differed for older vs. younger youth. CONCLUSIONS: Patterns of high-riskactivity beg<strong>in</strong> early <strong>and</strong> selective pressures may differ for younger vs. olderyoung offenders. Youth <strong>in</strong> detenti<strong>on</strong> provide a w<strong>in</strong>dow of opportunity forenhanced HIV/AIDSeducati<strong>on</strong>.Rowell R (1997) Develop<strong>in</strong>g AIDS Services for Native Americans: Rural <strong>and</strong> UrbanC<strong>on</strong>trasts. Journal-of-Gay-&-Lesbian-Social-Services 6:85-95Abstract: Describes similarities & differences <strong>in</strong> the experiences of acquiredimmune deficiency syndrome (AIDS) programs target<strong>in</strong>g Navajos <strong>in</strong> ruralCh<strong>in</strong>le, AZ, & Native Americans <strong>in</strong> New York City. Site-specific barriers thatprevent or discourage access to health care for Native Americans liv<strong>in</strong>g withhuman immunodeficiency virus/AIDS were identified. On the Navajoreservati<strong>on</strong>, the critical issues were c<strong>on</strong>fidentiality, lack of faith <strong>in</strong> local medicalservices, & lack of access to n<strong>on</strong>local medical services (a functi<strong>on</strong> of both f<strong>in</strong>ances& transportati<strong>on</strong>). In New York City, the critical issues were dual or multiplediagnosis (eg, substance addicti<strong>on</strong> & tuberculosis <strong>in</strong>fecti<strong>on</strong>), budget cuts, lack ofadequate hous<strong>in</strong>g, & c<strong>on</strong>fusi<strong>on</strong> about cultural values. 6 References. Adaptedfrom the source documentRoy É . HIV <strong>in</strong>fecti<strong>on</strong> am<strong>on</strong>g M<strong>on</strong>tréal street youth: prevalence study. 1996. M<strong>on</strong>treal,Unité de santé publique.Roy É, et al. <strong>Drug</strong> <strong>in</strong>jecti<strong>on</strong> <strong>in</strong>itiati<strong>on</strong> am<strong>on</strong>g street youth. World AIDS C<strong>on</strong>ference.Supported by the C<strong>on</strong>seil québécois de la recherche sociale.Abstract: BACKGROUND: In 1995, an epidemiological study showed that 36.1%of M<strong>on</strong>treal street youth had <strong>in</strong>jected drugs. OBJECTIVES: To describe drug<strong>in</strong>jecti<strong>on</strong> <strong>in</strong>itiati<strong>on</strong> am<strong>on</strong>g street youth <strong>and</strong> explore how <strong>in</strong>itiati<strong>on</strong> occurs with<strong>in</strong>their drug use it<strong>in</strong>erary. METHODS: In an exploratory qualitativestudy, <strong>in</strong>-depth semi-structured <strong>in</strong>terviews were c<strong>on</strong>ducted with 25 new<strong>in</strong>jecti<strong>on</strong> drug users (<strong>IDU</strong>s) (<strong>in</strong>itiati<strong>on</strong> < 4 years) aged 15-22 years. Participantswere recruited am<strong>on</strong>g M<strong>on</strong>treal street youth through various means <strong>in</strong>clud<strong>in</strong>goutreach at street youth agencies <strong>and</strong> snowball<strong>in</strong>g technique. RESULTS: Mostparticipants started drug use around 12-13 years of age, experimented with avariety of drugs <strong>in</strong> the follow<strong>in</strong>g years (pot, hash, acid, PCP, mushrooms) <strong>and</strong>started <strong>in</strong>ject<strong>in</strong>g with<strong>in</strong> five years. Many seemed attracted by the experience ofthe <strong>in</strong>jecti<strong>on</strong> itself (whatever the drug); a few were particularly attracted byhero<strong>in</strong> <strong>and</strong> believed <strong>in</strong>ject<strong>in</strong>g was the <strong>on</strong>ly way of tak<strong>in</strong>g that drug. Some were<strong>in</strong>itiated <strong>in</strong>to <strong>in</strong>jecti<strong>on</strong> by friends or acqua<strong>in</strong>tances, others asked to be <strong>in</strong>jected ortried bythemselves. Girls tended to be more pro active, more self-reliant <strong>and</strong>more organized than boys regard<strong>in</strong>g their first <strong>in</strong>jecti<strong>on</strong>. Overall, <strong>in</strong>itiati<strong>on</strong>of <strong>in</strong>jecti<strong>on</strong> did not seem to be experienced by street youth as a major happen<strong>in</strong>g<strong>in</strong> their life. Indeed, their first <strong>in</strong>jecti<strong>on</strong> was either idealized because of the 'trip'they had or seen as a casual event s<strong>in</strong>ce 'everybody was do<strong>in</strong>g it' <strong>and</strong> 'it's just
