Higher Syringe Coverage Is Associated with Lower Odds of HIV Risk and Does Not Increase Unsafe Syringe Disposal Among Syringe Exchange Program Clients

Published in: Drug and Alcohol Dependence, v. 89, no. 2, July 2007, p. 214-222

Posted on RAND.org on January 01, 2007

by Ricky N. Bluthenthal, Rachel Anderson, Neil M. Flynn, Alex H. Kral

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OBJECTIVE: To determine if adequate syringe coverage one shot for one syringe among syringe exchange program (SEP) clients is associated with injection-related HIV risk behaviors and syringe disposal. DESIGN: HIV risk assessments with 1577 injection drug users (IDUs) recruited from 24 SEPs in California between 2001 and 2003. Individual syringe coverage was calculated as a proportion of syringes retained from SEP visits to total number of injections in the last 30 days. RESULTS: Participants were divided into four groups based on syringe coverage: <50%, 50-99%, 100-149%, and 150% or more. In multivariate logistic regression, SEP clients with less than 50% syringe coverage had significantly higher odds of reporting receptive syringe sharing in the last 30 days (adjusted odds ratio [AOR] = 2.3; 95% confidence interval [CI] = 1.4, 3.6) and those with 150% or more coverage had lower odds of reporting receptive syringe sharing (AOR = 0.5; 95%CI = 0.3, 0.8) as compared to SEP clients with adequate syringe coverage of 100-149%. Similar associations were observed for other main outcomes of distributive syringe sharing and syringe re-use. No differences in safe syringe disposal were observed by syringe coverage. CONCLUSIONS: Individual syringe coverage is strongly associated with safer injection behaviors without impacting syringe disposal among SEP clients. Syringe coverage is a useful measure for determining if IDUs are obtaining sufficient syringes to lower HIV risk.

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