Journal of Urban Health

, Volume 85, Issue 3, pp 309–322 | Cite as

Greater Drug Injecting Risk for HIV, HBV, and HCV Infection in a City Where Syringe Exchange and Pharmacy Syringe Distribution are Illegal

  • Alan Neaigus
  • Mingfang Zhao
  • V. Anna Gyarmathy
  • Linda Cisek
  • Samuel R. Friedman
  • Robert C. Baxter
Article

Abstract

Comparing drug-injecting risk between cities that differ in the legality of sterile syringe distribution for injection drug use provides a natural experiment to assess the efficacy of legalizing sterile syringe distribution as a structural intervention to prevent human immunodeficiency virus (HIV) and other parenterally transmitted infections among injection drug users (IDUs). This study compares the parenteral risk for HIV and hepatitis B (HBV) and C (HCV) infection among IDUs in Newark, NJ, USA, where syringe distribution programs were illegal during the period when data were collected, and New York City (NYC) where they were legal. IDUs were nontreatment recruited, 2004–2006, serotested, and interviewed about syringe sources and injecting risk behaviors (prior 30 days). In multivariate logistic regression, adjusted odds ratios (AOR) and 95% confidence intervals (95% CI) for city differences are estimated controlling for potential city confounders. IDUs in Newark (n = 214) vs. NYC (n = 312) were more likely to test seropositive for HIV (26% vs. 5%; AOR = 3.2; 95% CI = 1.6, 6.1), antibody to the HBV core antigen (70% vs. 27%; AOR = 4.4; 95% CI = 2.8, 6.9), and antibody to HCV (82% vs. 53%; AOR = 3.0; 95% CI = 1.8, 4.9), were less likely to obtain syringes from syringe exchange programs or pharmacies (AOR = 0.004; 95% CI = 0.001, 0.01), and were more likely to obtain syringes from street sellers (AOR = 74.0; 95% CI = 29.9, 183.2), to inject with another IDU’s used syringe (AOR = 2.3; 95% CI = 1.1, 5.0), to reuse syringes (AOR = 2.99; 95% CI = 1.63, 5.50), and to not always inject once only with a new, sterile syringe that had been sealed in a wrapper (AOR = 5.4; 95% CI = 2.9, 10.3). In localities where sterile syringe distribution is illegal, IDUs are more likely to obtain syringes from unsafe sources and to engage in injecting risk behaviors. Legalizing and rapidly implementing sterile syringe distribution programs are critical for reducing parenterally transmitted HIV, HBV, and HCV among IDUs.

Keywords

HIV HBV HCV Drug injectors IDU Risk behaviors Syringe exchange Needle exchange Pharmacy syringes. 

