Résumés
Résumé
La dernière décennie a été marquée par une augmentation importante du nombre de pays rapportant que l’injection de drogues est présente dans leur population. Et, dans plusieurs pays, particulièrement dans ceux en voie de développement, la plupart des nouveaux injecteurs ont entre 15 et 24 ans. De nombreuses conséquences sociales et sanitaires sont associées à l’injection de drogues, les principales conséquences de type infectieux étant l’hépatite C et l’infection par le virus de l’immunodéficience humaine (VIH). Nous présenterons dans cet article les comportements d’injection et les comportements sexuels des injecteurs adolescents et jeunes adultes qui en font des personnes à risque pour ces deux infections. Nous y décrirons également des caractéristiques de ces jeunes injecteurs, qui sont liées à leur âge, dont il faut tenir compte dans l’élaboration de programmes de prévention : besoins liés au développement cognitif, physique et psychologique et aux contraintes d’ordre légal. Finalement, nous exposerons les résultats d’une vaste recherche que nous avons menée dans la littérature en vue de trouver des projets de prévention de l’infection par le VIH et de l’hépatite C qui ont répondu aux besoins spécifiques des jeunes injecteurs et qui ont fait l’objet d’une évaluation. Cette recherche a démontré qu’il existe très peu d’interventions satisfaisantes dans ce domaine. Selon nous, il est urgent que de telles interventions soient développées, évaluées et diffusées afin de contrer les épidémies de VIH et d’hépatite C qui sévissent chez les jeunes injecteurs.
Abstract
The last decade has been marked by a rapid rise in the number of countries reporting injection drug use in their population. The majority of persons initiating injection are youth 15 to 24 years of age. Many social and health problems are a result of injection drug use, and the main infectious consequences are viral infections due to Human Immunodeficiency Virus (HIV) and Hepatitis C virus (HCV). This article will review the sexual and injection behaviors of young injection drug users that put them at risk of acquiring these infections. Certain cognitive, physical and psychological age-related characteristics of youth will be reviewed. These specific developmental aspects, as well as the legal constraints facing many young people, need to be taken into consideration when developing and implementing prevention programs. Finally, we will present the results of an extensive literature search aimed at identifying HIV and HCV prevention projects that were developed specifically for youth and that had an evaluation component. This search shows that there exist very few evaluated interventions that specifically address the needs of young injection drug users. There is an urgent need for youth-specific interventions to be developed, evaluated and diffused given the growing epidemic of HIV and HCV infection among young injection drug users.
Resumen
La última decada fué marcada por un aumento importante del número de países que reportan la inyeccción de drogas en su populación, y que la mayoría de los que les las inyectan tienen entre 15 y 24 años. Numerosas consecuencias sociales y sanitarias están asociadas a la inyección de drogas, las principales, de tipo infeccioso, siendo la hepatitis C y la infección por el virus de inmunodeficiencia humana (VIH). Este artículo pasa en revista los comportamientos de inyección y los comportamientos sexuales de éstos adolescentes y jóvenes adultos, que les hacen correr el riesgo de atrapar éstas dos infecciones. Describiremos igualmente ciertas características de éstos jóvenes que se inyectan drogas, que se tienen que tomar en consideración en la elaboración de programas de prevención. En razón de su edad estas personas tienen necesidades relacionadas con el desarrollo cognitivo, físico y psicológico, y con las coacciones de orden legal que deben ser tomadas en consideración.. Finalmente, presentaremos los resultados de un amplio informe de la literatura cuyo objetivo es la identificación de los proyectos de prevención de la infección por la VIH y de la hepatitis C que responden a las necesidades específicos de los jóvenes que se inyectan drogas y que ya han sido evaluados. Este informe muestra que existent muy pocas intervenciones que respondan específicamente a las necesidades de éstos jóvenes. Consideramos que es urgente que tales intervenciones sean desarrolladas, evaluadas y difundidas afín de contrar las epidemias de VIH y de hepatitis C que hacen estragos en los jóvenes que se inyectan drogas.
Parties annexes
Références
- Ball, A.L. (2000). Adolescents, Substance Use, and HIV/AIDS: Implications for International Research. Third Annual Meeting Report, 2000 Global Research Network Meeting on HIV Prevention in Drug-Using Populations, Durban, South Africa (pp. 69-71). NIDA.
