title: Determinants of injection drug user (IDU) syringe sharing: the relationship between availability of syringes and risk network member characteristics in Winnipeg, Canada.
abstract: OBJECTIVE
  Despite the establishment of syringe exchange programmes, syringe-sharing behaviour remains common among some injection drug users (IDU). Previous studies have identified several individual- and social network-level variables associated with syringe sharing. We examine the extent to which each of these variables is related independently to this behaviour within a diverse study population.
  
  
  METHODS
  A cross-sectional survey of 435 IDU conducted between December 2003 and September 2004 in Winnipeg, Canada.
  
  
  METHODS
  Individual and social-network variables were obtained from a survey instrument administered through a personal interview. Syringe sharing was defined as receptive syringe sharing in the last 6 months. Logistic regression analysis with generalized estimating equations was used to determine simultaneously the role of individual-level and risk network member-level variables on the odds of syringe sharing.
  
  
  RESULTS
  Individuals' relationship to a risk network member (sex partner, OR: 15.3 95% CI: 7.6-30.8; family member, OR: 3.4 95% CI: 1.3-9.0) and difficulty of access to syringes (OR: 3.6 95% CI: 1.3-9.9) were predictive of syringe sharing. Dyads who 'often' pooled resources to obtain drugs were at 4.9 times (95% CI: 2.1-11.6) the odds of syringe sharing, while those who 'sometimes' pooled resources were at 2.8 times (95% CI: 1.1-6.7) the odds, compared to those who 'never' pooled resources together.
  
  
  CONCLUSIONS
  Syringe sharing in this population depended on both the availability of clean syringes and social network relationships. Adopting interventions that take into account relationships and behaviours that shape social norms present in networks/dyads would be a necessary prevention strategy alongside the provision of clean syringes.
authors.affiliation: Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Souradet Y
authors.initials: SY
authors.lastname: Shaw
authors.forename: Lena
authors.initials: L
authors.lastname: Shah
authors.forename: Ann M
authors.initials: AM
authors.lastname: Jolly
authors.forename: John L
authors.initials: JL
authors.lastname: Wylie
mesh_terms: D000293:Adolescent; D000328:Adult; D002170:Canada / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000635:transmission*; D006526:Hepatitis C / Q000453:epidemiology / Q000635:transmission*; D006801:Humans; D008297:Male; D016485:Needle Sharing / Q000009:adverse effects* / Q000706:statistics & numerical data; D018671:Needle-Exchange Programs; D012307:Risk Factors; D040242:Risk Reduction Behavior; D015819:Substance Abuse, Intravenous / Q000150:complications* / Q000453:epidemiology / Q000517:prevention & control