Abstract
Objective
To assess variation in injection risk behavior among unstably housed/homeless injecting drug users (IDUs) across programs in a national sample of US syringe exchange programs.
Methods
About 23 syringe exchange programs were selected through stratified random sampling of moderate to very large US syringe exchange programs operating in 2001–2005. Subjects at each program were randomly sampled. Risk behavior interviews were collected using audio-computer assisted self-interviewing (A-CASI). “Unstable housing/homelessness” was operationally defined as having lived “on the street or in a shanty” or “living in a shelter or single room occupancy hotel (SRO)” at any time in the 6 months prior to the interview. “Receptive sharing” was operationally defined as having injected with a needle or syringe that “had been used by someone else” in the 30 days prior to the interview. Six very large and nine moderate-to-large programs had at least 50 subjects who reported unstable housing, and these 15 programs were used in the analyses. Results: There was considerable variation among the 15 programs in the percentages of unstably housed participants (range from 35 to 74%, P < 0.0001), and in the percentages of unstably housed participants who reported receptive sharing (range from 8 to 52%, P < 0.0001). At each of the 15 programs, unstably housed exchange participants were approximately twice as likely to report receptive sharing than were stably housed participants. The weighted mean odds ratio was 2.02, 95% confidence interval, 1.68–2.41 (random effects model) and there was no statistically significant variation in these odds ratios. Across the 15 programs, receptive sharing among unstably housed participants was highly correlated with receptive sharing among stably housed participants (r = 0.95, P < 0.001, 90% of variance among unstably housed “explained” by variance among stably housed).
Conclusions
The programs clearly differ in the extent to which they are attracting unstably housed IDUs as participants. The consistency of more frequent injection risk behavior among unstably housed exchange participants and the lack of significant variation in the odds ratios for increased injection risk suggests that none of the programs were “better” or “worse” at reducing injection risk behavior among unstably housed participants. Reduction in injecting risk behavior among syringe exchange participants may require greater efforts to provide stable housing or the development of dramatically new interventions to reduce injecting risk behavior among IDUs with persistent unstable housing.
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References
Bourgois, P. (1998). The moral economies of homeless heroin addicts: Confronting ethnography, HIV risk, and everyday violence in San Francisco shooting encampments. Substance Use and Missuse, 33(11), 2333–2351.
Braine, N., Des Jarlais, D. C., Ahmad, S., Purchase, D. & Turner, C. (2004). Long term effects of syringe exchange on risk behavior and HIV prevention. AIDS Education and Prevention, 16(3), 263–275.
Bruneau, J., Lamothe, F, Franco, E., Lachance, N., Desy, M., Soto, J & Vincelette, J. (1997). High rates of HIV infection among injection drug users participating in needle exchange programs in Montreal: Results of a cohort study. American Journal of Epidemiology, 146(12), 994–1002.
Committee on the Prevention of HIV Infection among Injecting Drug Users in High Risk Countries (2006). Preventing HIV infection among injecting drug users in high risk countries: An assessment of the evidence. Washington: Institute of Medicine.
Corneil, T. A., Kuyper, L. M., Shoveller, J., Hogg, R. S., Li, K., Spittal, P. M., Schechter, M. T. & Wood, E. (2006). Unstable housing, associated risk behaviour, and increased risk for HIV infection among injection drug users. Health Place, 12(1), 79–85.
Des Jarlais, D., Hagan, H., Friedman, S., Friedmann, P., Goldberg, D., Frischer, M., Green, S., Tunving, K., Ljungberg, B., Wodak, A., Ross, M., Purchase, D., Millson, M. E. & Myers, T. (1995). Maintaining low HIV seroprevalence in populations of injecting drug users. Journal of the American Medical Association, 274(15), 1226–1231.
Des Jarlais, D., Paone, D., Milliken, J., Turner, C., Miller, H., Gribble, J., Shi, Q., Hagan, H. & Friedman, S. R. (1999). Audio-computer interviewing to measure HIV-risk behaviour among injecting drug users: a quasi-randomised trial. The Lancet, 353, 1657–1661.
Des Jarlais, D. C., Perlis, T., Arasteh, K., Torian, L. V., Beatrice, S., Milliken, J., Mildvan, D., Yancovitz, S. & Friedman, S. R. (2005). HIV incidence among injection drug users in New York City, 1990 to 2002: use of serologic test algorithm to assess expansion of HIV prevention services. American Journal of Public Health, 95(8), 1439–1444.
Gibson, D. R., Flynn, N. M. & Perales, D. (2001). Effectiveness of syringe exchange programs in reducing HIV risk behavior and HIV seroconversion among injecting drug users. AIDS, 15(11), 1329–1341.
Hagan, H., Des Jarlais, D. C., Purchase, D., Reid, T. & Friedman, S. R. (1991). The Tacoma syringe exchange. Journal of Addicitive Diseases, 10(4), 81–88.
McKnight, C., Des Jarlais, D., Perlis, T., Eigo, K., Krim, M., Auerbach, J., Purchase, D., Solberg, A., Jones, T. S. & Garfein, R. S. (2005). Update: Syringe exchange programs-United States, 2002. MMWR Morbidity and Mortality Weekly Report, 54(27), 673–676.
National Institutes of Health. (1997). Proceedings on the NIH consensus development conference on interventions to prevent HIV risk behaviors. Paper presented at the Proceedings on the NIH Consensus Development on Interventions to prevent HIV Risk Behaviors, Bethesda, MD.
Normand, J., Vlahov, D., & Moses, L. E. (Eds.). (1995). Preventing HIV transmission: The role of sterile needles and bleach. Washington, DC: National Academy Press/National Research Council/Institute of Medicine.
Stimson, G. V. (1995). AIDS and injecting drug use in the United Kingdom, 1987–1993: the policy response and the prevention of the epidemic. Social Science Medicine, 41(5), 699–716.
Strathdee, S., Patrick, D., Currie, S. L., Corneliese, P. G. A., Rekart, M. L., Montaner, J. S. G., Schechter, M. T. & O’Shaughnessy, M. V. (1997). Needle exchange is not enough: Lessons from the Vancouver injection drug use study. AIDS, 11, F59–F65.
The Cochrane Collaborative Review Group on HIV Infection and AIDS. (2004). Evidence assessment: Strategies for HIV/AIDS prevention, treatment and care. The Cochrane Collaboration.
Wodak, A. & Lurie, P. (1996). A tale of two countries: Attempts to control HIV among injecting drug users in Australia and the United States. Journal of Drug Issues, 27(1), 117–134.
Acknowledgments
Funding for this analysis was provided by the National Institutes of Health grant number 5 R01 DA1234. We would like to thank interns Alvin Edersheim and Robert Des Jarlais for their assistance with this manuscript.
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Des Jarlais, D.C., Braine, N. & Friedmann, P. Unstable Housing as a Factor for Increased Injection Risk Behavior at US Syringe Exchange Programs. AIDS Behav 11 (Suppl 2), 78–84 (2007). https://doi.org/10.1007/s10461-007-9227-6
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DOI: https://doi.org/10.1007/s10461-007-9227-6