title: Reduction in Needle Sharing Among Seattle-Area Injection Drug Users Across 4 Surveys, 1994-2013.
abstract: OBJECTIVE
  We evaluated time trends in sharing needles and other injection equipment from 1994 to 2013 among injection drug users in the Seattle, Washington area.
  
  
  METHODS
  We combined data from 4 sources: the Risk Activity Variables, Epidemiology, and Network (RAVEN) study, recruited from institutional settings; the Kiwi study, recruited from jails; National HIV Behavioral Surveillance system (NHBS) surveys, which used respondent-driven sampling; and surveys at needle-exchange sites.
  
  
  RESULTS
  Levels of needle sharing were higher in the earlier studies: RAVEN, 1994 to 1997 (43%) and Kiwi, 1998 to 2002 (61%). In the NHBS surveys, the initial level of 44% in 2005 declined to 31% in the period 2009 to 2012. Across needle-exchange surveys (2009-2013) the level was 21%. There was a parallel reduction in sharing other injection equipment. These trends persisted after control for sociodemographic and risk-associated variables. There was a contemporaneous increase in the number of needles distributed by local needle exchanges and a decline in the number of reported HIV cases among injection drug users.
  
  
  CONCLUSIONS
  The apparent long-term reduction in sharing injection equipment suggests substantial success in public health efforts to reduce the sharing of injection equipment.
authors.affiliation: The authors are with the HIV/STD Program, Public Health-Seattle & King County, Seattle, WA.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Burt
authors.affiliation: The authors are with the HIV/STD Program, Public Health-Seattle & King County, Seattle, WA.
authors.forename: Hanne
authors.initials: H
authors.lastname: Thiede
mesh_terms: D000293:Adolescent; D000328:Adult; D055030:Drug Users / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016485:Needle Sharing / Q000009:adverse effects / Q000639:trends*; D012309:Risk-Taking; D015819:Substance Abuse, Intravenous / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D014861:Washington / Q000453:epidemiology; D055815:Young Adult