Measures of harm reduction service provision for people who inject drugs.

Coverage is an important dimension in measuring the effectiveness of needle and syringe programmes in providing sterile injecting equipment for people who inject drugs. The World Health Organization (WHO), the United Nations Office on Drugs and Crime (UNODC) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) currently recommend methods for measuring coverage at the population level, that is, across an estimated population of people who inject drugs within a given geographical area. However, population-level measures of coverage rely on highly uncertain population estimates and cannot capture the different levels of syringe acquisition and injecting episodes among individual users. Consequently, such measures only broadly evaluate the extent of programme service delivery, rather than describe how people who inject drugs as individuals and sub-groups interact with needle and syringe programmes. In response to these limitations, several researchers have proposed measuring coverage at the individual level, by the percentage of injecting episodes in relation to the number of sterile needles and syringes acquired. These measures evaluate coverage according to each individual's needs. Such measures provide enhanced information for planning and monitoring of harm reduction programmes and have now been used in multiple international research studies. We advise that WHO, UNODC and UNAIDS add individual-level coverage measurement methods to their international monitoring guidelines for harm reduction programmes. By doing this, more responsive and effective programmes can be created to better reduce injecting risk behaviours and blood-borne virus transmission among people who inject drugs.

La couverture est une dimension importante lorsque l'on veut mesurer l'efficacité des programmes de distribution d'aiguilles et de seringues à fournir du matériel d'injection stérile aux consommateurs de drogues par injection. L'Organisation mondiale de la Santé (OMS), l'Office des Nations Unies contre la drogue et le crime (ONUDC) et le Programme commun des Nations Unies sur le VIH/sida (ONUSIDA) recommandent actuellement des méthodes pour mesurer la couverture au niveau de la population, c'est-à-dire sur une population estimée de consommateurs de drogues par injection dans une zone géographique donnée. Or, les mesures de la couverture au niveau de la population se fondent sur des estimations très incertaines de la population et ne permettent pas de refléter les différents degrés d'acquisition de seringues et d'épisodes d'injection chez les usagers. Par conséquent, ces mesures n'évaluent que globalement la portée des programmes au lieu de décrire la manière dont les consommateurs de drogues par injection interagissent, individuellement et en sous-groupes, avec les programmes de distribution d'aiguilles et de seringues. En réponse à ces limitations, plusieurs chercheurs ont proposé de mesurer la couverture au niveau individuel, en calculant le pourcentage d'épisodes d'injection par rapport au nombre d'aiguilles et de seringues stériles acquises. Ces mesures permettent d'évaluer la couverture en fonction des besoins de chaque personne. Ce type de mesures offre des informations plus fiables pour la planification et le suivi des programmes de réduction des risques et il est aujourd'hui utilisé dans plusieurs études de recherche internationales. Nous suggérons à l'OMS, à l'ONUDC et à l'ONUSIDA d'ajouter des méthodes de mesure de la couverture au niveau individuel à leurs directives internationales pour le suivi des programmes de réduction des risques. Cela permettra de mettre au point des programmes plus adaptés et efficaces afin de mieux réduire les comportements à risque liés aux injections ainsi que la transmission de virus par le sang chez les consommateurs de drogues par injection.

La cobertura es un factor importante para medir la eficacia de los programas de agujas y jeringas en el suministro de equipo de inyección estéril para las personas que se inyectan drogas. La Organización Mundial de la Salud (OMS), la Oficina de las Naciones Unidas contra la Droga y el Delito (ONUDD) y el Programa Conjunto de las Naciones Unidas sobre el VIH/SIDA (ONUSIDA) recomiendan actualmente métodos para medir la cobertura a nivel poblacional, es decir, a través de una población estimada de consumidores de drogas inyectables dentro de una zona geográfica determinada. Sin embargo, las medidas de cobertura a nivel poblacional se basan en estimaciones poblacionales altamente inciertas y no pueden captar los diferentes niveles de adquisición de jeringas y episodios de inyección entre los usuarios individuales. En consecuencia, esas medidas solo miden en términos generales el alcance de la prestación de servicios de los programas, en lugar de describir la forma en que las personas que se inyectan drogas como individuos y subgrupos interactúan con los programas de suministro de agujas y jeringas. En respuesta a estas limitaciones, varios investigadores han propuesto medir la cobertura a nivel individual, por el porcentaje de episodios de inyección en relación con el número de agujas y jeringas estériles adquiridas. Estas medidas miden la cobertura de acuerdo a las necesidades de cada individuo. Estas medidas proporcionan una mejor información para la planificación y el seguimiento de los programas de reducción de daños y se han utilizado actualmente en múltiples estudios de investigación internacionales. Aconsejamos que la OMS, la ONUDD y el ONUSIDA incorporen métodos de medición de la cobertura a nivel individual a sus directrices internacionales de vigilancia de los programas de reducción de daños. De este modo, se pueden crear programas más receptivos y eficaces para reducir mejor los comportamientos de riesgo en el uso de drogas inyectables y la transmisión de virus transmitidos por la sangre entre las personas que se inyectan drogas.

