Syringe Sharing and HIV Incidence Among Injection Drug Users and Increased Access to Sterile Syringes

• Published in: American journal of public health (1971) 2010-08, Vol.100 (8), p.1449-1453
• Main Authors: KERR, Thomas, SMALL, Will, BUCHNER, Chris, ZHANG, Ruth, LI, Kathy, MONTANER, Julio, WOOD, Evan
• Format: Article
• Language: English
• Subjects: Addictive behaviors; Adult; Adult and adolescent clinical studies; Behavior; Biological and medical sciences; Borrowing; British Columbia - epidemiology; Cocaine; Drug addiction; Drug use; Female; Gender; General aspects; Health Policy; Heroin; HIV; HIV Infections - epidemiology; HIV Infections - etiology; HIV Infections - prevention & control; Human immunodeficiency virus; Human viral diseases; Humans; Incidence; Infectious diseases; Linear Models; Logistic Models; Male; Medical sciences; Miscellaneous; Multivariate Analysis; Native peoples; Needle exchange programs; Needle Sharing - adverse effects; Needle Sharing - statistics & numerical data; Needle-Exchange Programs - organization & administration; Organizational Policy; Pharmacists; Program Evaluation; Proportional Hazards Models; Prospective Studies; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Public health; Public health. Hygiene; Public health. Hygiene-occupational medicine; Regression analysis; Research and Practice; Risk Factors; Risk-Taking; Studies; Substance Abuse, Intravenous - complications; Substance Abuse, Intravenous - epidemiology; Urban Health Services - organization & administration; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids
• ISSN: 0090-0036; 1541-0048
• DOI: 10.2105/AJPH.2009.178467

We assessed the effects of syringe exchange program (SEP) policy on rates of HIV risk behavior and HIV incidence among injection drug users. Using a multivariate generalized estimating equation and Cox regression methods, we examined syringe borrowing, syringe lending, and HIV incidence among a prospective cohort of 1228 injection drug users in Vancouver, British Columbia. We observed substantial declines in rates of syringe borrowing (from 20.1% in 1998 to 9.2% in 2003) and syringe lending (from 19.1% in 1998 to 6.8% in 2003) following SEP policy change. These declines coincided with a statistically significant increase in the proportion of participants accessing sterile syringes from nontraditional SEP sources (P < .001). In multivariate analyses, the period following the change in SEP policy was independently associated with a greater than 40% reduction in syringe borrowing (adjusted odds ratio [AOR] = 0.57; 95% confidence interval [CI] = 0.49, 0.65) and lending (AOR = 0.52; 95% CI = 0.45, 0.60), as well as declining HIV incidence (adjusted hazard ratio = 0.13; 95% CI = 0.06, 0.31). Widespread syringe distribution appears to be a more effective SEP policy than do more restrictive SEP policies that limit syringe access. Efforts should be made to ensure that SEP policies and program design serve to maximize rather than hinder syringe access.