What does this research mean for the field?

Over one-third of people who use substances accessing harm reduction sites in British Columbia have not been tested for sexually transmitted and bloodborne infections in the past 12 months, with women and those in smaller communities being less likely to have been tested. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This study aims to identify factors influencing recent testing for STBBIs among individuals using harm reduction services.

February 26, 2026Open Access

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

ATAmrit TiwanaUniversity of British Columbia KTKatherine A Twohig MFMieke FraserBC Centre for Disease Control

Key Points

This study aims to identify factors influencing recent testing for STBBIs among individuals using harm reduction services.
Analyzed cross-sectional data from the 2023 Harm Reduction Client Survey.
Included 433 respondents from 23 harm reduction sites.
Examined sociodemographic, substance use, and harm reduction factors related to STBBI testing.
Used Poisson regression to estimate adjusted risk ratios.
38% of respondents had not been tested for an STBBI in the last 12 months.
Less testing among women and those in smaller communities.
93% of respondents had undergone HIV testing, followed by syphilis (88%) and HCV (83%).
73% expressed interest in accessing STBBI self-testing kits.

Abstract

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. 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. Over one-third of respondents (38%) had not been tested for an STBBI in the previous 12 months. Those participating in smaller communities (aRR = 0.70; 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. 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. Not applicable.

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