Multiperson use of syringes among injection drug users in a needle exchange program: a gene-based molecular epidemiologic analysis

J Acquir Immune Defic Syndr. 2006 Nov 1;43(3):335-43. doi: 10.1097/01.qai.0000230528.25083.0b.

Abstract

Syringe-sharing behaviors among injection drug users (IDUs) are typically based on self-reports and subject to socially desirable responding. We used 3 short tandem repeat (STR) genetic biomarkers to detect sharing in 2,512 syringes exchanged by 315 IDUs in the Baltimore needle exchange program (NEP; 738 person-visits). Demographic characteristics as well as direct and indirect needle-sharing behaviors corresponding to the closest AIDS Link to Intravenous Experience (ALIVE) study visits were examined for association with multiperson use (MPU) of syringes. Overall, 56% of the syringes exchanged at the Baltimore NEP had evidence of MPU. Less MPU of syringes (48% vs. 71%; P < 0.0001) was seen with more rapid syringe turnaround (<3 days). IDUs always exchanging their own syringes ("primary" syringes) were less likely to return syringes with evidence of MPU (52%) than those who exchanged syringes for others ("secondary" syringes; 64%; P = 0.0001) and those exchanging primary and secondary syringes (58%; P = 0.004). In a multivariate analysis restricted to primary exchangers, MPU of syringes was associated with sharing cotton (adjusted odds ratio [AOR] = 2.06, 95% confidence interval [CI]: 1.30 to 3.28), lending syringes (AOR = 1.70, 95% CI: 1.24 to 2.34), and injecting less than daily (AOR = 0.64, 95% CI: 0.43 to 0.95). These findings support additional public health interventions such as expanded syringe access to prevent HIV and other blood-borne infections. Testing of STRs represents a promising approach to examining and accessing complex behavioral data, including syringe sharing.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, N.I.H., Intramural

MeSH terms

  • Adult
  • Algorithms
  • Cohort Studies
  • DNA, Viral / analysis*
  • Female
  • HIV Infections / epidemiology*
  • HIV Infections / prevention & control
  • HIV Infections / transmission
  • HIV-1 / classification
  • HIV-1 / genetics*
  • Humans
  • Male
  • Middle Aged
  • Needle Sharing / adverse effects
  • Needle Sharing / statistics & numerical data*
  • Needle-Exchange Programs / legislation & jurisprudence
  • Needle-Exchange Programs / statistics & numerical data
  • Prospective Studies
  • Risk-Taking
  • Substance Abuse, Intravenous / complications
  • Substance Abuse, Intravenous / psychology*
  • Surveys and Questionnaires
  • Syringes / adverse effects
  • Syringes / standards
  • Syringes / statistics & numerical data*
  • Tandem Repeat Sequences

Substances

  • DNA, Viral