Skip Navigation LinksHome > April 12, 2002 - Volume 16 - Issue 6 > Factors associated with persistent high-risk syringe sharing...
AIDS:
Research Letters

Factors associated with persistent high-risk syringe sharing in the presence of an established needle exchange programme

Wood, Evana,b; Tyndall, Mark W.a,b; Spittal, Patricia M.a,b; Li, Kathya; Hogg, Robert S.a,b; Montaner, Julio S. G.a,b,c; O'Shaughnessy, Michael V.a,d; Schechter, Martin T.a,b

Free Access
Article Outline
Collapse Box

Author Information

aBritish Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital; bDepartment of Health Care and Epidemiology; cDepartment of Medicine; and dDepartment of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada.

Sponsorship: Evan Wood is supported by the Canadian Institutes for Health Research, and the BC Heath Research Foundation. Dr Schechter holds a tier I Canada Research Chair in HIV/AIDS and Urban Population Health. The study was supported by the US National Institutes of Health (grant no. RO1 DA11591).

Received: 11 May 2001;

revised: 12 October 2001; accepted: 13 November 2001.

Vancouver has experienced an explosive HIV epidemic despite the presence of a needle exchange programme (NEP). We sought possible explanations for high-risk syringe sharing among Vancouver injection drug users over the period January 1999 to October 2000. Overall, 14% of participants reported high-risk sharing. Although acquiring needles exclusively from the NEP was independently associated with less sharing, we identified several risk factors for persistent sharing, including difficulty accessing sterile needles, bingeing, and frequent cocaine injection.

Needle exchange programmes (NEP) have been shown to be effective at reducing HIV risk behaviour [1] and HIV transmission among injection drug users (IDU) [2]. Nevertheless, the explosive HIV epidemic observed in Vancouver [3], despite the presence of a well-established NEP, has led to persistent questions about the efficacy of NEP as a public health intervention [4–6]. We have therefore sought possible explanations for high-risk needle sharing in an environment in which much effort has been made to make sterile needles accessible.

Data for these analyses were collected through the Vancouver Injection Drug User Study, a prospective cohort study described previously [7]. For the purposes of this study, high-risk needle sharing was defined as borrowing a used needle from someone other than the participant's intimate sexual partner in the previous 6 months. This definition was employed because we sought to examine weaker network linkages that were likely responsible for the rapid spread of HIV observed in the late 1990s [4].

Data from each participant's most recent follow-up during the period January 1999 to October 2000 were evaluated. Univariate and multivariate statistical techniques were applied to determine factors associated with high-risk needle sharing in the previous 6 months. Categorical explanatory variables were analysed using Pearson's chi-square test, and continuous variables were analysed using the Wilcoxon rank sum test. Variables were considered in logistic regression analyses.

Drug using characteristics considered in the analyses included: whether participants reported that they currently find it hard to get clean needles, bingeing, the frequency of cocaine and heroin injection, the source of sterile needles, HIV serostatus, and being on methadone maintenance treatment. Individuals who reported injecting cocaine or heroin once or more per day were defined as frequent cocaine and frequent heroin users, respectively. Bingeing was defined as binges or runs when drugs were injected more frequently than usual.

In order to evaluate the effect of the NEP, we compared participants whose exclusive needle source was the needle exchange to participants who acquired their needles exclusively from other sources or from several sources, including the NEP, pharmacies, the street, dealers, or friends. In an attempt to account for socially desirable reporting that could potentially increase with the number of encounters with the study research nurses, the multivariate model was adjusted for the number of previous visits of each participant.

A total of 997 individuals responded to at least one questionnaire during the period January 1999 to October 2000, and were eligible. Of the 997 participants eligible for the study, 776 (78%) reported injecting drugs in the past 6 months and were therefore included in these analyses. Of these, 671 subjects were defined as non-high-risk needle users and 105 (14%) were defined as high-risk.