another way of tak<strong>in</strong>g a drug'.CONCLUSION: Initiati<strong>on</strong> of <strong>in</strong>jecti<strong>on</strong> am<strong>on</strong>g street youth does not seem to bethe result of a dependence toward a specific drug. For these youth who are heavyusers of multiple drugs, drug <strong>in</strong>jecti<strong>on</strong> <strong>in</strong>itiati<strong>on</strong> appears to be just another wayof experiment<strong>in</strong>g with drug use.Roy É, et al. (1998) Injecti<strong>on</strong> drug use am<strong>on</strong>g street youth: a dynamic process. CanadianJournal of Public Health 89:239-240Réseau juridique canadien VIH/sida . L'<strong>in</strong>jecti<strong>on</strong> de drogue et le VIH/sida: questi<strong>on</strong>sjuridiques et éthiques:documents de f<strong>on</strong>d;Injecti<strong>on</strong> drug use <strong>and</strong> HIV/AIDS: legal <strong>and</strong> ethical issues.1999. M<strong>on</strong>tréal, QC, Réseau juridique canadien VIH/sida. Le f<strong>in</strong>ancement decette publicati<strong>on</strong> a été reçu de la Divisi<strong>on</strong> despolitiques, de la coord<strong>in</strong>ati<strong>on</strong> et des programmes sur le VIH/sida, Santé Canada,dans le cadre de la Stratégie canadienne sur le VIH/sida. Comprend lesdocuments de f<strong>on</strong>d suivants: Oscapella, Eugene; Elliot,Richard. Analyse juridique de questi<strong>on</strong>s prioritaires (68 p.) --Roy, David.Commentaire éthique sur des questi<strong>on</strong>s piroritaires. (60 p.) --Riley, Diane.Questi<strong>on</strong>s de politiques. (66 p.).Saskatchewan Health . At Risk. Saskatchewan Health.Shields S . Enhanced surveillance of Canadian street youth, phase II: self identifiedAborig<strong>in</strong>al youth: a sub analysis. Ottawa. 2000.S<strong>in</strong>gle E . The ec<strong>on</strong>omic implicati<strong>on</strong>s of <strong>in</strong>jecti<strong>on</strong> drug use. C<strong>on</strong>ference <strong>on</strong> Injecti<strong>on</strong><strong>Drug</strong> <strong>Use</strong>. 1999. Ottawa, Canadian Centre <strong>on</strong> Substance Abuse.Abstract: Injecti<strong>on</strong> drug use <strong>in</strong>volves a wide variety of adverse health <strong>and</strong> socialc<strong>on</strong>sequences which have negative impacts <strong>on</strong> the ec<strong>on</strong>omy. This presentati<strong>on</strong>describes a recently developed set of guidel<strong>in</strong>es for estimat<strong>in</strong>g the costs ofsubstance abuse <strong>and</strong> presents f<strong>in</strong>d<strong>in</strong>gs from a cost estimati<strong>on</strong> study utiliz<strong>in</strong>gthese guidel<strong>in</strong>es. It was estimated that 732 deaths, 31,147 years of potential lifelost <strong>and</strong> 7,095 hospitalizati<strong>on</strong>s were attributable to illicit drug use <strong>in</strong> Canada <strong>in</strong>1992 <strong>and</strong> that illicit drug use cost morethan $1.37 billi<strong>on</strong> to the Canadian ec<strong>on</strong>omy. The largest ec<strong>on</strong>omic costs of illicitdrug use are $823 milli<strong>on</strong> for lost productivity due to morbidity <strong>and</strong> prematuremortality <strong>and</strong> $400 milli<strong>on</strong> for law enforcement <strong>and</strong> $88 milli<strong>on</strong> <strong>in</strong> direct healthcare costs. While it is not possible to dist<strong>in</strong>guish the extent to which many of thecosts are attributable to <strong>in</strong>jecti<strong>on</strong> drug use rather than other aspects of illicit drugmisuse, it isclear that much of these costs result from <strong>in</strong>jecti<strong>on</strong> drug use. The largest causes of