Effectiveness of syringe exchange programs in reducing HIV risk behavior and HIV seroconversion among injecting drug users

Gibson, David R.; Flynn, Neil; Perales, Daniel

doi:10.1097/00002030-200107270-00002

Cited by 284 publications

(129 citation statements)

References 52 publications

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“…SEPs' direct effects on program participants have been extensively documented: individuals who routinely personally acquire syringes and other harm reduction materials from an SEP engage in less receptive syringe sharing (RSS) and have lower rates of HIV. [12][13][14][15][16][17][18] In contrast, the ways in which SEPs alter the contexts in which non-SEP-participants inject drugs (i.e., SEPs' indirect effects) have received substantially less empirical attention. One mechanism through which SEPs indirectly affect behavior is by increasing the volume of sterile syringes circulating within communities.…”

Section: Conceptualizing Seps As Structural Interventionsmentioning

confidence: 99%

Spatial Access to Sterile Syringes and the Odds of Injecting with an Unsterile Syringe among Injectors: A Longitudinal Multilevel Study

et al. 2012

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Despite the 2010 repeal of the ban on spending federal monies to fund syringe exchange programs (SEPs) in the USA, these interventions-and specifically SEP site locations-remain controversial. To further inform discussions about the location of SEP sites, this longitudinal multilevel study investigates the relationship between spatial access to sterile syringes distributed by SEPs in New York City (NYC) United Hospital Fund (UHF) districts and injecting with an unsterile syringe among injectors over time (1995)(1996)(1997)(1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006). Annual measures of spatial access to syringes in each UHF district (N = 42) were created using data on SEP site locations and site-specific syringe distribution data. Individual-level data on unsterile injecting among injectors (N = 4,067) living in these districts, and on individual-level covariates, were drawn from the Risk Factors study, an ongoing cross-sectional study of NYC drug users. We used multilevel models to explore the relationship of district-level access to syringes to the odds of injecting with an unsterile syringe in 975% of injection events in the past 6 months, and to test whether this relationship varied by district-level arrest rates (per 1,000 residents) for drug and drug paraphernalia possession. The relationship between district-level access to syringes and the odds of injecting with an unsterile syringe depended on district-level arrest rates. In districts with low baseline arrest rates, better syringe access was associated with a decline in the odds of frequently injecting with an unsterile syringe (AOR, 0.95). In districts with no baseline syringe access, higher arrest rates were associated with increased odds of frequently injecting with an unsterile syringe (AOR, 1.02) When both interventions were present, arrest rates eroded the protective effects of spatial access to syringes. Spatial access to syringes in small geographic areas appears to reduce the odds of injecting with an unsterile syringe among local injectors, and arrest rates elevate these odds. Policies and practices that curtail syringe flow in geographic areas (e.g., restrictions on SEP locations or syringe distribution) or that make it difficult for injectors to use the sterile syringes they have acquired may damage local injectors' efforts to reduce HIV transmission and other injection-related harms.

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Section: Conceptualizing Seps As Structural Interventionsmentioning

confidence: 99%

Spatial Access to Sterile Syringes and the Odds of Injecting with an Unsterile Syringe among Injectors: A Longitudinal Multilevel Study

et al. 2012

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“…Prevention strategies are needed to reduce the risk of infection among incarcerated injecting drug users (IDUs). Outside prisons, syringe exchange programmes have played a key role in reducing the spread of the viruses among IDUs [8][9][10][11]. Data on the effectiveness of syringe exchange programmes implemented inside prisons are scarce [12,13].…”

Section: Introductionmentioning

confidence: 99%

A syringe exchange programme in prison as prevention strategy against HIV infection and hepatitis B and C in Berlin, Germany

et al. 2005

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SUMMARYIn two prisons in Berlin, Germany, provision of sterile injection equipment for injecting drug users (IDUs) started in 1998. To assess the programme's impact, the frequency of injecting drug use and syringe sharing, and the incidence of HIV, HBV, and HCV infection were determined in a follow-up study. Of all IDUs (n=174), 75 % continued to inject. After the project start the level of syringe sharing declined from 71% during a 4-month period of previous imprisonment to 11% during the first 4 months of follow-up, and to virtually zero thereafter. Baseline seroprevalences for HIV, HBV, and HCV were 18, 53, and 82 %. HIV and HCV seroprevalence at baseline was significantly associated with drug injection in prison prior to the project start. No HIV and HBV seroconversions, but four HCV seroconversions occurred. The provision of syringes for IDUs in appropriate prison settings may contribute to a substantial reduction of syringe sharing. However, the prevention of HCV infection requires additional strategies.

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“…[1][2][3] As a result, needle-exchange programs (NEPs) have been endorsed by numerous independent scientific bodies, including the US National Institutes of Health Consensus Panel, US National Research Council, and the American Public Health Association, among others. 4 Nevertheless, federal funding of needle-exchange programs remains illegal in the United States, and limited funding for needle-exchange programs and restrictive service design remain constraints to optimal service delivery in many settings. 5,6 As a result, exchange operators are often forced to provide limited hours of service and only exchange syringes on a strict "one-for-one" basis.…”

Section: Introductionmentioning

confidence: 99%

An External Evaluation of a Peer-Run "Unsanctioned" Syringe Exchange Program

Wood

Kerr

Spittal

et al. 2003

Journal of Urban Health: Bulletin of the New York Academy of Me

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Effectiveness of syringe exchange programs in reducing HIV risk behavior and HIV seroconversion among injecting drug users

Cited by 284 publications

References 52 publications

Spatial Access to Sterile Syringes and the Odds of Injecting with an Unsterile Syringe among Injectors: A Longitudinal Multilevel Study

Spatial Access to Sterile Syringes and the Odds of Injecting with an Unsterile Syringe among Injectors: A Longitudinal Multilevel Study

A syringe exchange programme in prison as prevention strategy against HIV infection and hepatitis B and C in Berlin, Germany

An External Evaluation of a Peer-Run "Unsanctioned" Syringe Exchange Program

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