- Battjes, R.J., Leukefeld, C.G., & Pickens, R.W. (1992). Age at first injection and HIV Risk among intravenous drug users. Am J Drug Alcohol Abuse, 18(3): 263-273.
- Bukstein, O.G. (1995). Development, Risk, and Consequences. In I.B.Weiner (Ed.), Adolescent Substance Abuse: assessment, prevention, and treatment (pp. 53-72). Tampa, Florida: John Wiley & Sons, Inc.
- Burke, K.C., Burke, J.D., Jr., Regier, D.A., & Rae, D.S. (1990). Age at onset of selected mental disorders in five community populations. Arch Gen Psychiatry, 47(6): 511-518.
- Cassin, S., Geoghegan, T., & Cox, G. (1998). Young injectors: a comparative analysis of risk behaviour. Ir J Med Sci, 167(4): 234-237.
- CDC. (1995) Global AIDS Program Technical Strategies - Behavior Change Communications.
- CDC (2001). The Global HIV and AIDS Epidemic, 2001. MMWR, 50(21): 434-439.
- Cohen, E., Mackenzie, R.G., & Yates, G.L. (1991). HEADSS, a psychosocial risk assessment instrument: implications for designing effective intervention programs for runaway youth. J Adolesc Health, 12(7): 539-544.
- Cohen, M.S. (1998). Sexually transmitted diseases enhance HIV transmission: no longer a hypothesis. Lancet, 351 Suppl 3, 5-7.
- Cohn, J.A. (2002). HIV-1 infection in injection drug users. Infect Dis Clin North Am, 16(3): 745-770.
- Des Jarlais, D.C., Hagan, H., & Frieman, S. (1999). HIV among injecting drug users: epidemiology and emerging public health perspectives. Baltimore, Maryland: Williams and Wilkins.
- Doherty, M.C., Garfein, R.S., Monterroso, E., Brown, D., & Vlahov, D. (2000). Correlates of HIV infection among young adult short-term injection drug users. AIDS, 14(6): 717-726.
- Erickson, E.H. (1980). Identity and the life cycle. New York.
- Fennema, J.S.A., Van Ameijden, E.J.C., Van den Hoek, A., & Coutinho, R.A. (1997). Young and recent-onset injecting drug users are at higher risk for HIV. Addiction, 92(11): 1457-1465.
- Futterman, D., Chabon, B., & Hoffman, N.D. (2000). HIV and AIDS in adolescents. Pediatr Clin North Am, 47(1): 171-188.
- Garfein, R.S., Vlahov, D., Galai, N., Doherty, M.C., & Nelson, K.E. (1996). Viral Infections in Short-Term Injection Drug Users: The Prevalence of the Hepatitis C, Hepatitis B, Human Immunodeficiency, and Human T-Lymphotropic Viruses. Am J Public Health, 86(5): 655-661.
- Gleghorn, A.A., Clements, K.D., Marx, R., Vittinghoff, E., Lee-Chu, P., & Katz, M. (1997). The impact of intensive outreach on HIV prevention activities of homeless, runaway, and street youth in San Francisco: The AIDS Evaluation of Street Outreach Projet (AESOP). AIDS and Behavior, 1(4): 261-271.
- Hahn, J.A., Page-Shafer, K., Lum, P.J., Ochoa, K., & Moss, A.R. (2001). Hepatitis C Virus Infection and Needle Exchange Use Among Young Injection Drug Users in San Francisco. Hepatology, 34(1): 180-187.
- Health Canada (1999). Hepatitis C--prevention and control: a public health consensus. Ottawa, Canada, October 14-16, 1998. Can Commun Dis Rep, 25 Suppl 2, i-25.
- Hien, N.T. (2001). HIV Prevalence Trends and Risk Behaviors Among Injection Drug Users (IDUs) in Vietnam. Third Annual Meeting Report, 2000 Global Research Network Meeting on HIV Prevention in Drug-Using Populations, Durban, South Africa (pp. 56-63). NIDA.
- Hunter, G.M., Stimson, G.V., Judd, A., Jones, S., & Hickman, M. (2000). Measuring injecting risk behaviour in the second decade of harm reduction: a survey of injecting drug users in England. Addiction, 95(9): 1351-1361.