Syringe Stockpiling by Persons Who Inject Drugs: An Evaluation of Current Measures for Needle and Syringe Program Coverage.

Needle and syringe program (NSP) coverage is commonly used to assess NSP effectiveness. However, existing measures don't capture whether persons who inject drugs (PWIDs) stockpile syringes, an important and novel aspect of NSP coverage. In this study, we determine the extent of stockpiling in a sample of Australian PWIDs and assess whether including stockpiling enhances NSP coverage measures. As part of the Illicit Drug Reporting System study, PWIDs reported syringes procured and given away, total injections in the last month, and syringes currently stockpiled in 2014. We calculated NSP coverage with and without stockpiling to determine proportional change in adequate NSP coverage. We conducted receiver operating characteristic curve analysis to determine whether inclusion of stockpiled syringes in the measure improved sensitivity in discriminating cases and noncases of risky behaviors. Three-quarters of the sample reported syringe stockpiling, and stockpiling was positively associated with nonindigenous background, stable accommodation, no prison history, longer injecting careers, and more frequent injecting. Compared with previous measures, our measure was significantly better at discriminating cases of risky behaviors. Our results could inform NSP policy to loosen restricted-exchange practice, allowing PWIDs greater flexibility in syringe procurement practices, promoting greater NSP coverage, and reducing PWIDs' engagement in risky behaviors.

Antigen-driven patterns of TCR bias are shared across diverse outcomes of human hepatitis C virus infection.

Hepatitis C virus (HCV) infection causes significant morbidity and mortality worldwide. T cells play a central role in HCV clearance; however, there is currently little understanding of whether the disease outcome in HCV infection is influenced by the choice of TCR repertoire. TCR repertoires used against two immunodominant HCV determinants--the highly polymorphic, HLA-B*0801 restricted (1395)HSKKKCDEL(1403) (HSK) and the comparatively conserved, HLA-A*0101-restricted, (1435)ATDALMTGY(1443) (ATD)--were analyzed in clearly defined cohorts of HLA-matched, HCV-infected individuals with persistent infection and HCV clearance. In comparison with ATD, TCR repertoire selected against HSK was more narrowly focused, supporting reports of mutational escape in this epitope, in persistent HCV infection. Notwithstanding the Ag-driven divergence, T cell repertoire selection against either Ag was comparable in subjects with diverse disease outcomes. Biased T cell repertoires were observed early in infection and were evident not only in persistently infected individuals but also in subjects with HCV clearance, suggesting that these are not exclusively characteristic of viral persistence. Comprehensive clonal analysis of Ag-specific T cells revealed widespread use of public TCRs displaying a high degree of predictability in TRBV/TRBJ gene usage, CDR3 length, and amino acid composition. These public TCRs were observed against both ATD and HSK and were shared across diverse disease outcomes. Collectively, these observations indicate that repertoire diversity rather than particular Vß segments are better associated with HCV persistence/clearance in humans. Notably, many of the anti-HCV TCRs switched TRBV and TRBJ genes around a conserved, N nucleotide-encoded CDR3 core, revealing TCR sequence mosaicism as a potential host mechanism to combat this highly variant virus.

Hepatitis B virus exposure and vaccination in a cohort of people who inject drugs: what has been the impact of targeted free vaccination?