References

  1. 1.
    Des Jarlais DC, Marmor M, Paone D, et al. HIV incidence among injecting drug users in New York City syringe-exchange programmes. Lancet. 1996;348(9033):987–991.PubMedCrossRefGoogle Scholar
  2. 2.
    Bluthenthal RN, Kral AH, Gee L, Erringer EA, Edlin BR. The effect of syringe exchange use on high-risk injection drug users: a cohort study. AIDS. 2000;14(5):605–611.PubMedCrossRefGoogle Scholar
  3. 3.
    Centers for Disease Control and Prevention. Update: syringe exchange programs—United States, 2002. Morb Mort Wkly Rep. 2005;54(27):673–676.Google Scholar
  4. 4.
    Bailey SL, Huo D, Garfein RS, Ouellet LJ. The use of needle exchange by young injection drug users. J Acquir Immune Defic Syndr. 2003;34(1):67–70.PubMedCrossRefGoogle Scholar
  5. 5.
    Hagan H, Des Jarlais DC, Friedman SR, Purchase D, Alter MJ. Reduced risk of Hepatitis B and Hepatitis C among injecting drug users participating in the Tacoma Syringe-Exchange Program. Am J Public Health. 1995;85(11):1531–1537.PubMedGoogle Scholar
  6. 6.
    Hagan H, McGough JP, Thiede H, Weiss NS, Hopkins S, Alexander ER. Syringe exchange and risk of infection with hepatitis B and C viruses. Am J Epidemiol. 1999;149(3):203–213.PubMedGoogle Scholar
  7. 7.
    Normand J, Vlahov D, Moses L. Preventing HIV Transmission: The Role of Sterile Needles and Bleach. Washington, DC: National Academy; 1995.Google Scholar
  8. 8.
    Gibson DR, Flynn NM, Perales D. Effectiveness of syringe exchange programs in reducing HIV risk behavior and HIV seroconversion among injecting drug users. AIDS. 2001;15(11):1329–1341.PubMedCrossRefGoogle Scholar
  9. 9.
    Ksobiech K. A meta-analysis of needle sharing, lending, and borrowing behaviors of needle exchange program attenders. AIDS Educ Prev. 2003;15(3):257–268.PubMedCrossRefGoogle Scholar
  10. 10.
    Huo D, Ouellet LJ. Needle exchange and injection-related risk behaviors in Chicago: a longitudinal study. J Acquir Immune Defic Syndr. 2007;45(1):108–114.PubMedCrossRefGoogle Scholar
  11. 11.
    Burris S, Vernick JS, Ditzler A, Strathdee S. The legality of selling or giving syringes to injection drug users. J Am Pharm Assoc (Wash). 2002;42(6 Suppl 2):S13–S18.CrossRefGoogle Scholar
  12. 12.
    Bluthenthal RN, Malik MR, Grau LE, Singer M, Marshall P, Heimer R. Sterile syringe access conditions and variations in HIV risk among drug injectors in three cities. Addiction. 2004;99(9):1136–1146.PubMedCrossRefGoogle Scholar
  13. 13.
    Taussig JA, Weinstein B, Burris S, Jones TS. Syringe laws and pharmacy regulations are structural constraints on HIV prevention in the US. AIDS. 2000;14(Suppl 1):S47–S51.PubMedCrossRefGoogle Scholar
  14. 14.
    Rockwell R, Des Jarlais DC, Friedman SR, Perlis TE, Paone D. Geographic proximity, policy and utilization of syringe exchange programmes. AIDS Care. 1999;11(4):437–442.PubMedCrossRefGoogle Scholar
  15. 15.
    Bluthenthal RN, Kral AH, Lorvick J, Watters JK. Impact of law enforcement on syringe exchange programs: a look at Oakland and San Francisco. Med Anthropol. 1997;18(1):61–83.PubMedCrossRefGoogle Scholar
  16. 16.
    Davis CS, Burris S, Kraut-Becher J, Lynch KG, Metzger D. Effects of an intensive street-level police intervention on syringe exchange program use in Philadelphia, PA. Am J Public Health. 2005;95(2):233–236.PubMedCrossRefGoogle Scholar
  17. 17.
    New York State Department of Health. Expanded Syringe Access Demonstration Program (ESAP): Overview of the Law and Regulations. Accessed on: January 31, 2008. Available at: http://www.health.state.ny.us/diseases/aids/harm_reduction/needles_syringes/esap/overview.htm.
  18. 18.
    Center for Urban Epidemiologic Studies, New York Academy of Medicine, Beth Israel Medical Center, and National Development and Research Institutes. New York State Expanded Syringe Access Demonstration Program Evaluation. New York: New York Academy of Medicine; 2003.Google Scholar
  19. 19.
    Fuller CM, Ahern J, Vadnai L, et al. Impact of increased syringe access: preliminary findings on injection drug user syringe source, disposal, and pharmacy sales in Harlem, New York. J Am Pharm Assoc (Wash). 2002;42(6 Suppl 2):S77–S82.CrossRefGoogle Scholar
  20. 20.
    Rhodes T, Stimson GV, Crofts N, Ball A, Dehne K, Khodakevich L. Drug injecting, rapid HIV spread, and the ‘risk environment’: implications for assessment and response. AIDS. 1999;13(Suppl A):259–269.Google Scholar
