Injection Risk Behavior among Women Syringe Exchangers in San Francisco

Department of Medicine, University of California, San Francisco, San Francisco, California, United States
Substance Use & Misuse (Impact Factor: 1.23). 02/2005; 40(11):1681-96. DOI: 10.1080/10826080500222834
Source: PubMed


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.

Download full-text


Available from: Joseph Guydish
  • Source
    • "The dependent variables in the analysis were five types of injecting equipment sharing: sharing cookers, sharing filters, receptive syringe sharing, distributive syringe sharing and syringe-mediated drug sharing (backloading) in the past 30 days. Since having an IDU sex partner has been found to be associated with injecting equipment sharing (Evans et al. 2003; Lum, Sears, and Guydish 2005), and we had found strong infection disclosure norms among IDUs in Hungary (Gyarmathy et al. 2006), we created four-way interaction variables for self-report of HCV infection and having an IDU sex partner (1. no reported HCV infection and no IDU sex partner (reference category), 2. no reported HCV infection and IDU sex partner, 3. reported HCV infection and no IDU sex partner, 4. reported HCV infection and IDU sex partner). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Until the mid-1990s, the prevalence and incidence of HIV infection was uniformly low in countries across the Central and Eastern European region. In the past decade, however, this has changed dramatically, with a rapid increase in HIV infections in the region, especially in Eastern Europe where 41% of new HIV infection cases were among injecting drug users (IDUs) and as much as 66% of IDUs are infected with HIV in certain regions. While Russia, the largest country in Eastern Europe, has the fastest growing HIV rates in the world, the situation is different in Central Europe. For example, Hungary has low levels of HIV infection - estimated less than 1% of IDUs. Understanding the role of network factors in the spread and prevention of HIV could not only enable us to keep the HIV rates low among IDUs in countries like Hungary, but also provide a means for the effective prevention of other blood-borne and sexually transmitted infections (STIs) that share similar routes of transmission as HIV. Rogers' diffusion of innovations theory may help explain why HIV rates among IDUs are low in Hungary. Valente's related exposure or contagion model postulates that the more individuals within a social network adopt an innovation or a practice, the greater the probability of an individual is to adopt this innovation or practice. Personal network exposure (PNE), measured both within egocentric and sociocentric networks quantifies the extent to which a person is exposed to risk through their social network. The aim of this analysis was to assess the association of PNE and other correlates with injecting equipment sharing among IDUs in Budapest, Hungary.
    Full-text · Article · Dec 2015
  • Source
    • "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. "
    [Show abstract] [Hide abstract]
    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.
    Full-text · Article · May 2013 · Drug and alcohol dependence
  • Source
    • "Homeless persons also suffer disproportionate rates of sexual victimization, increasing their risk of contracting HIV [7-11]. Among injection drug users, the homeless have increased rates of needle sharing [5,12], and drug injection [13] and are more likely to frequent shooting galleries [6,14]. Many of these studies are longitudinal [13,15] and thus, document that homelessness often temporally precedes risk behaviors. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Much research has shown an association between homelessness and unstable housing and HIV risk but most has relied on relatively narrow definitions of housing status that preclude a deeper understanding of this relationship. Fewer studies have examined access to housing subsidies and supportive housing programs among low-income populations with different personal characteristics. This paper explores personal characteristics associated with access to housing subsidies and supportive housing, the relationship between personal characteristics and housing status, and the relationship between housing status and sexual risk behaviors among low-income urban residents. Surveys were conducted with 392 low-income residents from Hartford and East Harford, Connecticut through a targeted sampling plan. We measured personal characteristics (income, education, use of crack, heroin, or cocaine in the last 6 months, receipt of welfare benefits, mental illness diagnosis, arrest, criminal conviction, longest prison term served, and self-reported HIV diagnosis); access to housing subsidies or supportive housing programs; current housing status; and sexual risk behaviors. To answer the aims above, we performed univariate analyses using Chi-square or 2-sided ANOVA's. Those with significance levels above (0.10) were included in multivariate analyses. We performed 2 separate multiple regressions to determine the effects of personal characteristics on access to housing subsidies and access to supportive housing respectively. We used multinomial main effects logistic regression to determine the effects of housing status on sexual risk behavior. Being HIV positive or having a mental illness predicted access to housing subsidies and supportive housing, while having a criminal conviction was not related to access to either housing subsidies or supportive housing. Drug use was associated with poorer housing statuses such as living on the street or in a shelter, or temporarily doubling up with friends, acquaintances or sex partners. Living with friends, acquaintances or sex partners was associated with greater sexual risk than those living on the street or in other stable housing situations. Results suggest that providing low-income and supportive housing may be an effective structural HIV prevention intervention, but that the availability and accessibility of these programs must be increased.
    Full-text · Article · Nov 2011 · Substance Abuse Treatment Prevention and Policy
Show more