Univariate analyses found that being married [odds ratio (OR) 0.5], being older (OR 0.97 per year), and living in the Downtown Eastside HIV epicentre (OR 0.5) were inversely associated with high-risk needle sharing. Conversely, male sex (OR 1.7) was positively associated with high-risk sharing. We found no evidence that ethnicity, education, gay or bisexual sexual identity, unstable housing, or employment were associated with high-risk needle sharing.

Univariate analyses of drug using characteristics indicated that finding it hard to get clean needles (OR 3.6), bingeing (OR 2.0), and frequent cocaine injection (OR 1.8) were all positively associated with high-risk needle sharing. Conversely, we found that acquiring needles exclusively from needle exchange was associated with less syringe sharing (OR 0.4). We found no evidence that the frequency of heroin use, HIV positivity, or methadone were associated with sharing.

Logistic regression analyses, shown in Table 1, found that difficulty accessing clean needles [adjusted odds ratio (AOR) 3.36], bingeing (AOR 1.82), frequent cocaine injection (AOR 1.76), and male sex (AOR 1.89) were all independently associated with high-risk sharing. Variables negatively associated with sharing in the regression analyses included being married (AOR 0.49), and acquiring needles exclusively from needle exchange (AOR 0.46). The model was adjusted for the number of previous visits of each participant, HIV serostatus, and residence in proximity to the needle exchange.

Table 1
Table 1
Image Tools

Given the evidence supporting the effectiveness of NEP as a public health intervention, it is not surprising that we found that individuals who acquire needles exclusively from the NEP were significantly less likely to report syringe sharing [1,2,8–11]. However, we identified several independent risk factors for high-risk needle sharing, the strongest of which was difficulty accessing clean needles. Together, these findings suggest that the needle exchange program has had a strong protective effect against high-risk sharing, but that expanding needle access would probably have a substantial harm-reducing impact. Furthermore, it is noteworthy that bingeing and frequent cocaine injection remained independently associated with high-risk sharing, even after adjustment for residence in proximity to NEP and difficulty accessing needles. These findings suggest that more comprehensive harm reduction strategies may be required to prevent and reduce HIV epidemics in some settings [12,13].

There are several limitations to our analyses. First, in comparison with the participants who were included in these analyses, those participants who were not followed up had a number of characteristics such as being single, younger, and HIV negative, which our analyses suggest make them more likely to be involved in high-risk needle sharing. Second, whereas some studies have shown self-reported HIV risk behaviour to be valid [14], other investigations have suggested that IDU may under-report HIV risk behaviour [15].

Our analyses indicate that Vancouver's NEP has had a strong protective effect against high-risk needle sharing, a finding that was consistent when we considered other definitions of sharing (data not shown). Nevertheless, difficulty accessing sufficient sterile needles, bingeing, and frequent cocaine injection remained strongly associated with this risk behaviour. Whereas improving needle access by expanding the NEP's services may have substantial harm-reducing potential, our findings also suggest that improved needle provision alone, in the absence of additional support for IDU, may not be sufficient to prevent continued HIV transmission. This may be especially important in settings in which cocaine injection is prevalent, and where comprehensive harm reduction measures have yet to be implemented.

Evan Wooda,b

Mark W. Tyndalla,b

Patricia M. Spittala,b

Kathy Lia

Robert S. Hogga,b

Julio S. G. Montanera,b,c

Michael V. O'Shaughnessya,d

Martin T. Schechtera,b

Back to Top | Article Outline

Acknowledgements

The authors would like to thank Bonnie Devlin, Caitlin Johnston, Robin Brooks, Suzy Coulter, Steve Kain, Guillermo Fernandez, John Charette, Will Small and Nancy Laliberte for their research and administrative assistance, and all the participants in the VIDUS study.

Back to Top | Article Outline

References

1. Bluthenthal RN, Kral AH, Gee L, Erringer EA, Edlin BR. The effect of syringe exchange use on high-risk injection drug users: a cohort study. AIDS 2000, 14: 605–611.