- Kim, N., Stanton, B., Li, X., Dickersin, K., & Galbraith, J. (1997). Effectiveness of the 40 adolescent AIDS-risk reduction interventions: a quantitative review. J Adolesc Health, 20(3): 204-215.
- Kipke, M.D., Unger, J.B., Palmer, R.F., & Edgington, R. (1996). Drug use, needle sharing and HIV risk among injection drug-using street youth. Subst Use Misuse, 31(9): 1167-1187.
- Kohlberg, L. (1969). Stages in the development of moral thought and action. New York.
- Kral, A.H., Lorvick, J., & Edlin, B.R. (2000). Sex- and Drug-Related Risk Among Populations of Younger and Older Injection Drug Users in Adjacent Neighborhoods in San Francisco. J Acquir Immune Defic Syndr Hum Retrovirol, 2000(24): 162-167.
- Lamothe, F., Vincelette, J., & Bruneau, J. (1997). Prevalence, seroconversion rates and risk factors for hepatitis B core, hepatitis C and HIV antibodies among intravenous drug users (IDU) of the Saint-Luc cohort. Can J Infect Dis, 8(Suppl A): 28A.
- Louie, R., Rosenthal, D., & Crofts, N. (1996). Injecting and sexual risk-tating among young injecting drug users. Venereology, 9(2): 114-118.
- Loxley, W., Marsh, A., & Lo, S.K. (1991). Age and injecting drug use in Perth, Western Australia: the Australian national AIDS and injecting drug use study. AIDS Care, 3(4): 363-372.
- Maher, L., Sargent, P., Higgs, P., Crofts, N., Le, T., Kelsall, J., & Kerger, M. (2000). Sharing Knowledge To Protect Our Community: A Pilot Program for Research, Risk Reduction and Peer Education with Indo-Chinese Drug Users. Sydney: Centre for International and Multicultural Health, University of New South Wales.
- Miller, C.L., Johnston, C., Spittal, P.M., Li, K., Laliberte, N., Montaner, J.S., & Schechter, M.T. (2002). Opportunities for prevention: hepatitis C prevalence and incidence in a cohort of young injection drug users. Hepatology, 36(3): 737-742.
- Montgomery, S. B., Hyde, J., De Rosa, C. J., Rohrbach, L. A., Ennett, S., Harvey, S. M., Clatts, M., Iverson, E., and Kipke, M. D. (2002) Gender differences in HIV risk behaviors among young injectors and their social network members. Am J Drug Alcohol Abuse 28(3): 453-475.
- Mullen, L. & Barry, J. (2001). An analysis of 15-19-year-old first attenders at the Dublin Needle Exchange, 1990-97. Addiction (96): 251-258.
- Needle, R.H., Ball, A., Des Jarlais, D.C., Whitmore, C., & Lambert, E. (2001). The Global Research Network on HIV Prevention in Drug-Using Populations (GRN) 1998-2000: Trends in the Epidemiology, Ethnography, and Prevention of HIV/AIDS in injection Drug Users. Third Annual Meeting Report, 2000 Global Research Network Meeting on HIV Prevention in Drug-Using Populations, Durban, South Africa (pp. 9-17). NIDA.
- Padian, N.S., Shiboski, S.C., & Jewell, N.P. (1991). Female-to-male transmission of human immunodeficiency virus. JAMA, 266(12): 1664-1667.
- Paone, D., Caloir, S., Shi, Q., & Des, J. (1995). Sex, drugs, and syringe exchange in New York City: women’s experiences. J Am Med Womens Assoc, 50(3-4): 109-114.
- Patrick, D.M., Tyndall, M.W., Cornelisse, P.G.A., Li, K., Sherlock, C.H., Rekart, M.L., Strathdee, S.A., Currie, S.L., Schechter, M.T., & O’Shaughnessy, M.V. (2001). Incidence of hepatitis C virus infection among injection drug users during an outbreak of HIV infection. CMAJ, 165(7): 889-895.
- Peters, A., Davies, T., & Richardson, A. (1998). Multi-site samples of injecting drug users in Edinburgh: prevalence and correlates of risky injecting practices. Addiction, 93(2): 253-267.
