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Thomas Kerr - One of the best experts on this subject based on the ideXlab platform.
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Longitudinal Factors Associated with Used Syringe Lending Among HIV-Positive Antiretroviral Therapy-Naïve People Who Inject Drugs in a Canadian Setting
AIDS and Behavior, 2020Co-Authors: Ezequiel Blumenkrans, Thomas Kerr, Lindsey Richardson, M. Eugenia Socías, Jean Shoveller, Julio Montaner, M.-j. MilloyAbstract:Sharing used Syringes is an important route of HIV transmission, however, factors shaping used Syringe-lending among antiretroviral therapy (ART)-naïve HIV-positive people who inject drugs (PWID) are not well-characterized. Multivariable logistic regression analyses using generalized estimating equations (GEE) were employed to investigate correlates of used Syringe lending among ART-naïve PWID. Data was drawn from ACCESS, a prospective community-recruited cohort of HIV-positive illicit drug users in Vancouver, Canada, from 1996 to 2015. The analysis included 482 ART-naïve PWID, of which 116 (24.1%) reported ≥ 1 periods of used Syringe lending. In longitudinal analyses, incarceration (Adjusted Odds Ratio [AOR] = 2.18, 95% Confidence Interval [CI] 1.48–3.20), daily cocaine injection (AOR= 1.97, 95% CI 1.33–2.90), and sex work (AOR = 1.61, 95% CI 1.02–2.55) during the 180-day observation period were positively associated with used Syringe lending, while having a high school diploma (AOR = 0.63, 95% CI 0.43–0.93) and holding formal employment (AOR = 0.20, 95% CI 0.05–0.82) were negatively associated. We found a high prevalence of used Syringe lending among ART-naïve HIV-positive PWID, particularly among those recently incarcerated, involved in sex work or who injected cocaine frequently. Conversely, markers of higher socio-economic status were negatively associated with used Syringe lending. These findings highlight the critical need for policies and interventions to decrease socio-economic marginalization and criminalization among PWID living with HIV alongside the scale up of access to harm reduction services.
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Syringe sharing among people who inject drugs in London, Canada
Canadian Journal of Public Health, 2018Co-Authors: Ayden I. Scheim, Geoff Bardwell, Beth Rachlis, Sanjana Mitra, Thomas KerrAbstract:ObjectivesLondon, Ontario, is facing an outbreak of HIV among people who inject drugs (PWID), as well as persistently high levels of hepatitis C virus (HCV). Syringe sharing is the primary driver of HIV and HCV transmission risks among PWID, however, little is known about factors contributing to Syringe sharing in this setting. Therefore, we sought to characterize Syringe sharing and its correlates among London PWID.MethodsBetween March and April, 2016, PWID participated in a survey administered by peer research associates as part of the Ontario Integrated Supervised Injection Services Feasibility Study. Bivariable and multivariable logistic regression models examined associations with Syringe sharing (borrowing or lending previously used Syringes) over the previous 6 months. A sub-analysis described patterns of borrowing and lending by self-reported HIV and HCV statuses.ResultsOf 198 PWID, 44 (22%) reported Syringe sharing in the past 6 months. In the multivariable analysis, selling drugs (adjusted odds ratio; AOR = 1.92, 95% CI = 1.20–3.08), daily crystal methamphetamine injection (AOR = 1.66, 95% CI = 1.07–2.59), and identifying as HIV-positive (AOR = 3.11, 95% CI = 1.61–6.01) were independently associated with increased Syringe sharing. While not independently associated with Syringe sharing, problems accessing Syringes were common (13–50%). Self-reported HIV-positive respondents were more likely to report Syringe borrowing ( p
