Background Although many people who inject drugs (PID) contend with comorbidities, including high rates of mental illness, limited attention has been given to the differences in comorbidities among men and women or the potential links between psychiatric disorders and HIV risk behaviours. We sought to longitudinally examine associations between depression and HIV-related sexual risk behaviours among PID, stratified by gender. Methods Data were derived from a prospective cohort of PID in Vancouver, Canada between December 2005 and November 2009. Using generalised estimating equations, we examined the relationship between depressive symptoms and two types of sexual HIV risk behaviours: engaging in unprotected sex; and having multiple sexual partners. All analyses were stratified by self-reported gender. Results Overall, 1017 PID participated in this study, including 331 (32.5%) women. At baseline, women reported significantly higher depressive symptoms than men (P < 0.001). In multivariate generalised estimating equations analyses, after adjustment for potential social, demographic and behavioural confounders, more severe depressive symptomology remained independently associated with engaging in unprotected sex [adjusted odds ratio (AOR) = 1.62, 95% confidence interval (CI): 1.18 – 2.23] and having multiple sexual partners (AOR = 1.54, 95% CI: 1.09 – 2.19) among women, but was only marginally associated with having multiple sexual partners among men (AOR = 1.18, 95% CI: 0.98 – 1.41). Conclusions These findings call for improved integration of psychiatric screening and treatment services within existing public health initiatives designed for PID, particularly for women. Efforts are also needed to address sexual risk-taking among female PID contending with clinically significant depression.

We examined methadone maintenance therapy (MMT) use among HIV-positive injection drug users (IDU) in Vancouver. Among 353 participants, 199 (56.3%) were on MMT at baseline, and 48 initiated MMT during follow-up. Female gender (adjusted odds ratio [AOR] = 1.73, 95% CI: 1.14 – 2.62) and antiretroviral therapy use (AOR = 2.04, 95% CI: 1.46 – 2.86) were positively associated with MMT use, while frequent heroin injection (AOR = 0.34, 95% CI: 0.23–0.50), public injection (AOR = 0.76, 95% CI: 0.59 – 0.97), syringe borrowing (AOR = 0.54, 95% CI: 0.32 – 0.90), and non-fatal overdose (AOR = 0.58, 95% CI: 0.36 – 0.92) were negatively associated with MMT use. The rate of discontinuation of MMT was 12.46 (95% CI: 8.28 – 18.00) per 100 person years. Frequent heroin use (adjusted hazards ratio = 4.49, 95%CI: 1.81 – 11.13) was positively associated with subsequent discontinuation of MMT. These findings demonstrate the benefits of MMT among HIV-positive IDU and the need to improve access to and retention in MMT.

We observed a high prevalence and incidence of mental disorders among our community-recruited sample of PWID. The validity and implication of these diagnoses for key substance use and public health outcomes are an urgent priority.

While there has recently been considerable research and public investment in strategies to address homelessness in Canada, food charity remains the primary response to hunger, with little evaluation of current efforts and no initiatives to develop more effective approaches. Using data from a 2010-2011 survey of charitable food assistance in five Canadian cities, this study was undertaken to describe charitable meal provisioning in each city and to compare the relative roles of emergency programs and multi-service agencies and their capacity to meet food needs. Most meals were provided by multi-service agencies, but like emergency programs, these agencies were heavily dependent on donations and they were more likely than emergency programs to report constraints and service interruptions because demands exceeded available supplies. Our findings underscore the resource-limited and often fragile nature of charitable meal programs in Canada and highlight the need for more effective models of response to problems of hunger.