title: Difficulty accessing syringes mediates the relationship between methamphetamine use and syringe sharing among young injection drug users.
abstract: Injection drug users (IDU) who use methamphetamine (MA) are at an increased risk of HIV infection due to engagement in injection-related risk behavior including syringe sharing. In this cohort study of young IDU aged 18-30, we investigated the relationship between injection MA use and syringe sharing, and whether difficulty accessing sterile syringes mediated this association. Behavioral questionnaires were completed by 384 IDU in Vancouver, Canada between October 2005 and May 2008. Generalized estimating equations were used to estimate direct and indirect effects. The median age of participants was 24 (IQR: 22-27) and 214 (55.7%) were male. Injecting MA was independently associated with syringe sharing. Mediation analyses revealed that difficulty accessing sterile syringes partially mediated the association between injecting MA and syringe sharing. Interventions to reduce syringe sharing among young methamphetamine injectors must address social and structural barriers to accessing HIV prevention programs.
authors.affiliation: Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada.
authors.forename: Brandon D L
authors.initials: BD
authors.lastname: Marshall
authors.forename: Jean A
authors.initials: JA
authors.lastname: Shoveller
authors.forename: Evan
authors.initials: E
authors.lastname: Wood
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Patterson
authors.forename: Thomas
authors.initials: T
authors.lastname: Kerr
mesh_terms: D000293:Adolescent; D000328:Adult; D002170:Canada; D000697:Central Nervous System Stimulants / Q000008:administration & dosage*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D055030:Drug Users; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000517:prevention & control / Q000635:transmission; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008694:Methamphetamine / Q000008:administration & dosage*; D016485:Needle Sharing / Q000009:adverse effects / Q000706:statistics & numerical data*; D017008:Negotiating; D012307:Risk Factors; D040242:Risk Reduction Behavior; D012309:Risk-Taking; D012959:Socioeconomic Factors; D015819:Substance Abuse, Intravenous / Q000150:complications* / Q000523:psychology; D013594:Syringes / Q000600:supply & distribution*; D055815:Young Adult
chemical_list: D000697:Central Nervous System Stimulants; D008694:Methamphetamine