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Syringe Sharing Among a Prospective Cohort of Street-Involved Youth: Implications for Needle Distribution Programs
AIDS and Behavior, 2017Co-Authors: Nikki Bozinoff, Thomas Kerr, Huiru Dong, Lindsey Richardson, Evan Wood, Kora DebeckAbstract:The sharing of previously used Syringes is associated with the transmission of Hepatitis C and HIV. This longitudinal study examines Syringe borrowing and Syringe lending within a prospective cohort of street-involved youth in Vancouver, Canada. From September 2005 to May 2014, data were collected from the At-Risk Youth Study, a cohort of street-involved youth age 14–26 at enrollment, and analyzed using generalized estimating equations. Among 505 participants, 142 (28.1%) reported Syringe borrowing and 132 (26.1%) reported Syringe lending during the study period. In separate multivariable analyses, having difficulty finding clean needles and homelessness were significantly associated with Syringe borrowing (Adjusted Odds Ratio (AOR) = 2.28, 95% CI 1.66–3.12 and AOR = 1.52, CI 1.05–2.21, respectively) and Syringe lending (AOR = 1.89, 95% CI 1.32–2.71 and AOR = 1.65, 95% CI 1.11–2.44, respectively) (all p values
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High prevalence of Syringe lending among HIV-positive people who inject drugs in Bangkok, Thailand
Harm Reduction Journal, 2015Co-Authors: Pauline Voon, Lianping Ti, Karyn Kaplan, Paisan Suwannawong, Kanna Hayashi, Evan Wood, Thomas KerrAbstract:BackgroundSyringe sharing continues to be a major driver of the HIV pandemic. In light of efforts to enhance access to sterile Syringes and promote secondary prevention among HIV-positive individuals, we sought to identify the prevalence and correlates of used Syringe lending among self-reported HIV-positive people who inject drugs (PWID) in Bangkok, Thailand.FindingsWe used bivariable statistics to examine factors associated with self-reported Syringe lending among self-reported HIV-positive PWID participating in the Mitsampan Community Research Project, a serial cross-sectional study of PWID in Bangkok, between June 2009 and October 2011. In total, 127 individuals were eligible for this analysis, including 25 (19.7 %) women. Twenty-one (16.5 %) participants reported Syringe lending in the prior 6 months. Factors significantly associated with Syringe lending included daily methamphetamine injection (odds ratio (OR) = 10.2, 95 % CI, 2.1–53.6), daily midazolam injection (OR = 3.1, 95 % CI, 1.1–8.7), use of drugs in combination (OR = 4.5, 95 % CI, 1.0–41.6), injecting with others on a frequent basis (OR = 4.25, 95 % CI, 1.3–18.3), and not receiving antiretroviral therapy (OR = 2.9, 95 % CI, 1.1–7.9).ConclusionsA high prevalence of Syringe lending was observed among self-reported HIV-positive PWID in Bangkok, which was associated with high intensity drug use, polysubstance use, and frequently injecting with others. It is particularly concerning that individuals who lent Syringes were more likely to be untreated for HIV disease given the known benefits of antiretroviral provision on the prevention of HIV transmission. These findings underscore the need to expand access to sterile Syringes and HIV treatment among HIV-positive PWID in Thailand.
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Syringe sharing and hiv incidence among injection drug users and increased access to sterile Syringes
American Journal of Public Health, 2010Co-Authors: Thomas Kerr, Ruth Zhang, Will Small, Chris Buchner, Kathy Li, Julio S G Montaner, Evan WoodAbstract:Objectives. We assessed the effects of Syringe exchange program (SEP) policy on rates of HIV risk behavior and HIV incidence among injection drug users.Methods. 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.Results. 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;...
Georgiy V. Bobashev - One of the best experts on this subject based on the ideXlab platform.
