title: The effect of syringe exchange use on high-risk injection drug users: a cohort study.
abstract: OBJECTIVE
  To determine whether syringe exchange program use is associated with cessation of syringe sharing among high-risk injection drug users.
  
  
  METHODS
  Between 1992 and 1996, street-recruited injection drug users were interviewed and received HIV testing and counseling semi-annually, as part of a dynamic cohort study. We examined a cohort of 340 high-risk injection drug users for whom two observations, 6-months apart, were available and who reported syringe sharing at the first interview. Multivariate logistic regression analysis was performed to determine the relationship between syringe exchange program use and cessation of syringe sharing, while controlling for confounding factors.
  
  
  RESULTS
  At follow-up interview, 60% (204 of 340) reported quitting syringe sharing. High-risk injection drug users who began using the syringe exchange program were more likely to quit sharing syringes [adjusted odds ratio (AOR), 2.68; 95% confidence interval (CI), 1.35-5.33], as were those who continued using the syringe exchange program (AOR,1.98; 95% CI, 1.05-3.75) in comparison with non-syringe exchange program users, while controlling for confounding factors.
  
  
  CONCLUSIONS
  The initiation and continuation of syringe exchange program use among high-risk injection drug users is independently associated with cessation of syringe sharing. Syringe exchange program use can be an important component in reducing the spread of blood-borne infectious diseases among high-risk injection drug users.
authors.affiliation: Drug Policy Research Center and Health Program, RAND, Santa Monica, California 90407-2138, USA. Ricky_Bluthenthal@rand.org
authors.forename: R N
authors.initials: RN
authors.lastname: Bluthenthal
authors.forename: A H
authors.initials: AH
authors.lastname: Kral
authors.forename: L
authors.initials: L
authors.lastname: Gee
authors.forename: E A
authors.initials: EA
authors.lastname: Erringer
authors.forename: B R
authors.initials: BR
authors.lastname: Edlin
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016485:Needle Sharing / Q000009:adverse effects*; D018671:Needle-Exchange Programs; D015397:Program Evaluation / Q000706:statistics & numerical data*; D012307:Risk Factors; D015819:Substance Abuse, Intravenous / Q000453:epidemiology / Q000821:virology*; D011795:Surveys and Questionnaires