Among street-involved youth in our setting, 13% were HCV-antibody positive at enrollment and not surprisingly, injection drug use was the strongest predictor1
. Almost half of the young people reported injection drug use, among whom almost 30% were HCV-antibody positive. This study underscores this population as critical for continued and innovative evidence-based drug injection prevention and targeted harm reduction education and practice tools to avert a widespread HCV epidemic.
Youth who were injecting heroin frequently were at increased risk of HCV-infection. Previous research has shown that young people in this setting were more likely to inject heroin than older people who use inject drugs, however they were less likely to access methadone maintenance therapy6
. This study underscores the vulnerability of heroin dependent youth to blood-borne infection and the need to ensure that opioid treatment services (eg. methadone programs), are available and accessible to this vulnerable group7
The rise of crystal methamphetamine use among street-involved youth in this setting has been previously documented, but we are unaware of any prior study to report an association between methamphetamine use and hepatitis C.5
The present study highlights the dangers of this drug and its potential association with HCV spread. Furthermore, almost half of the youth who reported injection drug use were using injection crystal methamphetamines on an at least daily basis. These findings are worrisome considering the drug’s toxicity, widespread availability and association with blood-borne infection8
Injecting on a daily basis, difficulty finding a syringe and having a syringe taken were also associated with HCV-positive status. These factors underscore the need to ensure that street-involved youth have access to harm reduction services including needle exchanges and that service providers, including the police, are supportive of their access9
. Youth may avoid and/or live in locations away from harm reduction services to avoid arrest or to stay away from negative influences as a self-protective behaviour10
thus services such as a peer needle exchange, may be appropriate 11
Generalizability may be a limitation in this study given the challenging nature of working with hidden populations, thus, our findings may under represent the level of risk in this population. However, similarity between the findings of this study and those from Roy et al. suggest they are representative12
. Participants were informed of legislation requiring reporting of all sexual abuse disclosure among persons under 19, thus the association between HCV seroprevalence and sexual abuse may not be fully described. In addition, testing for HCV was conducted using antibody testing methods, therefore the number infected with HCV may be lower due to self-clearance of the virus.
This study highlights the need for public health programming to prioritize street youth to avert blood-borne infection outbreaks. The rise in use of drugs such as crystal methamphetamines and the level of HCV prevalence among young IDUs, is cause for concern. The need to support the expansion and evaluation of evidence-based approaches to address methamphetamine use among street-involved youth is critical.