title: Difficulty accessing syringes and syringe borrowing among injection drug users in Bangkok, Thailand.
abstract: OBJECTIVE
  Thailand's longstanding HIV epidemic among injection drug users (IDU) has been attributed, in part, to the Thai government's unwillingness to implement evidence-based HIV prevention interventions. This study was undertaken to examine risk factors for syringe borrowing among a community-recruited sample of Thai IDU.
  
  
  METHODS
  We examined the prevalence of syringe borrowing among 238 IDU participating in the Mit Sampan Community Research Project, Bangkok. Multivariate logistic regression was used to identify independent predictors of syringe borrowing in the past 6 months.
  
  
  RESULTS
  A total of 238 IDU participated in this study; 66 (26.2%) were female, and the median age was 36.5 years. In total, 72 (30.3%) participants reported borrowing a used syringe in the past 6 months, with 47 (65.3%) of these individuals reporting multiple borrowing events. In multivariate analyses, syringe borrowing was positively associated with difficulty accessing syringes [adjusted odds ratio (AOR) = 2.46; 95% confidence interval (CI): 1.08-5.60] and injecting with other people on a frequent basis (AOR = 3.17; 95% CI: 1.73-5.83). Primary reasons offered for experiencing difficulty accessing syringes included being too far from syringe outlets (34.1%), pharmacies being closed (13.6%) and being refused syringes at pharmacies (9.1%).
  
  
  CONCLUSIONS
  We observed an alarmingly high rate of syringe borrowing among a community-recruited sample of Thai IDU. Various lines of evidence indicate that poor access to sterile syringes is driving the high rate of syringe borrowing observed in this study. Immediate action should be taken to increase access to sterile syringes among Thai IDU.
authors.affiliation: Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada. uhri-tk@cfenet.ubc.ca
authors.forename: Thomas
authors.initials: T
authors.lastname: Kerr
authors.forename: Nadia
authors.initials: N
authors.lastname: Fairbairn
authors.forename: Kanna
authors.initials: K
authors.lastname: Hayashi
authors.forename: Paisan
authors.initials: P
authors.lastname: Suwannawong
authors.forename: Karyn
authors.initials: K
authors.lastname: Kaplan
authors.forename: Ruth
authors.initials: R
authors.lastname: Zhang
authors.forename: Evan
authors.initials: E
authors.lastname: Wood
mesh_terms: D000328:Adult; D019317:Evidence-Based Medicine; D005260:Female; D015658:HIV Infections / Q000517:prevention & control / Q000635:transmission; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016485:Needle Sharing / Q000706:statistics & numerical data*; D010594:Pharmacies / Q000458:organization & administration; D012307:Risk Factors; D015819:Substance Abuse, Intravenous / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D013594:Syringes / Q000600:supply & distribution*; D013785:Thailand / Q000453:epidemiology