Injection Risk Behavior among Women Syringe Exchangers in San Francisco

The Positive Health Program, Department of Medicine, University of California, San Francisco, California 94143-0936, USA.
Substance Use &amp Misuse (Impact Factor: 1.23). 02/2005; 40(11):1681-96. DOI: 10.1080/10826080500222834
Source: PubMed

ABSTRACT Women who inject drugs in cities where syringe exchange programs (SEPs) are well established may have different risks for HIV infection. In 1997, we interviewed 149 female syringe exchangers in San Francisco, CA, a city with high rates of injection drug use that is home to one of the largest and oldest SEPs in the United States. In this report, we describe their sociodemographics, health, and risk behavior, and we examine factors associated with recent syringe sharing. Fifty percent of respondents were women of color and the median age was 38 years. Most (86%) injected heroin and nearly half were currently homeless or had recently been incarcerated. One-third of all women reported needle sharing in the prior month. This was higher than the rate of needle sharing reported by a mixed gender sample of San Francisco exchangers in 1993, although it resembled the rate reported by a mixed gender sample in 1992. In a multivariate analysis, syringe sharing was associated with age, housing status, and sexual partnerships. Syringe sharers were more likely to be young, homeless, or have a sexual partner who was also an injection drug user. While wide access to sterile syringes is an important strategy to reduce HIV transmission among injection drug users (IDU), syringe exchange alone cannot eradicate risky injection by female IDU. Additional efforts to reduce risky injection practices should focus on younger and homeless female IDU, as well as address selective risk taking between sexual partners.

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Available from: Joseph Guydish, Aug 22, 2015
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    • "This may include practical advice about equipment access, including outreach provision for those unwilling to access N&S programmes. Recommendations for couple based interventions in the HIV prevention field include those that seek to increase supportive condom use attitudes, with a focus on skills building and communication techniques (Gyarmathy and Neaigus, 2009; Kapadia et al., 2011; Lazuardi et al., 2012; Lum et al., 2005). These recommendations could productively be incorporated into HCV prevention interventions (Bryant et al., 2010; Dwyer et al., 2011; Fraser et al., 2013; McMahon et al., 2007), with a couple-based focus on fostering supportive attitudes towards safer injecting practices as well as practical suggestions to implement this. "
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    ABSTRACT: BACKGROUND: Evidence indicates minimal hepatitis C (HCV) sexual transmission risk among HIV negative heterosexual partners. Limited HCV literacy has been demonstrated among people who inject drugs, yet there is a dearth of research exploring perceptions of HCV heterosexual transmission risk among this high risk population. METHODS: We conducted a qualitative life history study with people who had been injecting drugs for over six years, to explore the social practices and conditions of long-term HCV avoidance. Participants were recruited through London drug services and drug user networks. The sample comprised 10 women and 27 men (n=37), of whom 22 were HCV antibody negative. Participants were aged from 23 to 57 years and had been injecting for 6 to 33 years. Twenty participants were in long term heterosexual partnerships. FINDINGS: The majority of participants in relationships reported 'discriminate' needle and syringe sharing with their primary sexual partner. Significantly, and in tension with biomedical evidence, participants commonly rationalised syringe sharing with sexual partners in terms of 'risk equivalence' with sexual practices in regard to HCV transmission. Participants' uncertain knowledge regarding HCV transmission, coupled with unprotected sexual practices perceived as being normative were found to foster 'risk equivalence' beliefs and associated HCV transmission potential. CONCLUSION: HCV prevention messages that 'add on' safe sex information can do more harm than good, perpetuating risk equivalence beliefs and an associated dismissal of safe injecting recommendations among those already practicing unprotected sex.
    Drug and alcohol dependence 05/2013; 132(3). DOI:10.1016/j.drugalcdep.2013.04.012 · 3.28 Impact Factor
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    • "Freeman et al. (1994) highlighted the particular risks associated with having a drug-using sex partner; females in their sample were significantly more likely than males to report injecting with a sex partner in the previous six months, having a sex partner who is also an IDU, and having a sex partner inject them after injecting himself. Further, higher proportions of female IDUs than male IDUs appear to share syringes with their partners (Frajzyngier et al., 2007; Lum et al., 2005; Platt et al., 2005; Sherman et al., 2001). Females have also been found more likely to be injected by another IDU (Evans et al., 2003). "
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    ABSTRACT: Factors associated with syringe sharing differ between women and men; however, it is uncertain whether these hold within the setting of a single injection episode. A questionnaire eliciting information about the last injection episode with others present was administered to participants in a cohort of Montréal injection drug users (IDUs). Logistic regression was used to identify correlates of syringe sharing and to test potential gender differences in relation to syringe sharing. Data from 467 participants revealed significant differences between men and women with regard to situational factors; however, the relationships between situational factors and syringe sharing did not vary according to gender. In multivariate models including both genders, syringe sharing was associated with various attributes of other IDUs who were present as well as alcohol use during that specific episode. These results highlight the relevance of situational factors in injection drug use activity, regardless of gender.
    AIDS and Behavior 03/2009; 15(1):75-85. DOI:10.1007/s10461-009-9530-5 · 3.49 Impact Factor
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    • "In a qualitative study of Asian drug users in San Francisco (more than a third of whom were women), fear of needles and stigma were evident across all ethnic groups surveyed (Nemoto et al. 2000). In line with the broader literature (Sherman et al. 2001, Lum et al. 2005), Nemoto and colleagues (2000) also found that the Asian women in their sample were more likely to report an injecting sex partner than the men they interviewed, and so were doubly at risk of HIV through shared syringes and unprotected sex. "
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    ABSTRACT: Previous quantitative cross sectional studies of ethnic Vietnamese drug users in Melbourne have been overwhelmingly drawn from samples of men. In this qualitative investigation, 24 women aged between 18 and 33 years were interviewed. This exploratory study sought: to identify issues surrounding heroin initiation and drug use career; to examine relationships with family and primary sex partners; and to reveal participants' attitudes to drug treatment. Data reveal that for the women in this study the initiation and continued use of heroin was heavily influenced by men, especially their primary sex partners. The women interviewed reported strategies to minimise their risk taking including enrolling in pharmacotherapy treatment programmes, but they remained particularly vulnerable - especially to blood borne viruses - through both injecting and sexual risk behaviour. The data suggest that interventions which focus on the gendered nature of injecting practices within personal relationships may go some way to both reducing harm and increasing control for the women involved.
    Culture Health & Sexuality 11/2008; 10(7):681-96. DOI:10.1080/13691050802203838 · 1.55 Impact Factor
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