BACKGROUND AND AIM: Forty percent of new hepatitis B virus (HBV) infections in Australia occur in people who inject drugs (PWID); long-term infection carries the risk of serious liver disease. HBV incidence among Australian PWID has not been measured since the advent of targeted (2001) and adolescent school-based "catch-up" (1998) vaccination programs. We measured HBV incidence and prevalence in a cohort of PWID in Melbourne, Australia and examined demographic and behavioral correlates of exposure and vaccination. METHODS: Community-recruited PWID were surveyed about blood-borne virus risk behaviors and their sera tested for HBV markers approximately three-monthly over three years. Incidence was assessed using prospectively collected data. A cross-sectional design was used to examine prevalence of HBV exposure and vaccination at baseline. Poisson regression was used to identify correlates of HBV exposure and vaccination. RESULTS: At baseline, 33.1% of participants (114/344) had been vaccinated against HBV, 40.4% (139/344) had been exposed (previously or currently infected), and 26.5% (91/344) were susceptible. HBV incidence was 15.7 per 100 person-years. Independent associations with HBV exposure included female gender, South-East Asian ethnicity, drug treatment in the past three months, injecting in prison, and prior exposure to hepatitis C virus. Independent associations with vaccination included being ≤ 25 years old, reporting HBV vaccination, and never having been to prison. CONCLUSIONS: HBV infection continues at high incidence among Australian PWID despite the introduction of free vaccination programs. Innovative methods are needed to encourage PWID to complete HBV vaccination.

The more you look, the more you find: effects of hepatitis C virus testing interval on reinfection incidence and clearance and implications for future vaccine study design.

INTRODUCTION: Studies have explored whether spontaneous clearance of hepatitis C virus (HCV) infection decreases the likelihood of reinfection or increases the probability of clearance. This analysis investigates whether the conflicting findings from these studies could be due to differences in frequency of HCV RNA testing. METHODS: A model simulated the dynamics of HCV reinfection and clearance among a cohort of injection drug users. For different reinfection incidence and clearance rates, the model evaluated the accuracy of epidemiological studies that used different HCV testing frequencies. RESULTS: Experimental estimates for the reinfection incidence and clearance probability will be accurate (<20% error) if the testing interval is less than the reinfection clearance duration. Otherwise, experimental estimates can greatly underestimate the real values (≤66% error if reinfection duration is 1 month and the testing interval is 3 months). Uncertainty in experimental estimates also increases at lower reinfection incidences, whereas for lower clearance probabilities the uncertainty in the estimated clearance probability increases but estimated reinfection incidence decreases. DISCUSSION: Differences in HCV testing interval could account for most between-study variability in the estimated probability of clearing reinfections and is likely to have biased reinfection incidence estimates. Our findings suggest that a high reinfection clearance probability (>75%) is consistent with data.

Trends in sexual behavior, testing, and knowledge in young people; 2006-2011.

Cross-sectional surveys were conducted annually from 2006 to 2011 at a music festival. Eight thousand one hundred sixty-five young people completed surveys. STI testing rates increased over time, but there was an increase in the prevalence of some sexual risk behaviors and little improvement in STI knowledge between 2006 and 2011.

Home-based chlamydia testing of young people attending a music festival--who will pee and post?

BACKGROUND: Chlamydia is most common among young people, but only a small proportion of Australian young people are tested annually. Home-based chlamydia testing has been piloted in several countries to increase testing rates, but uptake has been low. We aimed to identify predictors of uptake of home-based chlamydia testing to inform future testing programs. METHODS: We offered home-based chlamydia testing kits to participants in a sexual behaviour cross-sectional survey conducted at a music festival in Melbourne, Australia. Those who consented received a testing kit and were asked to return their urine or vaginal swab sample via post. RESULTS: Nine hundred and two sexually active music festival attendees aged 16-29 completed the survey; 313 (35%) opted to receive chlamydia testing kits, and 67 of 313 (21%) returned a specimen for testing. One participant was infected with chlamydia (1% prevalence). Independent predictors of consenting to receive a testing kit included older age, knowing that chlamydia can make women infertile, reporting more than three lifetime sexual partners and inconsistent condom use. Independent predictors of returning a sample to the laboratory included knowing that chlamydia can be asymptomatic, not having had an STI test in the past six months and not living with parents. CONCLUSIONS: A low proportion of participants returned their chlamydia test, suggesting that this model is not ideal for reaching young people. Home-based chlamydia testing is most attractive to those who report engaging in sexual risk behaviours and are aware of the often asymptomatic nature and potential sequelae of chlamydia infection.

