Sexually transmitted and bloodborne infections testing among people who use substances: findings from the 2023 British Columbia Harm Reduction Client Survey

Background People who use substances (PWUS) experience disproportionately higher burden of sexually transmitted and bloodborne infections (STBBIs) compared to the general population. Harm reduction supply distribution sites are recognized as potential access points for STBBI testing among PWUS. However, little is known about the uptake of STBBI testing among PWUS who access these sites. This study aimed to identify factors associated with recent STBBI testing among PWUS accessing harm reduction sites. Methods We analyzed cross-sectional data from the 2023 Harm Reduction Client Survey in British Columbia, Canada, which included 433 respondents across 23 sites. Sociodemographic, substance use, and harm reduction-related factors associated with recent testing (previous 12 months) for HIV, hepatitis C virus (HCV), or syphilis were examined. Adjusted risk ratios (aRRs) and corresponding 95% confidence intervals (CIs) were estimated using Poisson regression with robust standard errors. Analysis and interpretation were guided by people with lived or living experience of substance use and/or STBBIs. Results Over one-third of respondents (38%) had not been tested for an STBBI in the previous 12 months. Those participating in smaller communities (aRR = 0.7; 95% CI: 0.48, 1.03), from health regions outside Vancouver Coastal (Fraser Health aRR = 0.66; 95% CI: 0.43–1.02), and women (aRR = 0.85; 95% CI = 0.64, 1.12) were less likely to have been recently tested. Participants prescribed alternatives to the toxic drug supply (aRR = 1.21; 95% CI: 0.93, 1.59) were more likely to report recent testing. Among those who reported a previous STBBI test, either within the previous 12 months or earlier (n = 281), HIV testing was the most common (93%), followed by syphilis (88%) and HCV (83%). Nearly one-quarter (23%) of respondents did not know their test results. The majority of respondents (73%) expressed interest in accessing STBBI self-testing kits through harm reduction sites. Conclusions Many PWUS accessing harm reduction sites reported no recent STBBI testing, particularly women and those outside large urban centres. Distributing self-testing kits through these sites could potentially help reduce the disproportionate burden of STBBIs among PWUS and contribute to progress toward eliminating STBBIs as a public health threat. Clinical trial number: Not applicable.