2. Des Jarlais DC, Marmor M, Paone D. et al. HIV incidence among injecting drug users in New York City syringe-exchange programmes. Lancet 1996, 348: 987–991.

3. Strathdee SA, Patrick DM, Currie SL. et al. Needle exchange is not enough: lessons from the Vancouver injecting drug use study. AIDS 1997, 11: F59–F65.

4. Schechter MT, Strathdee SA, Cornelisse PG. et al. Do needle exchange programmes increase the spread of HIV among injection drug users?: an investigation of the Vancouver outbreak. AIDS 1999, 13: F45–F51.

5. Bellm J. Needle-exchange programmes are not the answer [Letter; Comment]. Lancet 1999, 353: 1657–1661.

6. Discussion. Am J Public Health 2000, 90:1385–1396.

7. Wood E, Schechter MT, Tyndall MW, Montaner JS, O'Shaughnessy MV, Hogg RS. Antiretroviral medication use among injection drug users: two potential futures. AIDS 2000, 14: 1229–1235.

8. Lurie P, Drucker E. An opportunity lost: HIV infections associated with lack of a national needle-exchange programme in the USA. Lancet 1997, 349: 604–608.

9. Heimer R, Kaplan EH, Khoshnood K, Jariwala B, Cadman EC. Needle exchange decreases the prevalence of HIV-1 proviral DNA in returned syringes in New Haven, Connecticut. Am J Med 1993, 95: 214–220.

10. Bluthenthal RN, Kral AH, Erringer EA, Edlin BR. Use of an illegal syringe exchange and injection-related risk behaviors among street-recruited injection drug users in Oakland, California, 1992 to 1995. J Acquired Immune Defic Syndr 1998, 18: 505–511.

11. Monterroso ER, Hamburger ME, Vlahov D. et al. Prevention of HIV infection in street-recruited injection drug users. J Acquired Immune Defic Syndr 2000, 25: 63–70.

12. Perneger TV, Giner F, del Rio M, Mino A. Randomised trial of heroin maintenance programme for addicts who fail in conventional drug treatments. BMJ 1998, 317: 13–18.

13. Dolan K, Kimber J, Fry C, Fitzgerald J, McDonald D, Frautmann F. Drug consumption facilities in Europe and the establishment of supervised injecting centres in Australia. Drug Alcohol Rev 2000, 19: 337–346.

14. De Irala J, Bigelow C, McCusker J, Hindin R, Zheng L. Reliability of self-reported human immunodeficiency virus risk behaviors in a residential drug treatment population. Am J Epidemiol 1996, 143: 725–732.

15. Des Jarlais DC, Paone D, Milliken J. et al. Audio-computer interviewing to measure risk behaviour for HIV among injecting drug users: a quasi-randomised trial. Lancet 1999, 353: 1657–1661.

Cited By:

This article has been cited 67 time(s).

Journal of Substance Abuse Treatment
HIV rapid testing in drug treatment: comparison across treatment modalities
Schwartz, RP; Stitzer, ML; Feaster, DJ; Korthuis, PT; Alvanzo, AAH; Winhusen, TM; Donnard, L; Snead, N; Metsch, LR
Journal of Substance Abuse Treatment, 44(4): 369-374.
10.1016/j.jsat.2012.08.219
CrossRef
American Journal on Addictions
An Observation of Lower Rates of Drug Use over Time in Community Syringe Exchangers
Kidorf, M; King, VL; Peirce, J; Kolodner, K; Brooner, RK
American Journal on Addictions, 22(3): 271-276.
10.1111/j.1521-0391.2012.12002.x
CrossRef
Drug and Alcohol Review
A review of the efficacy and effectiveness of harm reduction strategies for alcohol, tobacco and illicit drugs
Ritter, A; Cameron, J
Drug and Alcohol Review, 25(6): 611-624.
10.1080/09595230600944529
CrossRef
Addiction Research & Theory
High prevalence of syringe sharing among street involved youth
Lloyd-Smith, E; Kerr, T; Zhang, R; Montaner, JSG; Wood, E
Addiction Research & Theory, 16(4): 353-358.
10.1080/16066350701823094
CrossRef
Lancet Infectious Diseases
Rationale for evaluating North America's first medically supervised safer-injecting facility
Wood, E; Kerr, T; Montaner, JS; Strathdee, SA; Wodak, A; Hankins, CA; Schechter, MT; Tyndall, MW
Lancet Infectious Diseases, 4(5): 301-306.