Smokers of illicit tobacco report significantly worse health than other smokers.

INTRODUCTION: The aim of this study was to ascertain whether the health of past and current smokers of illicit tobacco (chop-chop) differs from that of smokers of licit tobacco. METHODS: The design was a telephone survey, stratified by state, using computer aided telephone interviewing, with households selected by random digit dialing from the telephone white pages. Setting was all Australian states and territories, 1,621 regular tobacco smokers aged 18+ years. Measures were social and personal characteristics of tobacco smokers, smoking histories and patterns, and health status (SF-8 and disability weights). Binary logistic regression was used to identify variables associated with current and lifetime chop-chop use. RESULTS: Compared with licit-only tobacco smokers, current users of chop-chop had significantly greater odds of beginning smoking aged <16 years (odds ratio [OR] 1.65, 95% CI = 1.09-2.50), of reporting below-average social functioning (OR 1.61, 95% CI = 1.06-2.44), and of a measurable disability (OR 1.95, 95% CI = 1.08-3.51). Lifetime chop-chop users were relatively likely to be less than 45 years of age (OR 1.82, 95% CI = 1.38-2.39), report below-average mental health (OR 1.61, 95% CI = 1.22-2.13) and above-average bodily pain (OR 1.40, 95% CI = 1.06-1.85), smoke more than 120 cigarettes/week (OR 1.39, 95% CI = 1.06-1.83), and to have begun smoking aged <16 years (OR 1.33, 95% CI = 1.01-1.75). DISCUSSION: Current and lifetime users of chop-chop report significantly worse health than smokers of licit tobacco. Investigation of how to communicate this finding to current and potential chop-chop smokers is warranted.

Mortality among injecting drug users in Melbourne: a 16-year follow-up of the Victorian Injecting Cohort Study (VICS).

Multiple factors affect injecting drug-related mortality, many of which will vary over time and between jurisdictions. There are relatively few studies of mortality among injecting drug users (IDU) in Australia. We aimed to provide data comparable to those reported internationally on the rate of mortality among IDU in Australia. We retrospectively examined mortality among participants (N=220) from the first Australian cohort study of IDU by linking coded personal identifier records with a national death register. The overall mortality rate among those followed-up was 0.83 per 100 PY (95% CI, 0.56-1.21 per 100 PY). This rate is lower than those reported internationally but comparable to the limited Australian data from other cohorts of IDU. Mortality was higher among males, most common among those aged in their early thirties and drug-related mortality occurred typically after substantial injecting careers. Extensive experience of incarceration (>or=3 times) was associated with increased risk of mortality. These results suggest that rates of mortality among Australian IDU may be lower than those reported internationally, with low HIV prevalence and Australia's long-held harm reduction framework potentially contributing to this result. Further studies using defined cohorts followed over time are needed to examine long-term outcomes among IDU in Australia.

SMS STI: a review of the uses of mobile phone text messaging in sexual health.

Short messaging service (SMS) (a.k.a. text messaging) is a fast, low cost and popular mode of communication among young people, and these advantages can be used in a variety of ways in the field of sexual health. This paper reviews the current published and grey literature and discusses applications of SMS in sexual health and the evidence base for their effectiveness. Examples of uses of SMS in sexual health include: communication between sexual health clinics and patients, partner notification and contact tracing, contraception reminders and sexual health promotion and education. However, although SMS has been applied in many ways to improve sexual health and there is some evidence of its effectiveness, very few of the applications described in this article have been evaluated. As SMS is likely to become more and more commonly used for sexual health purposes, evaluation of its benefits and effectiveness is essential.

Longitudinal changes in personal wellbeing in a cohort of people who inject drugs.

