Use of an illegal syringe exchange and injection-related risk behaviors among street-recruited injection drug users in Oakland, California, 1992 to 1995.
OBJECTIVE
To determine factors associated with syringe and injection supply sharing among injection drug users (IDUs) in a community with an illegal underground syringe exchange program (SEP).


METHODS
From 1992 to 1995, semiannual cross-sectional samples of IDUs were recruited in Oakland, California. To account for multiple observations from the same individual, we used general estimating equations with logit transformations to determine factors associated with sharing syringes and other injection supplies.


RESULTS
1304 IDUs were interviewed; 684 (53%) returned for more than one interview. 2830 interviews were available for analysis. SEP use increased and syringe and supply sharing declined from 1992 to 1995 among study participants. In multivariate analysis, SEP users were less likely to share syringes than non-SEP users (adjusted odds ratio [AOR] = 0.57; 95% confidence interval [CI] = 0.46-0.72). SEP use was not significantly associated with the sharing of injection supplies (AOR = 0.85; 95% CI = 0.68-1.07). Syringe sharing and injection supply sharing were significantly less likely to occur among African American and HIV-positive IDUs.


CONCLUSIONS
These data suggest that illegal SEPs can be effective HIV prevention programs. Lower rates of syringe-based risk behaviors among African American and HIV-positive IDUs are encouraging.
Bluthenthal
R N
RN
Urban Health Study, Institute for Health Policy Studies, School of Medicine, University of California, San Francisco 94143-1304, USA. rnb@itsa.ucsf.edu
Kral
A H
AH
Erringer
E A
EA
Edlin
B R
BR
D002140:California / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D015999:Multivariate Analysis; D016485:Needle Sharing / Q000009:adverse effects / Q000706:statistics & numerical data*; D018671:Needle-Exchange Programs / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D012309:Risk-Taking; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000523:psychology*; D013594:Syringes / Q000009:adverse effects / Q000592:standards