International Journal of Drug Policy 17 (2006) 411–417 Research paper Preventing HIV transmission among marginalized injection drug users: New insights from a Qu´ ebec City based research  Franc ¸oise Cˆ ot´ e a,∗ , Gaston Godin a,b , Sarah-Am´ elie Mercure a , Lina No¨ el e , Michel Alary c,d,e a Research Group on Behaviours in the Health Field, Lacerte Building, Room 1038-G, Laval University, Qu´ ebec, G1K 7P4 Canada b Canada Research Chair on Behaviour and Health, Laval University, Qu´ ebec, G1K 7P4 Canada c Department of Social and Preventive Medicine, Laval University, Qu´ ebec, G1K 7P4 Canada d Population Health Research Unit, Centre hospitalier affili´ e Universitaire de Qu´ ebec e Institut National de Sant´ e Publique du Qu´ ebec, Qu´ ebec, Canada Received 25 January 2006; received in revised form 21 June 2006; accepted 10 July 2006 Abstract Persons who inject drugs and attend shooting galleries are at high-risk of HIV-seroconversion. However, this population does not easily lend itself to classical HIV-transmission prevention strategies such as increased access to sterile injection material, community outreach and long term drug use treatment. To identify factors likely to be useful in designing specific interventions for this population, a questionnaire assessing social cognitive and sociodemographic variables was administered to 92 injection drug users attending shooting galleries (SG attendees). A follow-up interview was held 6 months later among 40 participants. Factors assessed where used to build models predicting SG attendees’ intention (n = 88) and behaviour (n = 37) not to inject with syringes used by others. SG attendees’ intention to adopt a safe injection practice was determined by self-efficacy and perceived behavioural control whereas behaviour was predicted by self-efficacy. Models were not affected by other variables such as gender, age, HIV serostatus, or past sharing behaviour. Considering the high HIV prevalence found among the study population (22%), it is concluded that SG attendees should be given tools to improve their capacity to adopt safe injection practices. Our results suggest that working on their self-efficacy might prove an effective way to intervene among this population. © 2006 Elsevier B.V. All rights reserved. Keywords: Intention; Self-efficacy; Prevention; IDUs; Needle exchange; Shooting galleries Introduction Epidemiological data gathered by Canadian health author- ities show that the HIV epidemic is spreading rapidly among injection drug users (IDUs) (Public Health Agency of Canada, 2005). In 2002, IDUs accounted for about 30% of all new HIV infection cases estimated in Canada (Geduld, Gatali, Remis, & Archibald, 2003). To date, interventions  Funded by the Canadian Institutes of Health Research (Grant no. 6605- 05-1999/2550053) and the Conseil qu´ eb´ ecois de la recherche sociale (SR- 4329). Dr. Alary is a National researcher of the Fonds de la Recherche en Sant´ e du Qu´ ebec (8722). ∗ Corresponding author. Tel.: +1 418 656 2131x5666; fax: +1 418 656 7747. E-mail address: francoise.cote@fsi.ulaval.ca (F. Cˆ ot´ e). aimed at reducing HIV transmission among IDUs mostly relied on increasing accessibility to sterile injection equip- ment, community outreach and long-term drug use treatment (Des Jarlais et al., 2004). These interventions have proven effective in many populations and there is no doubt concern- ing their general relevance (Vlahov et al., 2001). However, not all IDUs can be reached by needle exchange programs (NEPs) and existing programs might not be appropriate for sub-groups of IDUs at high risk for HIV infection. This is par- ticularly true for IDUs frequenting shooting galleries (SG). The present study was motivated by the need to bet- ter understand this population in order to provide usable evidence conducive to implementation of health promoting interventions. Indeed, SG attendance has been frequently reported as a risk factor for HIV infection (e.g., Fuller et al., 0955-3959/$ – see front matter © 2006 Elsevier B.V. All rights reserved. doi:10.1016/j.drugpo.2006.07.002