AIMS: To determine whether the self-reported personal wellbeing of a cohort of people who inject drugs (PWID) changes over time, and to identify longitudinal correlates of change. METHODS: We used Personal Wellbeing Index (PWI) scores reported between April 2008 and February 2015 by 757 PWID (66% male) enrolled in the Melbourne Injecting Drug Use Cohort Study (2,862 interviews; up to seven follow-up waves). A mixed-effects model was used to identify correlations between changes in temporal variables and changes in individual PWI scores while controlling for demographic variables. RESULTS: The cohort's mean PWI score did not significantly differ over time (between 54.4/100 and 56.7/100 across the first four interview waves), and was 25-28% lower than general Australian population scores (76.0/100). However, there were large variations in individuals' PWI scores between interviews. Increased psychological distress, moving into unstable accommodation, reporting intentional overdose in the past 12 months and being the victim of assault in the past six months were associated with declines in PWI scores. CONCLUSIONS: Participants experienced substantially lower levels of personal wellbeing than the general Australian population, influenced by experiences of psychological distress, assault, overdose and harms related to low socioeconomic status. The results of this study suggest a need to ensure referral to appropriate housing and health support services for PWID.

Longitudinal changes in psychological distress in a cohort of people who inject drugs in Melbourne, Australia.

BACKGROUND: Previous research into psychological distress among people who inject drugs (PWID) is predominantly cross-sectional; we determined longitudinal predictors of change in psychological distress among a cohort of PWID. METHOD: We examined Kessler Psychological Distress Scale (K10) scores from 564 PWID (66% male) enrolled in the Melbourne Injecting Drug User Cohort Study. Gender-stratified linear models with fixed effects for each participant were used to examine correlates of change in individual K10 scores. Further linear regressions of adjusted K10 scores were used to measure correlations between demographic variables. RESULTS: Participants reported higher K10 scores (higher psychological distress) than the general Australian population (mean K10 scores 23.4 (95%CI 22.6-24.2) and 14.5 (95%CI 14.3-14.7) respectively). The cohort's mean K10 score did not significantly differ over time, but individual variations were common. Women reported higher K10 scores than men (mean baseline K10 scores 25.2 (95%CI 23.9-26.6) and 22.4 (95%CI 21.5-23.3) respectively), however no significant differences remained after controlling for temporal factors. Key predictors of increases in K10 scores were being the victim of an assault in the past six months (P<0.001 for women and men) and intentionally overdosing in the past 12 months (P=.010 for women and P<0.001 for men). CONCLUSIONS: PWID experience higher levels of psychological distress than the general population. Temporal rather than individual factors may account for the higher levels of psychological distress reported among women. Interventions to reduce rates of assault and/or intentional overdose should be explored to reduce high levels of psychological distress among PWID.

High rates of hepatitis C virus reinfection and spontaneous clearance of reinfection in people who inject drugs: a prospective cohort study.

UNLABELLED: Hepatitis C virus reinfection and spontaneous clearance of reinfection were examined in a highly characterised cohort of 188 people who inject drugs over a five-year period. Nine confirmed reinfections and 17 possible reinfections were identified (confirmed reinfections were those genetically distinct from the previous infection and possible reinfections were used to define instances where genetic differences between infections could not be assessed due to lack of availability of hepatitis C virus sequence data). The incidence of confirmed reinfection was 28.8 per 100 person-years (PY), 95%CI: 15.0-55.4; the combined incidence of confirmed and possible reinfection was 24.6 per 100 PY (95%CI: 16.8-36.1). The hazard of hepatitis C reinfection was approximately double that of primary hepatitis C infection; it did not reach statistical significance in confirmed reinfections alone (hazard ratio [HR]: 2.45, 95%CI: 0.87-6.86, p=0.089), but did in confirmed and possible hepatitis C reinfections combined (HR: 1.93, 95%CI: 1.01-3.69, p=0.047) and after adjustment for the number of recent injecting partners and duration of injecting. In multivariable analysis, shorter duration of injection (HR: 0.91; 95%CI: 0.83-0.98; p=0.019) and multiple recent injecting partners (HR: 3.12; 95%CI: 1.08-9.00, p=0.035) were independent predictors of possible and confirmed reinfection. Time to spontaneous clearance was shorter in confirmed reinfection (HR: 5.34, 95%CI: 1.67-17.03, p=0.005) and confirmed and possible reinfection (HR: 3.10, 95%CI: 1.10-8.76, p-value=0.033) than primary infection. Nonetheless, 50% of confirmed reinfections and 41% of confirmed or possible reinfections did not spontaneously clear. CONCLUSIONS: Hepatitis C reinfection and spontaneous clearance of hepatitis C reinfection were observed at high rates, suggesting partial acquired natural immunity to hepatitis C virus. Public health campaigns about the risks of hepatitis C reinfection are required.

