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Changes in Reported Injection Behaviors Following the Public Health Response to an HIV Outbreak Among People Who Inject Drugs: Indiana, 2016

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Abstract

A syringe services program (SSP) was established following the Indiana HIV outbreak among persons who inject drugs (PWID) in Scott County. Among Indiana-based PWID, we examined injection behaviors associated with HIV status, SSP use after its establishment, and changes in injection behaviors after the outbreak response. During 2016, we interviewed 200 PWID and assessed injection behaviors before the response by HIV status. We reported injection behaviors prior to the response and used Fisher’s exact Chi square tests (P < 0.05) to assess differences by HIV status. Next, among persons who injected both before (July–December 2014) and after (past 30 days) the response, we (1) reported the proportion of persons who used the SSP to obtain sterile syringes, and assessed differences in SSP use by HIV status using Fisher’s exact Chi square tests; and (2) compared distributive and receptive sharing of injection equipment and disposal of syringes before and after the outbreak response, and assessed statistical differences using McNemar’s test. We also compared injection behaviors before and after the response by HIV status. Injecting extended release oxymorphone (Opana® ER); receptive sharing of syringes and cookers; and distributive sharing of cookers, filters, or water before the response were associated with HIV infection. SSP use was high (86%), particularly among HIV-positive compared with HIV-negative persons (98% vs. 84%). Injection equipment sharing decreased and safe disposal of used syringes increased after the response, especially among HIV-positive persons. Injection equipment sharing contributed to the outbreak. High SSP use following the response, particularly among HIV-positive persons, contributed to decreased high-risk injection practices.

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Acknowledgements

We acknowledge the dedicated staff of the Indiana State Department of Health and Indiana University, the Scott County Health Department, the Backlot of HOPE Church, and Foundations Family Medicine, without whom this work would not be possible.

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Authors and Affiliations

  1. Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA, 30329, USA

    Sharoda Dasgupta, Dita Broz, Mary Tanner, Monita Patel, Philip J. Peters, Paul J. Weidle & Janet Burnett

  2. Division of Unintentional Injury Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA

    Julie O’Donnell

  3. Indiana State Department of Health, Indianapolis, IN, USA

    Brandon Halleck, Joseph Amlung, Erika Chapman & Ayriane Bailey

  4. Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA

    Cameron McAlister & Joan Duwve

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  1. Sharoda Dasgupta
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Correspondence to Sharoda Dasgupta.

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Dasgupta, S., Broz, D., Tanner, M. et al. Changes in Reported Injection Behaviors Following the Public Health Response to an HIV Outbreak Among People Who Inject Drugs: Indiana, 2016. AIDS Behav 23, 3257–3266 (2019). https://doi.org/10.1007/s10461-019-02600-x

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