title: Injection risk behaviors among clients of syringe exchange programs with different syringe dispensation policies.
abstract: While there have been numerous papers published in the medical, social, and epidemiologic literature about the effectiveness of syringe exchange programs (SEPs), few papers identify operational characteristics of the SEPs they study or assess which of those characteristics are associated with optimal HIV risk reduction among clients. The objective of this study was to examine whether different syringe dispensation policies were associated with client-level injection-related HIV risk. Injection drug users (IDUs) were recruited at 23 SEPs in California in 2001 (n = 531). SEPs were classified by their executive directors as to whether they provided a strict one-for-one syringe exchange, gave a few extra syringes above the one-for-one exchange, or distributed the amount of syringes based upon need as opposed to how many syringes were turned in by the clients. Injection-related risk was compared by SEP program type. In multivariate logistic regression analysis, clients of distribution-based programs had lower odds of reusing syringes (adjusted odds ratio = 0.43; 95% CI = 0.27, 0.71) when adjusting for confounding variables. There were no statistical differences with regards to distributive or receptive syringe sharing by dispensation policy. It is concluded that SEPs that base syringe dispensation policy upon need may facilitate reductions in reuse of syringes.
authors.affiliation: Urban Health Study, Department of Family and Community Medicine, University of California, San Francisco, CA 94110, USA. alkral@itsa.ucsf.edu
authors.forename: Alex H
authors.initials: AH
authors.lastname: Kral
authors.forename: Rachel
authors.initials: R
authors.lastname: Anderson
authors.forename: Neil M
authors.initials: NM
authors.lastname: Flynn
authors.forename: Ricky N
authors.initials: RN
authors.lastname: Bluthenthal
mesh_terms: D002140:California / Q000453:epidemiology; D015658:HIV Infections / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D015999:Multivariate Analysis; D016485:Needle Sharing / Q000009:adverse effects*; D018671:Needle-Exchange Programs / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D012309:Risk-Taking; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000208:ethnology / Q000523:psychology*; D013594:Syringes / Q000009:adverse effects / Q000592:standards