  21. 21.
    Des Jarlais DC. Structural interventions to reduce HIV transmission among injecting drug users. AIDS. 2000;14(Suppl 1):S41–S46.PubMedCrossRefGoogle Scholar
  22. 22.
    Bruneau J, Lamothe F, Franco E, et al. High rates of HIV infection among injection drug users participating in needle exchange programs in Montreal: results of a cohort study. Am J Epidemiol. 1997;146(12):994–1002.PubMedGoogle Scholar
  23. 23.
    Strathdee SA, Patrick DM, Currie SL, et al. Needle exchange is not enough: lessons from the Vancouver injecting drug use study. AIDS. 1997;11(8):F59–F65.PubMedCrossRefGoogle Scholar
  24. 24.
    Schechter MT, Strathdee SA, Cornelisse PG, et al. Do needle exchange programmes increase the spread of HIV among injection drug users?: an investigation of the Vancouver outbreak. AIDS. 1999;13(6):F45–F51.PubMedCrossRefGoogle Scholar
  25. 25.
    Wood E, Lloyd-Smith E, Li K, et al. Frequent needle exchange use and HIV incidence in Vancouver, Canada. Am J Med. 2007;120(2):172–179.PubMedCrossRefGoogle Scholar
  26. 26.
    Archibald CP, Ofner M, Strathdee SA, et al. Factors associated with frequent needle exchange program attendance in injection drug users in Vancouver, Canada. J Acquir Immune Defic Syndr Hum Retrovirol. 1998;17(2):160–166.PubMedGoogle Scholar
  27. 27.
    Hagan H, McGough JP, Thiede H, Hopkins SG, Weiss NS, Alexander ER. Volunteer bias in nonrandomized evaluations of the efficacy of needle-exchange programs. J Urban Health. 2000;77(1):103–112.PubMedCrossRefGoogle Scholar
  28. 28.
    Fisher DG, Reynolds GL, Harbke CR. Selection effect of needle exchange in Anchorage, Alaska. J Urban Health. 2002;79(1):128–135.PubMedGoogle Scholar
  29. 29.
    Valente TW, Foreman RK, Junge B, Vlahov D. Satellite exchange in the Baltimore Needle Exchange Program. Public Health Rep. 1998;113(Suppl 1):90–96.PubMedGoogle Scholar
  30. 30.
    National Institutes of Health. Interventions to prevent HIV risk behaviors. NIH Consensus Statement. Feb 11–13. 1997;15(2):1–41.Google Scholar
  31. 31.
    Shalala D. Needle Exchange Programs in America: Review of Published Studies and Ongoing Research. Report to the Committee on Appropriations for the Departments of Labor, Health and Human Services, Education and Related Agencies. February 18, 1997.Google Scholar
  32. 32.
    Centers for Disease Control and Prevention. Incorporating HIV prevention into the medical care of persons living with HIV: recommendations of CDC, the Health Resources and Services Administration, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. MMWR Recomm Rep. 2003;52(RR-12):1–24.Google Scholar
  33. 33.
    US Census Bureau. Population by Race and Hispanic or Latino Origin, for All Ages and for 18 Years and Over, for the United States: 2000. Accessed on: January 31, 2008. Available at: http://www.census.gov/main/www/cen2000.html.
  34. 34.
    Sifaneck SJ, Neaigus A. The ethnographic accessing, sampling and screening of hidden populations: heroin sniffers in New York City. Addict Res Theory. 2001;9(6):519–543.CrossRefGoogle Scholar
  35. 35.
    Watters J, Biernacki P. Targeted sampling: options for the study of hidden populations. Soc Probl. 1989;6(4):416–430.CrossRefGoogle Scholar
  36. 36.
    Heckathorn DD. Respondent-driven sampling: a new approach to the study of hidden populations. Soc Probl. 1997;44(2):174–199.CrossRefGoogle Scholar
  37. 37.
    Friedman SR, Chapman TF, Perlis TE, et al. Similarities and differences by race/ethnicity in changes of HIV seroprevalence and related behaviors among drug injectors in New York City, 1991–1996. J Acquir Immune Defic Syndr. 1999;22:83–91.PubMedGoogle Scholar
  38. 38.
    Centers for Disease Control and Prevention. HIV/AIDS among African Americans. CDC HIV/AIDS Fact Sheet. Accessed on: January 31, 2008. Available at: http://www.cdc.gov/hiv/topics/aa/resources/factsheets/aa.htm.
  39. 39.
    Friedman SR, Des Jarlais DC, Neaigus A, et al. AIDS and the new drug injector. Nature. 1989;339(6223):333–334.PubMedCrossRefGoogle Scholar
  40. 40.
    Holmberg SD. The estimated prevalence and incidence of HIV in 96 large US metropolitan areas. Am J Public Health. 1996;86(5):642–654.PubMedCrossRefGoogle Scholar
  41. 41.
    Latkin CA, Forman VL. Patterns of needle acquisition and sociobehavioral correlates of needle exchange program attendance in Baltimore, Maryland, U.S.A. J Acquir Immune Defic Syndr. 2001;27(4):398–404.PubMedGoogle Scholar