Impact of text and email messaging on the sexual health of young people: a randomised controlled trial.

OBJECTIVE: To carry out a randomised controlled trial on the effect of a new method of health promotion-email and mobile phone text messages (short messaging service (SMS))-on young people's sexual health. METHODS: 994 people aged 16-29 were recruited at a music festival to a non-blinded randomised controlled trial. Participants were randomised to either receive sexual health promotion messages (n=507) or the control group (n=487). The 12-month intervention included SMS (catchy sexually transmissible infections prevention slogans) and emails. Participants completed questionnaires at the festival at baseline and online after 3, 6 and 12 months. Outcomes were differences between the control and intervention groups in health-seeking behaviour, condom use with risky partners (new or casual partners or two or more partners within 12 months) and STI knowledge. RESULTS: 337 (34%) completed all three follow-up questionnaires and 387 (39%) completed the final questionnaire. At 12 months, STI knowledge was higher in the intervention group for both male (OR=3.19 95% CI 1.52 to 6.69) and female subjects (OR=2.36 95% CI 1.27 to 4.37). Women (but not men) in the intervention group were more likely to have had an STI test (OR=2.51, 95% CI 1.11 to 5.69), or discuss sexual health with a clinician (OR=2.92, 95% CI 1.66 to 5.15) than their control counterparts. There was no significant impact on condom use. Opinions of the messages were favourable. CONCLUSION: This simple intervention improved STI knowledge in both sexes and STI testing in women, but had no impact on condom use. SMS and email are low cost, popular and convenient, and have considerable potential for health promotion. CLINICAL TRIAL REGISTRATION NUMBER: Australian Clinical Trials Registry - ACTRN12605000760673.

Randomised controlled trial of paper, online and SMS diaries for collecting sexual behaviour information from young people.

BACKGROUND: Diaries are used in sexual behaviour research to reduce recall bias. Diary collection via mobile phone text messaging (SMS) has not been trialled previously in sexual behaviour research. This randomised controlled trial compared SMS, paper and online diaries on response rate, timeliness, completeness of data and acceptability. The correlation between behaviour reported in all three types of diaries and data collected in a retrospective questionnaire was also determined. METHODS: Participants were recruited by telephone and randomised into one of three groups. They completed weekly sexual behaviour diaries for 3 months by SMS, online or paper (by post). An online survey was conducted at the end of 3 months to compare retrospective reports to the diaries and assess opinions on the diary collection method. RESULTS: 72 participants were enrolled in the study, 24 in each group. Online diaries were more likely to be submitted late than SMS diaries (p<0.001). 3.9% of SMS diaries, 3.1% of paper diaries and 0.5% of online diaries were incomplete (p=0.001). Online data collection was the preferred mode for 51%. 65 participants completed the end point retrospective questionnaire. The correlation between the diary and questionnaire on sexual risk classification was substantial (kappa=0.74) regardless of diary mode. CONCLUSIONS: SMS is a convenient and timely method of collecting brief behavioural data, but online data collection was preferable to most participants and more likely to be complete. Data collected in retrospective sexual behaviour questionnaires were found to agree substantially with data collected through weekly self-reported diaries.

Surveillance of drug use among young people attending a music festival in Australia, 2005-2008.

