Risk factors for hepatitis C virus infection among street youths

Background: The relative contributions to risk of hepatitis C virus (HCV) infection resulting from unsafe sexual behaviours and exposures to blood (e.g., tattooing, body piercing and injection drug use) among youths at risk are not well known. We interviewed street youths about risk factors for HCV infection and documented their HCV antibody status. Methods: From December 1995 to September 1996 we recruited 437 youths aged 14 to 25 years who met specific criteria for itinerancy. Data on sociodemographic characteristics and lifetime risk factors were obtained during a structured interview, and a venous blood sample was taken for HCV antibody testing. Results: Many of the subjects reported behaviours that pot them at risk for bloodborne diseases: 45.8% had injected drugs, 56.5% had at least 1 tattoo, and 78.3% had body piercing. The overall prevalence of HCV infection was 12.6% (95% confidence interval [Cl] 9.7%-15.9%). In a multivariate logistic regression analysis, injecting drugs (adjusted odds ratio [OR] 28.4 [95% Cl 6.6-121.4]), being over 18 years of age (adjusted OR 3.3 [95% Cl 1.6-7.0]) and using crack cocaine (adjusted OR 2.3 [95% Cl 1.0-5.3]) were independent risk factors for HCV infection. Having more than 1 tattoo (adjusted OR 1.8 [95% Cl 0.95-3.6]) was marginally associated with HCV infection, and body piercing was not. Interpretation: Drug injection was the factor most strongly associated with HCV infection among street youths. Given that injection drug users are the driving force of the HCV infection epidemic in Canada, increased intervention efforts to prevent initiation of drug injection are urgently needed to curb the epidemic.