Factors Associated with Likelihood of Initiating Others into Injection Drug Use Among People Who Inject Drugs in West Virginia

AIDS Behav. 2022 Jan;26(1):47-56. doi: 10.1007/s10461-021-03325-6. Epub 2021 Jun 2.


People who inject drugs (PWID) play a critical role in injection-naïve individuals transitioning to injection drug use. We investigated factors associated with future likelihood of initiating injection-naïve individuals using multivariable logistic regression among 418 PWID in rural Appalachia (Cabell County, West Virginia). Less than 10% reported they were likely to initiate someone in the future. Acquiring syringes from a syringe services program was associated with decreased odds of being likely to initiate someone in the future (adjusted odds ratio [aOR] 0.46, 95% CI 0.23, 0.95), while having previously initiated someone into injection drug use was associated with increased odds (aOR 8.65, 95% CI 4.07, 18.41). Among our sample of PWID in Appalachia, a small proportion reported that they would be likely to initiate an injection-naïve individual in the future. Efforts to reduce injection initiation assistance should focus on this subpopulation of PWID who indicate a willingness to engage in this behavior.

Keywords: Harm reduction; Injection drug use; Injection initiation; People who inject drugs; Rural health; Syringe services programs.

MeSH terms

  • Drug Users*
  • HIV Infections* / epidemiology
  • HIV Infections* / prevention & control
  • Humans
  • Pharmaceutical Preparations*
  • Substance Abuse, Intravenous* / epidemiology
  • West Virginia / epidemiology


  • Pharmaceutical Preparations