AIDS and Behavior

, Volume 16, Issue 5, pp 1156–1163 | Cite as

Syringe Coverage in an Australian Setting: Does a High Level of Syringe Coverage Moderate Syringe Sharing Behaviour?

  • Joanne BryantEmail author
  • Dana Paquette
  • Hannah Wilson
Original Paper


We examined individual-level syringe coverage among 417 people who inject drugs who were recruited from pharmacies in New South Wales in 2009. There was a U-shaped distribution of syringe coverage with many people having very high (51%) or very low (23%) coverage. Overall, two-thirds of respondents (63%) reported adequate coverage (≥100%). Respondents who had not used a needle and syringe program in the previous month were more likely to report inadequate coverage (AOR 2.25, 95% CI 1.25–4.05) as were those who reported daily or more frequent injecting (AOR 3.69, 95% CI 2.00–6.81). Inadequate syringe coverage was not independently associated with receptive needle sharing. The level of syringe coverage was high among this sample, and met targets set out by UNAIDS and other organisations. We found that inadequate syringe coverage was not independently correlated with receptive needle sharing, possibly because coverage is sufficient to diminish the relationship between syringe availability and sharing behaviours.


Injecting drug use Syringe coverage HIV Hepatitis C Australia 



The authors are grateful to the staff at participating pharmacies for their time and care in facilitating the data collection, and to the survey respondents. Professor Carla Treloar provided comment on an earlier version of this paper. The Pharmacy Needle and Syringe Survey was funded by NSW Health. The National Centre in HIV Social Research is supported by a core grant from the Australian Government Department of Health and Aging.