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Feasibility of needle and Syringe programs in Tajikistan distributing low dead space needles
Harm Reduction Journal, 2018Co-Authors: William A. Zule, David Otiashvili, Alisher Latypov, Steffani Bangel, Georgiy V. BobashevAbstract:BackgroundIn 2012, the World Health Organization recommended that needle and Syringe programs offer their clients low dead space insulin Syringes with permanently attached needles. However, in many countries, these Syringes are not acceptable to a majority of people who inject drugs. This study assessed the feasibility of working with needle and Syringe programs to implement the WHO recommendation using low dead space detachable needles. The study also assessed the acceptability of the needles.MethodsTwo needle and Syringe programs in Tajikistan—one in Kulob and one in Khudjand—received 25,000 low dead space detachable needles each. The programs distributed low dead space detachable needles and a marketing flyer that emphasized the relative advantages of the needles. Each program also enrolled 100 participants, and each participant completed a baseline interview and a 2-month follow-up interview.ResultsAt follow-up, 100% of participants reported trying the low dead space detachable needles, and 96% reported that they liked using the needles. Both needle and Syringe programs distributed all their needles within the first 60 days of the project indicating use of the needles, even among clients who did not participate in the study.ConclusionsThis project demonstrates that it is feasible for needle and Syringe programs to offer and promote low dead space needles to their clients. The findings indicate that low dead space needles are acceptable to needle and Syringe program clients in these Tajikistan cities. To reduce HIV and hepatitis C virus transmission, needle and Syringe programs should offer low dead space needles, low dead space insulin Syringes in addition to standard needles, and Syringes to their clients.
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Options for reducing HIV transmission related to the dead space in needles and Syringes
Harm Reduction Journal, 2018Co-Authors: William A. Zule, David Otiashvili, Georgiy V. Bobashev, Poonam G. Pande, V. Anna Gyarmathy, Samuel R. Friedman, D. C. Des JarlaisAbstract:BackgroundWhen shared by people who inject drugs, needles and Syringes with different dead space may affect the probability of HIV and hepatitis C virus (HCV) transmission differently.MethodsWe measured dead space in 56 needle and Syringe combinations obtained from needle and Syringe programs across 17 countries in Europe and Asia. We also calculated the amounts of blood and HIV that would remain in different combinations following injection and rinsing.ResultsSyringe barrel capacities ranged from 0.5 to 20 mL. Needles ranged in length from 8 to 38 mm. The average dead space was 3 μL in low dead space Syringes with permanently attached needles, 13 μL in high dead space Syringes with low dead space needles, 45 μL in low dead space Syringes with high dead space needles, and 99 μL in high dead space Syringes with high dead space needles. Among low dead space designs, calculated volumes of blood and HIV viral burden were lowest for low dead space Syringes with permanently attached needles and highest for low dead space Syringes with high dead space needles.ConclusionThe dead space in different low dead space needle and Syringe combinations varied substantially. To reduce HIV transmission related to Syringe sharing, needle and Syringe programs need to combine this knowledge with the needs of their clients.
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Factors that influence the characteristics of needles and Syringes used by people who inject drugs in Tajikistan
Harm Reduction Journal, 2015Co-Authors: William A. Zule, David Otiashvili, Irma Kirtadze, Alisher Latypov, Umedjon Ibragimov, Georgiy V. BobashevAbstract:Background“Low dead space” Syringes with permanently attached needles retain less fluid, blood, and HIV after use than standard “high dead space” Syringes. This reduces the probability of HIV transmission if they are shared by people who inject drugs (PWID). The World Health Organization recently recommended that needle and Syringe programs (NSP) offer clients low dead space Syringes. The success of this recommendation will depend on PWID switching to low dead space needles and Syringes. This paper examines the needles and Syringes that PWID in Tajikistan use and factors that influence their choices.MethodsIn May 2014, we conducted six focus groups in Kulob and six in Khorog, Tajikistan, with a total of 100 participants. NSP staff members recruited participants. Focus group topics included the needles and Syringes used and factors that influence choice of needles and Syringes. Focus groups were conducted in Russian and Tajik, audio recorded, transcribed, and translated into English. The translated files were imported into NVivo 10 for coding and analysis.ResultsAll participants in both cities were male and reported injecting heroin. Everyone also reported using Syringes with detachable needles almost exclusively. The most popular Syringe sizes were 2 and 5 ml. Needles ranged in gauge from 25 to 21 g. Needle gauge was influenced by the size of the vein, the viscosity of drug solution to be injected, and problems with blood clotting. Needles ranged in length from 12 to 38 mm, with 25 and 32 mm being the most popular. Needle length was influenced by the depth of the vein being used. Many PWID inject volumes of fluid greater than 1 ml into deep veins that require needles at least 25 mm long and 25 g in diameter.ConclusionMost low dead space Syringes are 1-ml insulin Syringes with 12 mm 28 g permanently attached needles. Findings from this project suggest that these will not be acceptable to PWID who need larger Syringes and longer and thicker needles that are detachable. Low dead space detachable needles appear to be an acceptable option that could overcome barriers to the widespread use of low dead space equipment for reducing HIV and HCV transmission.
