent new infections have focused on HIV, they have generally neglected hepatitis B and C. This study was designed to examine the interrelationships among HIV and hepatitis knowledge, risky drug preparation and injection practices, and participation in syringe exchange programs (SEPs). Design Surveys of injection drug users (IDUs) collected data on socio‐demographics, medical history, drug use and injection practices, and HIV‐ and hepatitis‐related knowledge. Setting Inner‐city US neighborhoods in Chicago, IL, Hartford, CT and Oakland, CA. Participants The study population was a convenience sample of 493 IDUs recruited using street outreach and snowball sampling strategies. Measurements HIV and hepatitis knowledge, injection‐related risks for virus transmission, associations between the two, and with SEP use. Findings HIV knowledge was significantly higher than hepatitis knowledge among SEP customers and non‐customers alike. Elevated hepatitis knowledge was associated with a history of substance abuse treatment, hepatitis infection, hepatitis B vaccination and injection practices that reduced contact with contaminated blood or water but not with SEP use. SEP customers were consistently less likely to engage in risk behaviors, with the notable exception of safely staunching blood postinjection. Conclusion Increased hepatitis awareness among IDUs is necessary for reducing hepatitis transmissions. Although SEPs continue to effectively disseminate HIV prevention messages—as evidenced by lowered risk behaviors among their customers—they must do more to prevent hepatitis transmissions.