Conflict of interest



  1. 1.
    Falck RS, Siegal HA, Wang J, Carlson RG. Usefulness of the health belief model in predicting HIV needle risk practices among injection drug users. AIDS Educ Prev. 1995;7:523–33.PubMedGoogle Scholar
  2. 2.
    Gibson DR, Choi KH, Catania JA, Sorenson JL, Kegeles S. Psychosocial predictors of needle sharing among intravenous drug users. Subst Use Misuse. 1993;28:973–81.CrossRefGoogle Scholar
  3. 3.
    Neaigus A, Friedman SR, Kottiri BJ, Des Jarlais DC. HIV risk networks and HIV transmission among injecting drug users. Eval Prog Plan. 2001;24:221–6.CrossRefGoogle Scholar
  4. 4.
    Curtis R, Friedman SR, Neaigus A, Jose B, Goldstein M, Ildefonso G. Street level drug markets: network structure and HIV risk. Soc Netw. 1995;17:229–49.CrossRefGoogle Scholar
  5. 5.
    Loxley W. Double risk Young injectors and sexual relationships. Sex Relatsh The. 2000;15:297–310.CrossRefGoogle Scholar
  6. 6.
    Rhodes T, Quirk A. Drug users’ sexual relationships and the social organisation of risk: the sexual relationship as a site of risk management. Soc Sci Med. 1998;2:157–69.CrossRefGoogle Scholar
  7. 7.
    Tempalski B, Cooper HL, Friedman SR, Des Jarlais DC, Brady J, Gostnell K. Correlates of syringe coverage for heroin injection in 35 large metropolitan areas in the US in which heroin is the dominant injected drug. Int J Drug Pol. 2008;19(suppl 1):47–58.CrossRefGoogle Scholar
  8. 8.
    Da Fonseca EM, Ribeiro JM, Bertoni N, Bastos FI. Syringe exchange programs in Brazil: preliminary assessment of 45 programs. Cad Saude Publica. 2006;22(4):761–70.PubMedCrossRefGoogle Scholar
  9. 9.
    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 Alc Dep. 2007;89(2–3):214–22.CrossRefGoogle Scholar
  10. 10.
    Heller DI, Paone D, Sieglet A, Karpati A. The syringe gap: an assessment of sterile syringe need and acquisition among syringe exchange program participants in New York City. Harm Red J. 2009;6:1. doi: I0.II86/1477-7517-6-1.CrossRefGoogle Scholar
  11. 11.
    Burrows D. Advocacy and coverage of needle exchange programs: results of a comparative study of harm reduction programs in Brazil, Bangladesh, Belarus, Ukraine, Russian Federation, and China. Cad Saude Publica. 2006;22(4):871–9.PubMedCrossRefGoogle Scholar
  12. 12.
    Bluthenthal RN, Ridgeway G, Schell T, Anderson R, Flynn NM, Kral AH. Examination of the association between syringe exchange program (SEP) dispensation policy and SEP client-level syringe coverage among injecting drug users. Addiction. 2007;102(4):638–46.PubMedCrossRefGoogle Scholar
  13. 13.
    Kral AH, Anderson R, Flynn NM, Bluthenthal RN. Injection risk behaviours among clients of syringe exchange programs with different syringe dispensation policies. JAIDS. 2004;37:1307–12.PubMedCrossRefGoogle Scholar
  14. 14.
    Sharma M, Burrows D, Bluthenthal R. Coverage of HIV prevention programs for injection drug users: confusions, aspirations, definitions and ways forward. Int J Drug Pol. 2007;18:92–8.CrossRefGoogle Scholar
  15. 15.
    Des Jarlais DC, Friedman SR. Fifteen years of preventing HIV infection among injecting drug users. What we have learned, what we have not learned, what we have done, what we have not done. Pub Health Rep. 1998;113:182–8.Google Scholar
  16. 16.
    Burrows D. Rethinking coverage of needle exchange programs. Sub Use Mis. 2006;41(6–7):1045–8.CrossRefGoogle Scholar
  17. 17.
    WHO. Task force for the urgent response to the epidemics of sexually transmitted infections in eastern Europe and central Asia. Copenhagen: WHO Regional Office for Europe; 2000.Google Scholar
  18. 18.
    Suh T, Mandell W, Latkin C, Kim J. Social network characteristics and injecting HIV-risk behaviors among street injection drug users. Drug Alc Dep. 1997;47(2):137–43.CrossRefGoogle Scholar
  19. 19.
    Latkin C, Mandell W, Oziemkowska M, Celentano D, Vlahov D, Ensminger M, et al. Using social network analysis to study patterns of drug use among urban drug users at high risk for HIV/AIDS. Drug Alc Dep. 1995;38(1):1–9.CrossRefGoogle Scholar
  20. 20.
    Aceijas C, Hickman M, Donoghoe MC, Burrows D, Stuikyte R. Access and coverage of needle and syringe programmes (NSP) in central and eastern Europe and central Asia. Addiction. 2007;102(8):1244–50.PubMedCrossRefGoogle Scholar
  21. 21.
    Heimer R. Community coverage and HIV prevention: assessing metrics for estimating HIV incidence through syringe exchange. Int J Drug Policy. 2008;19(suppl 1):65–73.CrossRefGoogle Scholar
  22. 22.
    Thein H-H, Denoe M, van Beek I, Dore G, MacDonald M. Injecting behaviour of injecting drug users at needle and syringe programmes and pharmacies in Australia. Int J Drug Policy. 2003;14:425–30.CrossRefGoogle Scholar