William A. Zule - One of the best experts on this subject based on the ideXlab platform.
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Feasibility of needle and Syringe programs in Tajikistan distributing low dead space needles
Harm Reduction Journal, 2018Co-Authors: William A. Zule, David Otiashvili, Alisher Latypov, Steffani Bangel, Georgiy V. BobashevAbstract:BackgroundIn 2012, the World Health Organization recommended that needle and Syringe programs offer their clients low dead space insulin Syringes with permanently attached needles. However, in many countries, these Syringes are not acceptable to a majority of people who inject drugs. This study assessed the feasibility of working with needle and Syringe programs to implement the WHO recommendation using low dead space detachable needles. The study also assessed the acceptability of the needles.MethodsTwo needle and Syringe programs in Tajikistan—one in Kulob and one in Khudjand—received 25,000 low dead space detachable needles each. The programs distributed low dead space detachable needles and a marketing flyer that emphasized the relative advantages of the needles. Each program also enrolled 100 participants, and each participant completed a baseline interview and a 2-month follow-up interview.ResultsAt follow-up, 100% of participants reported trying the low dead space detachable needles, and 96% reported that they liked using the needles. Both needle and Syringe programs distributed all their needles within the first 60 days of the project indicating use of the needles, even among clients who did not participate in the study.ConclusionsThis project demonstrates that it is feasible for needle and Syringe programs to offer and promote low dead space needles to their clients. The findings indicate that low dead space needles are acceptable to needle and Syringe program clients in these Tajikistan cities. To reduce HIV and hepatitis C virus transmission, needle and Syringe programs should offer low dead space needles, low dead space insulin Syringes in addition to standard needles, and Syringes to their clients.
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Options for reducing HIV transmission related to the dead space in needles and Syringes
Harm Reduction Journal, 2018Co-Authors: William A. Zule, David Otiashvili, Georgiy V. Bobashev, Poonam G. Pande, V. Anna Gyarmathy, Samuel R. Friedman, D. C. Des JarlaisAbstract:BackgroundWhen shared by people who inject drugs, needles and Syringes with different dead space may affect the probability of HIV and hepatitis C virus (HCV) transmission differently.MethodsWe measured dead space in 56 needle and Syringe combinations obtained from needle and Syringe programs across 17 countries in Europe and Asia. We also calculated the amounts of blood and HIV that would remain in different combinations following injection and rinsing.ResultsSyringe barrel capacities ranged from 0.5 to 20 mL. Needles ranged in length from 8 to 38 mm. The average dead space was 3 μL in low dead space Syringes with permanently attached needles, 13 μL in high dead space Syringes with low dead space needles, 45 μL in low dead space Syringes with high dead space needles, and 99 μL in high dead space Syringes with high dead space needles. Among low dead space designs, calculated volumes of blood and HIV viral burden were lowest for low dead space Syringes with permanently attached needles and highest for low dead space Syringes with high dead space needles.ConclusionThe dead space in different low dead space needle and Syringe combinations varied substantially. To reduce HIV transmission related to Syringe sharing, needle and Syringe programs need to combine this knowledge with the needs of their clients.
