Needle exchange programs (NEPs) play a critical role in reducing the spread of HIV in injection drug users (IDUs). However, many IDUs do not access NEPs and rely on needle sellers. This study examined differences between needle sellers and others in a drug-using community and assessed sources and quantity of needles sold by needle sellers. The study also explored factors associated with needle selling. Compared with nonsellers, needle sellers were more likely to be homeless, HIV-positive, and unemployed. The NEP was the most frequent source of needles for needle sellers. Needle sellers were more likely to share their needles with sex partners and strangers than were nonsellers. Within the whole sample, needle selling was associated with injecting drugs and the number of roles in the drug economy. For injectors, needle selling was associated with obtaining needles from the NEP and having >1 role in the drug economy. Because needle sellers frequently interact with IDUs, training needle sellers may be an effective strategy for risk reduction and HIV prevention. However, because some needle sellers disseminate used needles, all injectors need to be educated about proper disposal techniques.
[Show abstract][Hide abstract] ABSTRACT: Syringe-sharing behaviors among injection drug users (IDUs) are typically based on self-reports and subject to socially desirable responding. We used 3 short tandem repeat (STR) genetic biomarkers to detect sharing in 2,512 syringes exchanged by 315 IDUs in the Baltimore needle exchange program (NEP; 738 person-visits). Demographic characteristics as well as direct and indirect needle-sharing behaviors corresponding to the closest AIDS Link to Intravenous Experience (ALIVE) study visits were examined for association with multiperson use (MPU) of syringes. Overall, 56% of the syringes exchanged at the Baltimore NEP had evidence of MPU. Less MPU of syringes (48% vs. 71%; P < 0.0001) was seen with more rapid syringe turnaround (<3 days). IDUs always exchanging their own syringes ("primary" syringes) were less likely to return syringes with evidence of MPU (52%) than those who exchanged syringes for others ("secondary" syringes; 64%; P = 0.0001) and those exchanging primary and secondary syringes (58%; P = 0.004). In a multivariate analysis restricted to primary exchangers, MPU of syringes was associated with sharing cotton (adjusted odds ratio [AOR] = 2.06, 95% confidence interval [CI]: 1.30 to 3.28), lending syringes (AOR = 1.70, 95% CI: 1.24 to 2.34), and injecting less than daily (AOR = 0.64, 95% CI: 0.43 to 0.95). These findings support additional public health interventions such as expanded syringe access to prevent HIV and other blood-borne infections. Testing of STRs represents a promising approach to examining and accessing complex behavioral data, including syringe sharing.
[Show abstract][Hide abstract] ABSTRACT: Comparing drug-injecting risk between cities that differ in the legality of sterile syringe distribution for injection drug use provides a natural experiment to assess the efficacy of legalizing sterile syringe distribution as a structural intervention to prevent human immunodeficiency virus (HIV) and other parenterally transmitted infections among injection drug users (IDUs). This study compares the parenteral risk for HIV and hepatitis B (HBV) and C (HCV) infection among IDUs in Newark, NJ, USA, where syringe distribution programs were illegal during the period when data were collected, and New York City (NYC) where they were legal. IDUs were nontreatment recruited, 2004-2006, serotested, and interviewed about syringe sources and injecting risk behaviors (prior 30 days). In multivariate logistic regression, adjusted odds ratios (AOR) and 95% confidence intervals (95% CI) for city differences are estimated controlling for potential city confounders. IDUs in Newark (n=214) vs. NYC (n=312) were more likely to test seropositive for HIV (26% vs. 5%; AOR=3.2; 95% CI=1.6, 6.1), antibody to the HBV core antigen (70% vs. 27%; AOR=4.4; 95% CI=2.8, 6.9), and antibody to HCV (82% vs. 53%; AOR=3.0; 95% CI=1.8, 4.9), were less likely to obtain syringes from syringe exchange programs or pharmacies (AOR=0.004; 95% CI=0.001, 0.01), and were more likely to obtain syringes from street sellers (AOR=74.0; 95% CI=29.9, 183.2), to inject with another IDU's used syringe (AOR=2.3; 95% CI=1.1, 5.0), to reuse syringes (AOR=2.99; 95% CI=1.63, 5.50), and to not always inject once only with a new, sterile syringe that had been sealed in a wrapper (AOR=5.4; 95% CI=2.9, 10.3). In localities where sterile syringe distribution is illegal, IDUs are more likely to obtain syringes from unsafe sources and to engage in injecting risk behaviors. Legalizing and rapidly implementing sterile syringe distribution programs are critical for reducing parenterally transmitted HIV, HBV, and HCV among IDUs.
Journal of Urban Health 06/2008; 85(3):309-22. DOI:10.1007/s11524-008-9271-1 · 1.90 Impact Factor
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