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According to the ANSPS, Hepatitis C (HCV) is more common than HIV among PWID. Almost 2 in 5 (36%) of respondents were HCV antibody positive in 2021, a decline from 49% in 2017 (Heard et al. 2022, Table 1.3.1).
- HCV antibody prevalence was higher among older respondents and those with longer injection histories.
- Prevalence of HCV antibodies continues to be higher among respondents reporting heroin or other opioids as the last drug injected (48% and 49%, respectively) compared to respondents who last injected methamphetamine (27%).
- HCV RNA prevalence (active infection) was consistently higher among respondents who reported imprisonment in the year preceding survey completion compared to those who had not been incarcerated.
- HCV RNA prevalence was also consistently higher among respondents who reported receptive needle and syringe sharing in the last month compared to respondents who did not report receptive sharing.
- HCV Direct Acting Antiviral (DAA) therapy was included on the Australian Government Pharmaceutical Benefits Scheme (PBS) from March 2016. Lifetime HCV treatment, among respondents eligible for treatment only, increased from 45% in 2017 to 62% in 2021 (Heard et al. 2022).
Data collection for the 2021 ANSPS was impacted by COVID-19 restrictions. The survey took place in several phases from September to December 2021, instead of the usual October timeframe. Victoria and NSW experienced outbreaks between June and November 2021, resulting in a reduction in the amount of participating NSP services. This should be taken into account when comparing data from 2021 with previous years.
Data from the 2022 IDRS found that:
- Nearly 2 in 5 (38%) participants reported receiving treatment for substance use in 2022, similar to 2021 (37%).
Of participants not receiving treatment in 2021, 13% reported difficulties accessing treatment. Among these same participants, methamphetamine (60%) and heroin (27%) were the main substances for which participants intended to seek treatment (Sutherland et al. 2021).
Policy context
For related content on policy related to injecting drug use, see also:
Policy support
The 2019 NDSHS showed that most people support measures to reduce problems associated with injecting drugs. About two-thirds of the population aged 14 and over supported rapid detoxification therapy (69%), methadone/buprenorphine maintenance programs (67%), needle and syringe programs (64%), treatment with drugs other than methadone (66%) and the use of naltrexone (65%), which is a medication that blocks the effect of opioids such as heroin. In addition:
- a trial of prescribed heroin received the least support (33%)
- apart from a trial of prescribed heroin, use of naltrexone, and availability of take-home naloxone, higher proportions of females than males supported measures aimed at reducing problems associated with injecting drug use
- support for needle and syringe programs (90%), use of naltrexone (83%), availability of take-home naloxone (83%), and a trial of prescribed heroin (60%) was particularly high among recent injecting drug users compared with the general population (AIHW 2020, Table 9.21)
- in 2019, there were declines in the support for needle and syringe programs (from 67% in 2016 to 64%) and a trial of prescribed heroin (from 35% to 33%) (AIHW 2020, Table 9.19).
Needle and syringe programs
All Australian states and territories operate needle syringe programs (NSPs), providing a range of services to PWID (Heard et al. 2022). See Harm reduction: Minimising risky behaviours
According to the IDRS, in 2017, NSPs were by far the most common source of needles and syringes in the preceding 6 months (94%), followed by NSP vending machines (19%). Chemists were used by 16% of participants nationally (Karlsson & Burns 2018, Table 51). This is supported by the findings of the 2019 NDSHS that NSPs were the most commonly reported source (39%), followed by chemists (34%) (AIHW 2020, Table 4.95). This is likely to reflect the different sampling of the 2 surveys whereby the NDSHS is targeted at the general population, while the IDRS accesses PWID.
Medically supervised injecting centres
Medically supervised injecting centres (MSIC) are places where people can use and inject drugs under the supervision of registered nurses, counsellors and health education professionals. This service aims to prevent injury and death by being present when someone injects in order to provide immediate medical assistance as required. Kings Cross in Sydney has been home to an MSIC since 2001 (Uniting 2017), and a second opened in Richmond, Victoria in July 2018.