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Factors that influence the characteristics of needles and Syringes used by people who inject drugs in Tajikistan
Harm Reduction Journal, 2015Co-Authors: William A. Zule, David Otiashvili, Irma Kirtadze, Alisher Latypov, Umedjon Ibragimov, Georgiy V. BobashevAbstract:Background“Low dead space” Syringes with permanently attached needles retain less fluid, blood, and HIV after use than standard “high dead space” Syringes. This reduces the probability of HIV transmission if they are shared by people who inject drugs (PWID). The World Health Organization recently recommended that needle and Syringe programs (NSP) offer clients low dead space Syringes. The success of this recommendation will depend on PWID switching to low dead space needles and Syringes. This paper examines the needles and Syringes that PWID in Tajikistan use and factors that influence their choices.MethodsIn May 2014, we conducted six focus groups in Kulob and six in Khorog, Tajikistan, with a total of 100 participants. NSP staff members recruited participants. Focus group topics included the needles and Syringes used and factors that influence choice of needles and Syringes. Focus groups were conducted in Russian and Tajik, audio recorded, transcribed, and translated into English. The translated files were imported into NVivo 10 for coding and analysis.ResultsAll participants in both cities were male and reported injecting heroin. Everyone also reported using Syringes with detachable needles almost exclusively. The most popular Syringe sizes were 2 and 5 ml. Needles ranged in gauge from 25 to 21 g. Needle gauge was influenced by the size of the vein, the viscosity of drug solution to be injected, and problems with blood clotting. Needles ranged in length from 12 to 38 mm, with 25 and 32 mm being the most popular. Needle length was influenced by the depth of the vein being used. Many PWID inject volumes of fluid greater than 1 ml into deep veins that require needles at least 25 mm long and 25 g in diameter.ConclusionMost low dead space Syringes are 1-ml insulin Syringes with 12 mm 28 g permanently attached needles. Findings from this project suggest that these will not be acceptable to PWID who need larger Syringes and longer and thicker needles that are detachable. Low dead space detachable needles appear to be an acceptable option that could overcome barriers to the widespread use of low dead space equipment for reducing HIV and HCV transmission.
D. C. Des Jarlais - One of the best experts on this subject based on the ideXlab platform.
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Options for reducing HIV transmission related to the dead space in needles and Syringes
Harm Reduction Journal, 2018Co-Authors: William A. Zule, David Otiashvili, Georgiy V. Bobashev, Poonam G. Pande, V. Anna Gyarmathy, Samuel R. Friedman, D. C. Des JarlaisAbstract:BackgroundWhen shared by people who inject drugs, needles and Syringes with different dead space may affect the probability of HIV and hepatitis C virus (HCV) transmission differently.MethodsWe measured dead space in 56 needle and Syringe combinations obtained from needle and Syringe programs across 17 countries in Europe and Asia. We also calculated the amounts of blood and HIV that would remain in different combinations following injection and rinsing.ResultsSyringe barrel capacities ranged from 0.5 to 20 mL. Needles ranged in length from 8 to 38 mm. The average dead space was 3 μL in low dead space Syringes with permanently attached needles, 13 μL in high dead space Syringes with low dead space needles, 45 μL in low dead space Syringes with high dead space needles, and 99 μL in high dead space Syringes with high dead space needles. Among low dead space designs, calculated volumes of blood and HIV viral burden were lowest for low dead space Syringes with permanently attached needles and highest for low dead space Syringes with high dead space needles.ConclusionThe dead space in different low dead space needle and Syringe combinations varied substantially. To reduce HIV transmission related to Syringe sharing, needle and Syringe programs need to combine this knowledge with the needs of their clients.