INTRODUCTION AND AIMS: In order to monitor trends in illicit drug use among youth, surveillance of drug use behaviours among a variety of populations in different settings is required. We monitored drug use among music festival attendees. DESIGN AND METHODS: Cross-sectional studies of young people's reported drug use were performed at a music festival in Melbourne from 2005 to 2008. Self-administered questionnaires collected information on drug use, demographics and other risk behaviour. RESULTS: From 2005 to 2008, over 5000 questionnaires were completed by people aged 16-29; 2273 men and 3011 women. Overall, use of any illicit drug in the past month was reported by 44%. After adjusting for demographic and behavioural characteristics, the prevalence of recent illicit drug use decreased significantly from 46% in 2005 to 43% in 2008 (OR 0.92, 95% CI 0.87-0.97). After adjusting for age and sex the downwards trend was repeated for amphetamines and cannabis, but a significant increase in prevalence was observed in hallucinogen, ecstasy and inhalant use. Drug use was more common among men, older participants and those engaging in high-risk sexual behaviour. DISCUSSION AND CONCLUSIONS: Illicit drug use was much more common in this sample than in the National Drug Strategy Household survey, but the direction of trends in drug use were similar; drug use prevalences were much lower than in the Ecstasy and Related Drugs Reporting System, the Illicit Drug Reporting System or National Needle and Syringe Program Survey. Music festival attendees are a potentially useful group for monitoring trends in illicit drug use.

Discrepancies between young people's self-reported sexual experience and their perceptions of 'normality'.

Young people's sexual behaviour is influenced by their perceptions of peer norms. In this survey of 445 people aged 16 to 29 years, 69% of participants believed they had fewer lifetime sexual partners than average. The mean number of actual lifetime partners reported was 5.5 and the mean perceived 'average' partners for peers was 6.6 (P < 0.01). When broken down by age and sex, the discrepancy was only significant for females aged 16 to 19. Comparison to a national survey also showed that peers' average sexual experience was overestimated. Adolescents are highly susceptible to the influence of peer norms, hence it is concerning that their perceptions of these norms are so distorted.

The economic burden to the public health system of treating non-viral injecting-related injury and disease in Australia (a cost of illness analysis).

OBJECTIVE: We estimated the cost to the public health system of treating Injecting-Related Injuries and Diseases (IRIDs) in the three most populous states in Australia in the 12 months over 2005/06. METHODS: We conducted a cost of illness analysis from the perspective of the public health system. Costs of treating IRIDs in the community were estimated from health service utilisation surveys of injecting drug users and physicians (yielding data on Government subsidised physician visits, medicines prescribed and emergency department presentations). Data on admitted hospitalisations in public hospitals due to IRIDs were extracted from State Government databases. Appropriate costs were attached to all Government-borne services and prescriptions to estimate the total cost to the public health system of treating IRIDs in 2005/06 in Queensland, NSW and Victoria. RESULTS: Our estimate of the cost to the public health system of treating IRIDs in Queensland, NSW and Victoria in 2005/06 was $20 million. CONCLUSION: IRIDs are an under-recognised harm resulting from injecting drug use, but the economic burden of IRIDs in Australia are non-negligible. Research is needed to identify cost effective programs to reduce the clinical and economic burden caused by IRIDs, particularly to reduce hospitalisations due to IRIDs. IMPLICATIONS: General practitioners, clinicians and other health workers need to be alert to IRIDs in their injecting drug user clients to prevent progression to more serious disease and consequent elevation of the associated economic costs.

Surveillance of STI risk behaviour among young people attending a music festival in Australia, 2005-08.

OBJECTIVE: To explain rising rates of sexually transmitted infections it is necessary to monitor trends among high risk groups, such as youth. Surveillance of risk behaviours and testing among a variety of populations in different settings is required. We monitored self-reported sexual behaviour among music festival attendees. METHODS: Cross-sectional studies of young people's behaviour were conducted annually at a music festival between 2005 and 2008 using self-administered questionnaires. Logistic regression, adjusted for age and gender, determined trends in risk behaviours. RESULTS: More than 5,000 questionnaires were completed. The proportion reporting multiple sexual partners in the past year remained stable from 2005 to 2008 and condom use with these partners increased. Reporting a new sexual partner in the past three months decreased, while condom use with new partners increased. Reporting a casual sexual partner increased and condom use with casual partners remained stable. Reporting a recent STI test increased from 23% in 2006 to 32% in 2008. CONCLUSIONS AND IMPLICATIONS: Despite increases in STI notifications, most risk behaviours are decreasing in this group, possibly as a function of increased STI testing. Music festivals are a useful setting for monitoring behaviour trends within a sub-population of young people at relatively high risk of STIs.