Investigation of a Secondary Syringe Exchange Program for Homeless Young Adult Injection Drug Users in San Francisco, California, U.S.A.

Abstract

This study investigated an HIV prevention program for homeless young adult injection drug users (IDUs) that combined a secondary syringe exchange program (SEP) with community-level activities. Homeless young IDUs were recruited from street-based settings in San Francisco, and a structured questionnaire was administered. The secondary SEP operated in a circumscribed geographic area, and for analytic purposes respondents were assigned to the intervention site group if they primarily spent time in this area (n = 67), or the comparison site group if they primarily spent time elsewhere (n = 55). Almost all (96%) intervention site youth had used the secondary SEP in the past 30 days and were significantly more likely to regularly use SEP. In bivariate analysis, comparison site IDUs were more likely to share syringes, reuse syringes, share the cotton used to filter drugs, and use condoms with casual sex partners only inconsistently. In multivariate analysis, comparison site remained positively associated with sharing syringes (adjusted odds ratio [AOR], 3.748; 95% confidence interval [CI], 1.406-9.988), reusing syringes (AOR, 2.769; 95% CI,1.120-6.847), and inconsistent condom use with casual sex partners (AOR, 4.825; 95% CI, 1.392- 16.721). This suggests that the intervention was effective in delivering SEP services to homeless young adult IDUs, and that IDUs who frequented the intervention site had a lower HIV risk than comparison group IDUs.

Decreased Odds of Injection Risk Behavior Associated With Direct Versus Indirect Use of Syringe Exchange: Evidence From Two California Cities

“…In Baltimore, for example, it was estimated such high-volume “satellite” exchangers, representing less than 10% of SEP clients, accounted for nearly 65% of syringes distributed (Valente et al 1998). Various kinds of formal satellite exchange have been implemented in the United States, Canada, Russia and China by drug user activists or outreach workers funded by government entities (Anderson et al, 2003; Hayashi et al, 2010; Irwin et al, 2006; Liu et al, 2007; Sears et al, 2001). In the United States, secondary syringe exchange (not including satellite exchange) occurs primarily in connection with stand-alone SEPs; in Britain and Australia, however, it also serves as an adjunct to large-scale syringe distribution through pharmacies and drug abuse treatment clinics (Bryant and Hopwood, 2009; Craine et al, 2010, Lenton et al, 2006).…”

“…While the descriptive qualitative data just cited suggest that secondary syringe exchange may play a vital role in preventing HIV infection, only three studies we are aware of have assessed its effectiveness using analytic designs such as pre-post comparisons or comparisons between primary and secondary exchange clients and nonclients (Huo et al, 2005; Murphy et al, 2004; Sears et al, 2001). In the first (Sears et al, 2001), young homeless PWID interviewed in the vicinity of a satellite SEP in San Francisco’s Golden Gate Park were compared with PWID recruited at a site geographically distant from the exchange, which was operated by a core group of four youth who were available to exchange syringes 24 hours a day, 7 days a week.…”

“…In the first (Sears et al, 2001), young homeless PWID interviewed in the vicinity of a satellite SEP in San Francisco’s Golden Gate Park were compared with PWID recruited at a site geographically distant from the exchange, which was operated by a core group of four youth who were available to exchange syringes 24 hours a day, 7 days a week. Respondents at the intervention site were 73% less likely to share syringes than those at the comparison site.…”

Drug use and emotional distress differentiate unstably- versus stably-housed adults living with HIV who engage in unprotected sex

“…Past findings suggest that UALH are likely to engage in HIV-related transmission acts at a rate higher than SALH, often under the influence of alcohol and/or drugs (Kidder et al, 2008; Sears et al, 2001). Lack of stable housing may increase the likelihood of trading sex for money, drugs, or shelter in order to survive (Reback et al, 2007; Surratt and Inciardi, 2004).…”

Using implicit association to access drug use trajectories of young people: Understanding the different drug use pathways for young people who use illicit substances and investigating the role of implicit identification as a useful indicator of risk of drug dependency

“…Recruitment sites for the study were concentrated around the Sydney metropolitan area, a geographical area where a large proportion of people who use drugs are known to congregate. Young people at risk of drug use are known to be hard to reach through traditional health and harm reduction services and they tend to be less willing than older people to talk about their risk practices for fear of getting in trouble with the law (Bryant et al, 2012;Sears, Guydish, Weltzien & Lum, 2001). Additionally, young people are unlikely to attend health services of any form (Booth et al, 2004;Youth Affair Council of WA, 2006).…”