  23. 23.
    Bryant J, Topp L, Hopwood M, Iversen J, Treloar C, Maher L. Is point of access to needles and syringes related to needle sharing? Comparing data collected from pharmacies and needle and syringe programs in south east Sydney. Drug Alc Rev. 2010;29(4):364–70.CrossRefGoogle Scholar
  24. 24.
    Craine N, Hickman M, Parry JV, Smith J, McDonald T, Lyons M. Characteristics of injecting drug users accessing different types of needle and syringe programme or using secondary distribution. J Pub Health. 2010;32(3):328–35.CrossRefGoogle Scholar
  25. 25.
    Lorvick J, Bluthenthal R, Scott A, Gilbert ML, Riehman KS, Anderson RL, et al. Secondary syringe exchange among users of 23 California syringe exchange programs. Sub Use Mis. 2006;41:865–82.CrossRefGoogle Scholar
  26. 26.
    Bryant J, Hopwood M. Secondary exchange of sterile injecting equipment in a high distribution environment: a mixed method analysis in south east Sydney, Australia. Int J Drug Pol. 2009;20:324–8.CrossRefGoogle Scholar
  27. 27.
    National Centre in HIV Epidemiology and Clinical Research. Australian NSP survey national data report 2005–2009. Syndey: National Centre in HIV Epidemiology and Clinical Research, The University of New South Wales; 2010.Google Scholar
  28. 28.
    Sarang A, Rhodes T, Platt L. Access to syringes in three Russian cities: implications for syringe distribution and coverage. Int J Drug Pol. 2008;19(suppl 1):25–36.CrossRefGoogle Scholar
  29. 29.
    Mathers B, Degenhardt L, Ali H, Wiessing L, Hickman M, Mattick R, et al. HIV prevention, treatment and care services for people who inject drugs: a systematic review of global, regional and national coverage. Lancet. 2010;375:1014–28.PubMedCrossRefGoogle Scholar
  30. 30.
    NSW Department of Health. Needle and syringe program policy and guidelines for NSW 2006. NSW Department of Health, Sydney, NSW.
  31. 31.
    Bryant J, Wilson H, Hull P, Treloar C. Pharmacy needle and syringe survey 2006–2008: New South Wales. Sydney: National Centre in HIV Social Research, The University of New South Wales; 2010.Google Scholar
  32. 32.
    Evans JL, Hahn JA, Page-Shafer K, Lum PJ, Stein ES, Davidson PJ, et al. Gender differences in sexual and injection risk behaviour among active young injection drug users in San Francisco (the UFO Study). J Urb Health. 2003;80:137–46.CrossRefGoogle Scholar
  33. 33.
    Miller CL, Strathdee SA, Spittal PM, Kerr T, Li K, Schecter M, et al. Elevated rates of HIV infection among young aboriginal injection drug users in a Canadian setting. Harm Red J. 2006;3:9.CrossRefGoogle Scholar
  34. 34.
    Marshall B, Wood E, Li K, Kerr T. Elevated syringe borrowing among men who have sex with men: a prospective study. JAIDS. 2007;46(2):248–52.PubMedCrossRefGoogle Scholar
  35. 35.
    Rondinelli A, Ouellet LJ, Strathdee S, Latka MH, Hudson SM, Hagan H, Garfein RS. Young adult injection drug users in the United States continue to practice HIV risk behaviours. Drug Alc Dep. 2009;104(1–2):167–74.CrossRefGoogle Scholar
  36. 36.
    Aitken CA, Lewis J, Tracy SL, Spelman T, Bowden DS, Bharadwaj M, Drummer H, Hellard M. High incidence of hepatitis C virus reinfection in a cohort of injecting drug users. Hepatology. 2008;48(6):1746–52.PubMedCrossRefGoogle Scholar
  37. 37.
    Roy E, Alary M, Morissette C, Leclerc P, Boudreau JF, Parent R, et al. High hepatitis C virus prevalence and incidence among Canadian intravenous drug users. Int J STD AIDS. 2007;18:23–7.PubMedCrossRefGoogle Scholar
  38. 38.
    Habib S. Understanding the context of risk practices among injecting drug users: implications for hepatitis C prevention. Aust J Soc Issues. 2003;38:1–17.Google Scholar
  39. 39.
    Vickerman P, Hickman M, Rhodes T, Watts C. Model projections on the required coverage of syringe distribution to prevent HIV epidemics among injecting drug users. JAIDS. 2006;42(3):355–61.PubMedCrossRefGoogle Scholar
  40. 40.
    Kaplan E, O’Keefe E. Let the needles do the talking! Evaluating the new haven needle exchange. Interfaces. 1993;23(1):7–26.CrossRefGoogle Scholar
  41. 41.
    Best D, Noble A, Finch E, Gossop M, Sidwell C, Strang J. Accuracy of perceptions of hepatitis B and C status: crosssectional investigation of opiate addicts in treatment. BMJ. 1999;319:290–1.PubMedCrossRefGoogle Scholar
  42. 42.
    Hagan H, Campbell J, Thiede H, Strathdee S, Ouellet L, Kapadia F, et al. Self-reported hepatitis C virus antibody status and risk behaviour in young injectors. Pub Health Rep. 2006;121:710–9.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.National Centre in HIV Social ResearchThe University of New South WalesSydneyAustralia

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