The association between knowledge of hepatitis C virus status and risk behaviors in injection drug users

Aims The three primary objectives of this study were (1) to document the prevalence of the hepatitis C virus (HCV) and awareness of one's status in a sample of street-recruited injection drug users (IDUs); (2) to compare the drug use and HCV risk behaviors of IDUs who reported that they were HCV infected with those who were unaware of their status and subsequently tested positive for HCV antibodies; and (3) to assess associations between risk factors and HCV status by comparing those who tested positive with those who tested negative. Design IDUs responded to structured interview questions assessing HCV risk behaviors and were offered a free HCV test. Setting Subjects were recruited through street outreach in Denver, CO, USA. Participants Participants were current. out-of-treatment IDUs. Measurements A modified version of the Risk Behavior Assessment (RBA) and HCV test results were used. Findings Of the 197 participants, 20% had been diagnosed previously with HCV. Of those who did not know their status, 61%, tested positive for HCV antibodies. Those who knew they were positive had been injecting longer but engaged in fewer HCV risk behaviors than those who did not know their status. Compared to those who tested negative. those who tested positive were more likely to be male, non-white and older. They also had been injecting longer, were more likely to use heroin and/or crack cocaine and consumed more alcohol. Conclusions In this study, a very large proportion of injection drug users who had hepatitis C were unaware of it, and they were engaging in more risk behaviors than those who were aware of their positive status. Risk factors associated with positive HCV status were identified so that those who are most at-risk for HCV might be targeted for testing and subsequent prevention or care.