title: Associations between HIV-related injection behaviour and distance to and patterns of utilisation of syringe-supply programmes.
abstract: BACKGROUND
  Studies indicate that needle-exchange programmes (NEPs) can reduce the incidence of HIV infection; however, a positive impact of syringe-supply programmes has not been consistently demonstrated. The associations between high-risk injection behaviour and distance to and patterns of utilisation of syringe-supply programmes in injection drug users (IDUs) were investigated.
  
  
  METHODS
  Participants in a cohort of IDUs (n = 456) residing in Montreal were interviewed between 2004 and 2006. Behavioural questionnaires were administered by trained interviewers, and venous blood samples were drawn and tested for HIV antibodies. The distance from regular IDU dwelling places to nearest NEP or pharmacy was calculated using a Geographic Information System. Logistic regression was used to assess relations with high-risk injection behaviour.
  
  
  RESULTS
  Associations between high-risk injection behaviour and distance to syringe-supply source were not linear. The odds of high-risk behaviour grew modestly as distance from the NEP site increased to 1600 m, followed by a flat trend to 3000 m, and thereafter decreased with distance beyond this point. The odds of high-risk behaviour dropped sharply for the relatively few IDUs residing 1 km or more from the nearest pharmacy but this measure was not strongly associated with the outcome. IDUs who exclusively acquired syringes at NEPs or pharmacies had less than half the odds of reporting high-risk injection behaviour than IDUs with inconsistent syringe-access patterns.
  
  
  CONCLUSIONS
  The study confirms that Montreal NEPs were implemented where they are most needed. These results also suggest that sterile syringe acquisition patterns might influence high-risk injection behaviour.
authors.affiliation: Hôpital Saint Luc du Centre Hospitalier de l'Université de Montréal, 1058 rue Saint-Denis, Montréal, Québec, Canada. julie.bruneau@umontreal.ca
authors.forename: J
authors.initials: J
authors.lastname: Bruneau
authors.forename: M
authors.initials: M
authors.lastname: Daniel
authors.forename: Y
authors.initials: Y
authors.lastname: Kestens
authors.forename: G
authors.initials: G
authors.lastname: Zang
authors.forename: M
authors.initials: M
authors.lastname: Généreux
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003157:Community Pharmacy Services; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D006297:Health Services Accessibility; D006302:Health Services Research / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D018671:Needle-Exchange Programs / Q000706:statistics & numerical data*; D011792:Quebec / Q000453:epidemiology; D012309:Risk-Taking; D015819:Substance Abuse, Intravenous / Q000150:complications* / Q000453:epidemiology