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State laws, Syringe exchange, and HIV among persons who inject drugs in the United States: History and effectiveness
Journal of Public Health Policy, 2015Co-Authors: Heidi Bramson, D. C. Des Jarlais, Kamyar Arasteh, Ann Nugent, Vivian Guardino, Jonathan Feelemyer, Derek HodelAbstract:In 1981, when acquired immune deficiency syndrome (AIDS) was first observed among persons who inject drugs, almost all US states had laws criminalizing the possession and distribution of needles and Syringes for injecting illicit drugs. We reviewed changes to these laws to permit ‘Syringe exchanges’ and the provision of public funding for such programs. Most of the changes in law occurred during the 1990s, 5–10 years later than in many other countries. Public funding of Syringe exchanges is associated with lower rates of human immunodeficiency virus (HIV) infection, greater numbers of Syringes distributed (a possible causal mechanism), and greater numbers of health and social services provided. Experience in the United states may prove useful in other countries: state, provincial, and local governments may need to move ahead of central governments in addressing HIV infection among persons who inject drugs.
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Syringe Exchange in the United States: A National Level Economic Evaluation of Hypothetical Increases in Investment
AIDS and Behavior, 2014Co-Authors: Trang Quynh Nguyen, D. C. Des Jarlais, Brian W. Weir, Steven D. Pinkerton, David R HoltgraveAbstract:To examine whether increasing investment in needle/Syringe exchange programs (NSPs) in the US would be cost-effective for HIV prevention, we modeled HIV incidence in hypothetical cases with higher NSP Syringe supply than current levels, and estimated number of infections averted, cost per infection averted, treatment costs saved, and financial return on investment. We modified Pinkerton’s model, which was an adaptation of Kaplan’s simplified needle circulation theory model, to compare different Syringe supply levels, account for Syringes from non-NSP sources, and reflect reduction in Syringe sharing and contamination. With an annual $10 to $50 million funding increase, 194–816 HIV infections would be averted (cost per infection averted $51,601–$61,302). Contrasted with HIV treatment cost savings alone, the rate of financial return on investment would be 7.58–6.38. Main and sensitivity analyses strongly suggest that it would be cost-saving for the US to invest in Syringe exchange expansion.
Evan Wood - One of the best experts on this subject based on the ideXlab platform.
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Syringe Sharing Among a Prospective Cohort of Street-Involved Youth: Implications for Needle Distribution Programs
AIDS and Behavior, 2017Co-Authors: Nikki Bozinoff, Thomas Kerr, Huiru Dong, Lindsey Richardson, Evan Wood, Kora DebeckAbstract:The sharing of previously used Syringes is associated with the transmission of Hepatitis C and HIV. This longitudinal study examines Syringe borrowing and Syringe lending within a prospective cohort of street-involved youth in Vancouver, Canada. From September 2005 to May 2014, data were collected from the At-Risk Youth Study, a cohort of street-involved youth age 14–26 at enrollment, and analyzed using generalized estimating equations. Among 505 participants, 142 (28.1%) reported Syringe borrowing and 132 (26.1%) reported Syringe lending during the study period. In separate multivariable analyses, having difficulty finding clean needles and homelessness were significantly associated with Syringe borrowing (Adjusted Odds Ratio (AOR) = 2.28, 95% CI 1.66–3.12 and AOR = 1.52, CI 1.05–2.21, respectively) and Syringe lending (AOR = 1.89, 95% CI 1.32–2.71 and AOR = 1.65, 95% CI 1.11–2.44, respectively) (all p values
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High prevalence of Syringe lending among HIV-positive people who inject drugs in Bangkok, Thailand
