Article

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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    • "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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    • "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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    • "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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