AEGiS-14IAC: HIV risk reduction behaviors among secondary syringe exchangers: Their natural role in HIV prevention efforts among IDUs.

14th International AIDS Conference

Barcelona, Spain - July 7-12, 2002

HIV risk reduction behaviors among secondary syringe exchangers: Their natural role in HIV prevention efforts among IDUs.

Int Conf AIDS 2002 Jul 7-12; 14:(abstract no. MoOrD1061)

Sherman SG, Shepherd M, Vlahov D, Bareta JC, Valente TW, Huettner S, Strathdee SA
Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, United States

BACKGROUND: Secondary exchangers may play an important role in increasing sterile syringe coverage to IDUs who do not attend syringe exchange programs (SEPs). We compared HIV injection risk and syringe disposal practices between high (HVEs) and low volume exchangers (LVEs).

METHODS: All syringes exchanged at the Baltimore SEP from 08/94-02/97 were barcoded. IDUs participating in a cohort study during this period underwent semi-annual HIV testing and interviews on injection behaviors and needle disposal. Cohort and SEP data were linked to examine characteristics of exchangers. HVE classification was based on 6 aspects of frequency and volume of syringes exchanged. Generalized estimating equations were used to model syringe risk and disposal behaviors associated with high volume exchange.

RESULTS: Of 561 IDUs, 77% were male and 90% were African American. Median age and duration of injection drug use were 40 and 21 years, respectively. HVEs represented 20% of the sample (n=110). Compared to LVE (n=451), HVE were more likely to return SEP syringes to the SEP (32% vs. 22%, p = 0.001). Of more than 120,000 syringes obtained from the SEP, HVEs obtained 77% and returned 82% of all exchanged syringes. HVEs were more likely to be speedball injectors (AOR=1.9, 95%CI: 1.08-3.4), to inject more than twice per week (AOR=1.7: 95%CI: 1.12-2.67), to always use their own syringes (AOR=1.6, 95%CI: 1.04-2.42), and were less likely to use shooting galleries (AOR=0.52, 95%CIs: 0.28-0.98), dispose of syringes unsafely (AOR=0.31, 95%CI: 0.23-0.41) or test HIV positive (AOR=0.53, 95%CI: 0.32-0.88).

CONCLUSIONS: HVEs accounted for the majority of syringes exchanged at the SEP. In spite of injecting more frequently, HVEs were significantly safer in their needle behaviors and were half as likely to be HIV+ compared to LVEs. This study suggests that syringe limits at SEPs should be discouraged. HVEs appear to have a natural role in HIV prevention programs targeting IDUs.

Keywords: AEGIS, Needle-Exchange Programs, Syringes, HIV Infections, Risk Reduction Behavior, HIV Seropositivity, Substance-Related Disorders, Interviews, Injections, African Americans, Cohort Studies, Baltimore, Male, prevention & control

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