  42. 42.
    Latkin CA, Hua W, Davey MA. Exploring the role of needle selling in a drug-using community in Baltimore, Maryland. J Acquir Immune Defic Syndr. 2005;38(1):57–60.PubMedCrossRefGoogle Scholar
  43. 43.
    Bluthenthal RN, Anderson R, Flynn NM, Kral AH. Higher syringe coverage is associated with lower odds of HIV risk and does not increase unsafe syringe disposal among syringe exchange program clients. Drug Alcohol Depend. 2007;89(2–3):214–222.PubMedCrossRefGoogle Scholar
  44. 44.
    Hagan H, Thiede H, Weiss NS, Hopkins SG, Duchin JS, Alexander ER. Sharing of drug preparation equipment as a risk factor for hepatitis C. Am J Public Health. 2001;91(1):42–46.PubMedGoogle Scholar
  45. 45.
    Neaigus A, Gyarmathy VA, Miller M, et al. Injecting and sexual risk correlates of HBV and HCV seroprevalence among new drug injectors. Drug Alcohol Depend. 2007;89(2–3):234–243.PubMedCrossRefGoogle Scholar
  46. 46.
    Neaigus A, Gyarmathy VA, Zhao M, Miller M, Friedman SR, Des Jarlais DC. Sexual and other noninjection risks for HBV and HCV seroconversions among noninjecting heroin users. J Infect Dis. 2007;195(7):1052–1061.PubMedCrossRefGoogle Scholar
  47. 47.
    Morgenstern H. Ecologic studies. In: Rothman KJ, Greenland S, eds. Modern Epidemiology. Philadelphia: Lippincott Williams & Wilkins; 1998:459–480.Google Scholar
  48. 48.
    Wodak A, Cooney A. Do needle syringe programs reduce HIV infection among injecting drug users: a comprehensive review of the international evidence. Subst Use Misuse. 2006;41(6–7):777–813.PubMedCrossRefGoogle Scholar
  49. 49.
    Watters JK, Estilo MJ, Clark GL, Lorvick J. Syringe and needle exchange as HIV/AIDS prevention for injection drug users. JAMA. 1994;271(2):115–120.PubMedCrossRefGoogle Scholar
  50. 50.
    Vlahov D, Junge B. The role of needle exchange programs in HIV prevention. Public Health Rep. 1998;113(Suppl 1):75–80.PubMedGoogle Scholar
  51. 51.
    van Ameijden EJC, Coutinho RA. Large decline in injecting drug use in Amsterdam, 1986–1998: explanatory mechanisms and determinants of injecting transitions. J Epidemiol Community Health. 2001;55:356–363.PubMedCrossRefGoogle Scholar
  52. 52.
    Neaigus A, Gyarmathy VA, Miller M, Frajzyngier VM, Friedman SR, Des Jarlais DC. Transitions to injecting drug use among non-injecting heroin users: social network influence and individual susceptibility. J Acquir Immune Defic Syndr. 2006;41(4):493–503.PubMedCrossRefGoogle Scholar
  53. 53.
    Hurley SF, Jolley DJ, Kaldor JM. Effectiveness of needle-exchange programmes for prevention of HIV infection. Lancet. 1997;349(9068):1797–1800.PubMedCrossRefGoogle Scholar
  54. 54.
    New Jersey Department of Health and Senior Services, Division of HIV/AIDS Services. Prevalence Rate of Top Ten Cities With HIV/AIDS Reported As Of June 30, 2006. Accessed on: January 31, 2008. Available at: http://www.state.nj.us/health/aids/repa/cities.shtml.
  55. 55.
    New Jersey Department of Health and Senior Services, Division of HIV/AIDS Services, Epidemiologic Services Unit. Persons reported with HIV/AIDS in City of Newark, 7/1/2005–6/30/2006. Report from Dr. Helene Cross, Ph.D., Director of the Epidemiologic Services Unit. July 6 2007.Google Scholar
  56. 56.
    New York City Department of Health and Mental Hygiene. New York City HIV/AIDS Annual Surveillance Statistics 2005. New York, NY: Department of Health and Mental Hygiene; 2006.Google Scholar

Copyright information

© The New York Academy of Medicine 2008

Authors and Affiliations

  • Alan Neaigus
    • 1
    • 2
  • Mingfang Zhao
    • 1
  • V. Anna Gyarmathy
    • 1
    • 3
  • Linda Cisek
    • 1
  • Samuel R. Friedman
    • 4
    • 5
  • Robert C. Baxter
    • 6
  1. 1.Institute for International Research on Youth at RiskNational Development and Research InstitutesNew YorkUSA
  2. 2.Department of Epidemiology, Mailman School of Public HealthColumbia UniversityNew YorkUSA
  3. 3.Department of Mental Health, Bloomberg School of Public HealthJohns Hopkins UniversityBaltimoreUSA
  4. 4.Institute for AIDS ResearchNational Development and Research InstitutesNew YorkUSA
  5. 5.Department of Epidemiology, Bloomberg School of Public HealthJohns Hopkins UniversityBaltimoreUSA
  6. 6.North Jersey Community Research InitiativeNewarkUSA

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