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


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.


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


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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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