Current Injecting Behaviour and Practices

Much of the trouble associated with the use of illicit drugs, such as heroin, comes not from the direct effect of the drug, but rather the circumstances surrounding its use (Hamilton, 2001). In this regard, it was important to include various questions which would examine the injecting practices of homeless individuals. As outlined above, 19% of the total study population reported current IV drug use (n=66), all of whom were from the Dublin sample.

7.3.1 Place of Injecting

Current injectors were asked in some detail about their injecting behaviour (n=66). Firstly they were asked where they usually injected. Table 7.1 illustrates that almost a third of current injectors usually injected at their place of residence (n=19; 32%). Others reported injecting in various public places;

park (n=9; 15%), street (n=7; 12%), public toilets (n=4; 7%) or “anywhere” (n=6; 9%).

Analysis revealed that female injectors were significantly more likely to report injecting within their place of residence than their male injecting counterparts (x2=6.89;df=1;p<0.01). Sixty-three percent of female injectors reported that they usually inject at place of residence, compared with 37% of the male respondents. Further analysis revealed that the respondent’s current accommodation type was related

61 “Skin-popping” refers to an injection between skin and fat layers. Also called “subcutaneous” or “sub-Q” it is injecting the drug just beneath the skin.

Drug Use Among the Homeless Population in Ireland

100

to whether clients reported injecting at their place of residence. Sixty-eight percent of those who reported injecting in their place of residence were B&B occupants (n=13), while 21% were staying in a hostel (n=4), and two respondents were staying, one with friends or relatives, and one in a squat (5.5% respectively).

Table 7.1 Place of Injecting by Gender

Place of Injecting Male Female Total

% n % n % n

Place of Residence 19.5 [7] 52 [12] 32 [19]

Park 19.5 [7] 9 [2] 15 [9]

Street 14 [5] 9 [2] 12 [7]

Anywhere 14 [5] 4 [1] 9 [6]

Public Toilet 8 [3] 4 [1] 7 [4]

Home of Friends/Relatives 3 [1] 9 [2] 5 [3]

Other* 22 [8] 13 [3] 20 [11]

Missing [5] [2] [7]

* “Other” place of injecting refers to; squats (n=3), car (n=2), behind church (n=2), phone booth (n=1), waste ground (n=1), canal (n=1), not specified (n=1).

7.3.2 Injecting Company

All respondents were asked with whom they usually injected. Figure 7.1 illustrates that nearly half the respondents reported that they inject alone (n=28; 46%), 34% reported that normally they inject with partner (n=21), and 20% (n=12) reported they are usually in a group when they inject. Analysis revealed that male respondents were significantly more likely to report injecting alone than their female drug injectors (x2=6.96;df=1;p<0.01). Sixty percent of male injectors (n=22) reported injecting alone in comparison to 25% of female injectors (n=6). There were no significant differences in injecting habits across categories of accommodation.

Figure 7.1 Injecting Company

In Group 20%

With Partner 34%

Alone 46%

Drug Use Among the Homeless Population in Ireland

101

Current injectors were also asked whether they usually inject themselves (as opposed to being injected by another person). Table 7.2 shows that just over three-in-four of current injectors reported always injecting themselves (n=50; 76%). However, 15% (n=10) also reported never injecting themselves. This was highly gendered with 36% of female injectors (n=9) reporting not injecting self in comparison to only one member (2%) of the male population of injectors. Female injectors were significantly less likely to report injecting themselves (x2=13.61; df=1; p<0.001). Analysis revealed, although not significant, those that injected themselves were older than those that never injected themselves (mean age of 28 years v 25 years).

Table 7.2 Inject Self by Gender

Inject Self Male Female Total

7.3.3 Levels of Risk Behaviour

Current injectors were firstly asked to state at what part of the body they currently inject. This was to ascertain whether individuals were injecting in any particularly dangerous sites. Table 7.3, illustrates that the majority of current injectors reported injecting in the arm (n=37; 57%), while almost one-in-four reported injecting in the groin which is cause for concern as it can increase the occurrence of blood clots (n=14; 22%). Arms and hands were also reported as an injecting site by 7 injectors (11%).

Other areas reported included; leg, hand, feet, shoulder and neck.