- Piaget, J. (1972). Intellectual evalution from adolescence to adulthood. Human Development.
- Rew, L., Chambers, K.B., & Kulkarni, S. (2002). Planning a sexual health promotion intervention with homeless adolescents. Nurs Res, 51(3): 168-174.
- Rogstad, K.E., Ahmed-Jushuf, I.H., & Robinson, A.J. (2002). Standards for comprehensive sexual health services for young people under 25 years. Int J STD AIDS, 13(6): 420-424.
- Roy, E., Haley, N., Leclerc, P., Boivin, J.F., Cedras, L., & Vincelette, J. (2001a). Risk factors for hepatitis C virus infection among street youths. CMAJ, 165(5): 557-560.
- Roy, E., Haley, N., Leclerc, P., Cedras, L., & Boivin, J.F. (2002). Drug injection among street youth: the first time. Addiction, 97(8): 1003-1009.
- Roy, E., Haley, N., Leclerc, P., Lemire, N., Boivin, J.F., Frappier, J.Y., & Claessens, C. (2000). Prevalence of HIV infection and risk behaviours among Montreal street youth. Int J STD AIDS, 11(4): 241-247.
- Roy, É., Haley, N., Leclerc, P., Cédras, L., & Boivin, J.F. (2001b). Hepatitis C among Montreal street youth cohort participants who injected drugs (MSYC-IDUs). Can J Infect Dis, 12(Suppl B): 60B.
- Schilling, R.F. (1991). Corelates of drug use, sexual behavior, and attitudes toward safer sex among African American and Hispanic women in methadone maintenance. Journal of Drug Issues, 21, 685-698.
- Sears, C., Guydish, J.R., Weltzien, E.K., & Lum, P.J. (2001). Investigation of a secondary syringe exchange program for homeless young adult injection drug users in San Francisco, California, U.S.A. J Acquir Immune Defic Syndr Hum Retrovirol, 27(2): 193-201.
- Sheaves, F., Preston, P., O’Neil, E., Klein, G., & Hort, K. (2001). That’s SIC: Mobilising Youth for Hepatitis C Prevention. Health Promotion Journal of Australia, 12(3): 217-222.
- Smyth, B.P., Barry,J., & Keenan, E. (2001). Syringe borrowing persists in Dublin despite harm reduction interventions. Addiction, 96(5): 717-727.
- Somlai, A. M., Kelly, J. A., Benotsh, E., Gore-Felton, C., Otrovski, D., McAuliffe, T., and Kozlov, A. P. (2002). Characteristics and predictors of HIV risk behaviors among injection-drug-using. AIDS Educ Prev 14(4): 295-305.
- Thomas, A., Forster, G., Robinson, A., & Rogstad, K. (2002). National guideline for the management of suspected sexually transmitted infections in children and young people. Sex Transm Infect, 78(5): 324-331.
- Thorpe, L.E., Bailey, S.L., Huo, D., Monterroso, E.R., & Ouellet, L.J. (2001). Injection-related risk behaviors in young urban and suburban injection drug users in Chicago (1997-1999). J Acquir Immune Defic Syndr Hum Retrovirol, 27(1): 71-78.
- UNAIDS (2000). Report on the Global HIV/AIDS Epidemic. UNAIDS. Geneva, Switzerland.
- UNAIDS (2001). Report on the Global HIV/AIDS Epidemic. Geneva, Switzerland, UNAIDS.
- UNAIDS (2002). Report on the Global HIV/AIDS Epidemic. Geneva, Switzerland, UNAIDS.
- Walters, A.S. (1999). HIV Prevention in Street Youth. J Adolesc Health, 25(3): 187-198.
- Weiker, R.L., Edgington, R., & Kipke, M.D. (1999). A Collaborative Evaluation of a Needle Exchange Program for Youth. Health Education & Behavior, 26(2): 213-224.
- WHO (1997). Hepatitis C. Weekly Epidemiologic Record, 72, 65-72.
- Yates, G.L., MacKenzie, R., Pennbridge, J., & Cohen, E. (1988). A risk profile comparison of runaway and non-runaway youth. Am. J Public Health, 78(7): 820-821.