Harm Reduction Journal, 2015Co-Authors: Pauline Voon, Lianping Ti, Karyn Kaplan, Paisan Suwannawong, Kanna Hayashi, Evan Wood, Thomas KerrAbstract:BackgroundSyringe sharing continues to be a major driver of the HIV pandemic. In light of efforts to enhance access to sterile Syringes and promote secondary prevention among HIV-positive individuals, we sought to identify the prevalence and correlates of used Syringe lending among self-reported HIV-positive people who inject drugs (PWID) in Bangkok, Thailand.FindingsWe used bivariable statistics to examine factors associated with self-reported Syringe lending among self-reported HIV-positive PWID participating in the Mitsampan Community Research Project, a serial cross-sectional study of PWID in Bangkok, between June 2009 and October 2011. In total, 127 individuals were eligible for this analysis, including 25 (19.7 %) women. Twenty-one (16.5 %) participants reported Syringe lending in the prior 6 months. Factors significantly associated with Syringe lending included daily methamphetamine injection (odds ratio (OR) = 10.2, 95 % CI, 2.1–53.6), daily midazolam injection (OR = 3.1, 95 % CI, 1.1–8.7), use of drugs in combination (OR = 4.5, 95 % CI, 1.0–41.6), injecting with others on a frequent basis (OR = 4.25, 95 % CI, 1.3–18.3), and not receiving antiretroviral therapy (OR = 2.9, 95 % CI, 1.1–7.9).ConclusionsA high prevalence of Syringe lending was observed among self-reported HIV-positive PWID in Bangkok, which was associated with high intensity drug use, polysubstance use, and frequently injecting with others. It is particularly concerning that individuals who lent Syringes were more likely to be untreated for HIV disease given the known benefits of antiretroviral provision on the prevention of HIV transmission. These findings underscore the need to expand access to sterile Syringes and HIV treatment among HIV-positive PWID in Thailand.
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Syringe sharing and hiv incidence among injection drug users and increased access to sterile Syringes
American Journal of Public Health, 2010Co-Authors: Thomas Kerr, Ruth Zhang, Will Small, Chris Buchner, Kathy Li, Julio S G Montaner, Evan WoodAbstract:Objectives. We assessed the effects of Syringe exchange program (SEP) policy on rates of HIV risk behavior and HIV incidence among injection drug users.Methods. 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.Results. 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;...
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Difficulty accessing Syringes and Syringe borrowing among injection drug users in Bangkok, Thailand
Drug and Alcohol Review, 2009Co-Authors: Thomas Kerr, Karyn Kaplan, Paisan Suwannawong, Kanna Hayashi, Nadia Fairbairn, Ruth Zhang, Evan WoodAbstract:Introduction and Aims. Thailand's longstanding HIV epidemic among injection drug users (IDU) has been attributed, in part, to the Thai government's unwillingness to implement evidence-based HIV prevention interven- tions.This study was undertaken to examine risk factors for Syringe borrowing among a community-recruited sample ofThai IDU.Design and Methods.We examined the prevalence of Syringe borrowing among 238 IDU participating in the Mit Sampan Community Research Project, Bangkok. Multivariate logistic regression was used to identify independent predictors of Syringe borrowing in the past 6 months. Results. A total of 238 IDU participated in this study; 66 (26.2%) were female, and the median age was 36.5 years. In total, 72 (30.3%) participants reported borrowing a used Syringe in the past 6 months, with 47 (65.3%) of these individuals reporting multiple borrowing events. In multivariate analyses, Syringe borrowing was positively associated with difficulty accessing Syringes (adjusted odds ratio (AOR) = 2.46; 95% confidence interval (CI): 1.08-5.60) and injecting with other people on a frequent basis (AOR = 3.17; 95% CI: 1.73-5.83). Primary reasons offered for experiencing difficulty accessing Syringes included being too far from Syringe outlets (34.1%), pharmacies being closed (13.6%) and being refused Syringes at pharmacies (9.1%). Discussion and Conclusions. We observed an alarmingly high rate of Syringe borrowing among a community-recruited sample ofThai IDU.Various lines of evidence indicate that poor access to sterile Syringes is driving the high rate of Syringe borrowing observed in this study. Immediate action should be taken to increase access to sterile Syringes amongThai IDU. (KerrT, Fairbairn N, Hayashi K, Suwannawong P, Kaplan K, Zhang R, Wood E. Difficulty accessing Syringes and Syringe borrowing among injection drug users in Bangkok, Thailand. Drug Alcohol Rev 2010;29;157-161)