Table 7.3 Injecting Sites

* “Other” injecting site refers to feet (n=1), shoulder (n=1) and neck (n=1)

Regarding injecting risk behaviour, all injectors were asked about the sharing of injecting equipment in the four weeks prior to interview. Table 7.4 below illustrates that over half of current injectors reported the recent sharing of injecting paraphernalia, that is spoons and filters (n=35; 53%). Almost one-in-four current injectors reported lending injecting equipment while rates for borrowing were lower at 17%

Drug Use Among the Homeless Population in Ireland

102

(n=11). Analysis revealed that current injectors were significantly more likely to report lending used injecting equipment rather than borrowing others equipment (x²=12.58;df=1;p<0.01).

Table 7.4 Current Sharing Behaviour by Gender

Current Sharing Behaviour* Male Female Total

% n % n % n

Shared IV Paraphernalia 54 [22] 52 [13] 53 [35]

Lent Used IV Equipment 27 [11] 16 [4] 23 [15]

Borrowed used IV Equipment 17 [7] 16 [4] 17 [11]

*Refers to behaviour four weeks prior to administration of survey questionnaire.

Multiple responses allowed.

Although there was no significant gender difference in the levels of such sharing, male respondents were proportionately more likely to report lending others their used injecting equipment and borrowing others’ injecting equipment.

Further analysis revealed that there was no significant difference in reported injecting risk behaviour across categories of accommodation. However, rough sleepers were proportionally more likely to report borrowing others’ injecting equipment than individuals staying in either B&B or hostel

accommodation. Forty-six percent of injecting rough sleepers (n=5) reported borrowing used injecting equipment in comparison to only 27% (n=3) of B&B occupants and 9% (n=1) of hostel dwellers.

Another measure to determine the intensity of sharing injecting equipment was employed by asking current injectors “how often had they used a needle after someone else had used it”. Seventy-eight percent (n=47) said “never”. Of those who did report reusing a needle the most common reported frequency was “once” (n=7). However, 3 injectors reported twice, and one injector each reporting 3-5 times, 6-10 times and more than 10 times.

7.3.4 Injecting Difficulties

All injectors were asked whether they had ever experienced any injecting difficulties. Figure 7.2 shows that of the 66 current injectors, only 17 reported never having experienced an injecting-related difficulty (26%). Male injectors were significantly more likely to report having “never” experienced injecting difficulties in comparison to their female injecting counterparts (x2=3.98;df=1;p<0.05). Thirty-four percent (n=14) of male injectors reported no difficulties as opposed to 12% (n=3) of the female current injecting population.

Figure 7.2 Ever Experienced Injecting Difficulties

Never 26%

Sometimes 42%

Always 32%

Drug Use Among the Homeless Population in Ireland

103

Table 7.5 illustrates the experience of various injecting difficulties reported by current injectors within the last three months. Almost three-quarters of current injectors reported scarring or bruising of the injecting site (n=47; 71%), while nearly two-thirds reported difficulty injecting (n=42; 64%). Although not significant, female injectors were proportionally more likely to report scarring/bruising of injecting site than their male counterparts (71% v 57%).

Table 7.5 Injecting Difficulties within the Past Three Months

Injecting Difficulties Current Injectors

Only two-thirds (n=24, 36%) of injectors reported having a ‘dirty hit’⁶²with almost one-in-three reporting the experience of abscesses or infection in the three months prior to interview (n=21; 32%).

Finally, one-in-five of injectors reported accidental overdose (n=13; 20%). Male injectors accounted for 69% of those who reported an accidental overdose in the last three months.

7.3.5 Overview of Injecting Risk Behaviour

Table 7.6 provides an overview of injecting risk behaviour practices among the cohort of homeless injectors. As conveyed below, a range of factors can contribute towards injecting risk behaviour and were commonplace among homeless injectors. Practical issues, such as not having appropriate and safe storage facilities for clean injecting equipment when experiencing homelessness, were reported as influencing risk behaviour. One individual equated his situation to that of “a tortoise”, in having

“to carry the load on his back”.

Table 7.6 Overview of Injecting Risk Behaviour

Variable Current Injectors

62 Dirt, bacteria, fungi and other micro-organisms in and on your needle can cause bends (a dirty hit).

Drug Use Among the Homeless Population in Ireland

104