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However, few studies examine the independent contribution of sexual behaviour to HCV acquisition among people who inject drugs (PWID). We estimated HCV incidence and examined sexual behaviour as a time\u2010varying predictor of HCV acquisition in a prospective cohort study of PWID in Montreal (2004\u20102017). Initially, HCV\u2010negative participants completed behavioural questionnaires and HCV antibody testing (6\u00a0months until 2011, 3\u00a0months thereafter). A time\u2010updating exposure variable (no sex, opposite\u2010sex partner only, \u22651 same\u2010sex partner) was generated for the previous 6\/3\u00a0months. Time to HCV seroconversion was examined using Cox regression analysis, adjusted for age, unstable housing and incarceration (both past 3\u00a0months), and daily, heroin, cocaine and prescription opioid injecting (all past month). Among 440 PWID (baseline: median age 33\u00a0years, 18.9% female, 1.4% HIV\u2010positive), 156 participants seroconverted during follow\u2010up (overall incidence rate: 11.9\/100 person\u2010years [PY]). Incidence was lowest in the no sex group (8.70 and 2.91 cases\/100 PY in males and females, respectively) and highest in the \u22651 same\u2010sex partner group (24.14 and 21.97 cases\/100 PY in males and females, respectively). Among males, HCV risk was 47% lower in those reporting no sex compared to \u22651 same\u2010sex partner (adjusted hazard ratio: 0.53, 95% confidence interval: 0.28, 0.99). In this cohort of PWID, reporting recent same\u2010sex partners was associated with greater risk of HCV acquisition among males, necessitating targeted harm reduction strategies that consider the complex interplay of sexual and injecting risk behaviours.<\/jats:p>","DOI":"10.1111\/jvh.13194","type":"journal-article","created":{"date-parts":[[2019,8,21]],"date-time":"2019-08-21T19:39:33Z","timestamp":1566416373000},"page":"1413-1422","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Sexual behaviour as a risk factor for hepatitis C virus infection among people who inject drugs in Montreal, Canada"],"prefix":"10.1111","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5910-853X","authenticated-orcid":false,"given":"Brendan","family":"Jacka","sequence":"first","affiliation":[{"name":"Research Centre Centre Hospitalier de l\u2019Universit\u00e9 de Montr\u00e9al (CHUM) Montr\u00e9al QC 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