title: Beyond equipment distribution in Needle and Syringe Programmes: an exploratory analysis of blood-borne virus risk and other measures of client need.
abstract: Despite high levels of equipment distribution through Needle and Syringe Programmes (NSPs) in Australia, the levels of reuse of equipment among people who inject drugs remain concerning. This paper used an exploratory analysis to examine the needs of NSP client that could be addressed by NSPs to enhance service impact and blood-borne virus risk practices.
  
  
  
  People who inject drugs were recruited from six NSP sites in Sydney, Australia, to undertake a self-completed survey.
  
  
  
  Using the responses of 236 NSP client participants, three factors were identified in an exploratory factor analysis: recent risky injection (Eigenvalue 3.63, 20.2 % of variance); disadvantage and disability (Eigenvalue 2.26, 12.5 % of variance); and drug use milieu (Eigenvalue 1.50, 8.4 % of variance). To understand the distribution of these factors, the standardised factor scores were dichotomised to explore those participants with 'above average' vulnerability on each factor. A small group of NSP clients reported a cluster of vulnerability measures. Most participants (55.5 %) reported vulnerability on none or only one factor, indicating that 45.5 % could be considered as having double (35.6 %) or triple (8.9 %) vulnerability.
  
  
  
  These results challenge NSPs to understand the heterogeneity among their client group and develop programmes that respond to their clients' range of needs beyond those immediately associated with blood-borne virus (BBV) risk. This paper contributes to the growing evidence base regarding the need for BBV prevention efforts to examine strategies beyond equipment distribution.
authors.affiliation: Centre for Social Research in Health, UNSW, Sydney, 2052, NSW, Australia. c.treloar@unsw.edu.au.
authors.forename: Carla
authors.initials: C
authors.lastname: Treloar
authors.affiliation: Centre for Social Research in Health, UNSW, Sydney, 2052, NSW, Australia.
authors.forename: Limin
authors.initials: L
authors.lastname: Mao
authors.affiliation: Centre for Social Research in Health, UNSW, Sydney, 2052, NSW, Australia.
authors.forename: Hannah
authors.initials: H
authors.lastname: Wilson
mesh_terms: D000328:Adult; D005260:Female; D040261:Harm Reduction; D006304:Health Status; D006801:Humans; D008297:Male; D018671:Needle-Exchange Programs; D020380:Needs Assessment; D009517:New South Wales; D012309:Risk-Taking; D015819:Substance Abuse, Intravenous / Q000534:rehabilitation*; D014777:Virus Diseases / Q000517:prevention & control* / Q000635:transmission; D035862:Vulnerable Populations / Q000706:statistics & numerical data
keywords: Blood-borne virus risk; Equipment reuse; Injecting drugs; Needle and Syringe Programme