The Threat of HIV and Hepatitis C Transmission among Grenadian Adolescents from Injection Drug Use

IntroductionWhen HIV penetrates a network of injecting drug users who share needles there is a possibility that 50% of the network of drug users will get infected within a few months" (1). Due to how transmissible diseases occur amongst injection drug users (IDUs), the spread of HIV and Hepatitis C is of serious concern in the Caribbean, particularly small island nations such as Grenada. Injectable drug use has not been identified as an issue in Grenada (Dave Alexander, personal communication, June 4, 2013 Office of Drug Control Secretariat; Francis Martin, personal communication, April 3, 2015, Government of Grenada Ministry of Health). However, given the drug trade routes using the Caribbean islands to transport drugs from South America to West Africa, Europe and the United States (2), where injectable drugs are a serious problem (3), islands comprising the Eastern Caribbean route are vulnerable to the introduction of injectable drugs.Injection drug use is linked to many serious health complications. Drug use increases the probability that a user will engage in other risky behaviors, such as unsafe sexual practices and the sharing of drug paraphernalia, which in the case of injection drug use includes syringes. These two risk behaviors are major contributors to the spread of diseases, such as HIV and Hepatitis C and were responsible for more new cases of Hepatitis C than any other practice and were a major reason for the spread of HIV in Canada (4). In Canada, the Public Health Agency of Canada found that approximately 17% of new cases of HIV and 70-80% of new cases of Hepatitis C were due to these types of risky behaviors (5). Within the United States, approximately 8% of the new cases of HIV infection each year are due to injection drug use (6).The spread of HIV and Hepatitis C among adolescent IDUs is concerning because this group is more likely to partake in certain risky behaviors. Such activities include, having sexual relations with multiple partners, engaging in unprotected sex, and sharing syringes (7). Adolescent injecting drug users tend to have an earlier age-onset of sexual activity, multiple sexual partners, sex while under the influence of a substance, and inconsistent use of protection (8). In 2008 Pluddermann and colleagues reported that among the IDUs, 67% sometimes used a condom and 5% never used a condom with their regular partner and 63% sometimes used a condom and 1% never used a condom with a non-regular or casual partner (9)The sharing of needles and syringes is also a concern for adolescents receiving and transmitting these diseases. Although HIV and Hepatitis C are spread through both unsafe sexual practices and sharing of syringes, the transmission of Hepatitis C is more related the sharing of non-sterile needles among IDUs (10). Pluddermann et al. (9) found that 89% of IDU reported that they had shared syringes within the past month. In addition, Matthews found that transmission of Hepatitis C through injection drug use occurred for 73% of subjects, with sexual transmission occurring for 18% (10).Whilst vast amounts of data has been collected and analyzed on injection drug use in other countries, such as the United States (12), however there has been no research conducted in Grenada related to injection drug use among adolescents. The purpose of this study was to examine the prevalence of injection drug use, unsafe sexual practices, and improper syringe use in Grenada adolescents. The aims of this study were to: (1) determine the prevalence of injection drug use among secondary school students; (2) examine the patterns of syringe use among students that admit to using injectable drugs; and (3) compare the health risk behaviors between students that are IDUs and those that are not IDUs.MethodsAs part of monitoring and evaluating the prevalence of adolescent drug use in Grenada, an anonymous questionnaire developed by the Drug Control Secretariat of Grenada and the Inter-American Drug Abuse Control Commission (CICAD) was administered to a random sample of secondary school students. …