Canadian Medical Association Journal
Displacement of Canada's largest public illicit drug market in response to a police crackdown
Wood, E; Spittal, PM; Small, W; Kerr, T; Li, K; Hogg, RS; Tyndall, MW; Montaner, JSG; Schechter, MT
Canadian Medical Association Journal, 170(): 1551-1556.

American Journal of Public Health
Service uptake and characteristics of injection drug users utilizing North America's first medically supervised safer injecting facility
Wood, E; Tyndall, MW; Qui, ZG; Zhang, R; Montaner, JSG; Kerr, T
American Journal of Public Health, 96(5): 770-773.
10.2105/AJPH.2004.057828
CrossRef
Canadian Journal of Public Health-Revue Canadienne De Sante Publique
Requiring help injecting as a risk factor for HIV infection in the Vancouver epidemic - Implications for HIV prevention
Wood, E; Spittal, PM; Kerr, T; Small, W; Tyndall, MW; O'Shaughnessy, MV; Schechter, MT
Canadian Journal of Public Health-Revue Canadienne De Sante Publique, 94(5): 355-359.

Drug and Alcohol Dependence
Perceived risk, peer influences, and injection partner type predict receptive syringe sharing among young adult injection drug users in five US cities
Bailey, SL; Ouellet, LJ; Mackesy-Amiti, ME; Golub, ET; Hagan, H; Hudson, SM; Latka, MH; Gao, W; Garfein, RS
Drug and Alcohol Dependence, 91(): S18-S29.
10.1016/j.drugalcdep.2007.02.014
CrossRef
Drug and Alcohol Dependence
Attendance, drug use patterns, and referrals made from North America's first supervised injection facility
Tyndall, MW; Kerr, T; Zhang, R; King, E; Montaner, JG; Wood, E
Drug and Alcohol Dependence, 83(3): 193-198.
10.1016/j.drugalcdep.2005.11.011
CrossRef
Drug and Alcohol Dependence
Incidence and determinants of initiation into cocaine injection and correlates of frequent cocaine injectors
Lloyd-Smith, E; Wood, E; Li, K; Montaner, JSG; Kerr, T
Drug and Alcohol Dependence, 99(): 176-182.
10.1016/j.drugalcdep.2008.07.003
CrossRef
Journal of Drug Issues
Responding to an explosive HIV epidemic driven by frequent cocaine injection: Is there a role for safe injecting facilities?
Kerr, T; Wood, E; Palepu, A; Wilson, D; Schechter, MT; Tyndall, MW
Journal of Drug Issues, 33(3): 579-608.

Harm Reduction Journal
The perspectives of injection drug users regarding safer injecting education delivered through a supervised injecting facility
Fast, D; Small, W; Wood, E; Kerr, T
Harm Reduction Journal, 5(): -.
ARTN 32
CrossRef
Drug and Alcohol Dependence
Risk profile of individuals who provide assistance with illicit drug injections
Fairbairn, N; Wood, E; Small, W; Stoltz, JA; Li, K; Kerr, T
Drug and Alcohol Dependence, 82(1): 41-46.
10.1016/j.drugalcdep.2005.08.007
CrossRef
Addictive Behaviors
Psychiatric distress, risk behavior, and treatment enrollment among syringe exchange participants
Kidorf, M; King, VL; Peirce, J; Burke, C; Kolodner, K; Brooner, RK
Addictive Behaviors, 35(5): 499-503.
10.1016/j.addbeh.2009.12.033
CrossRef
Public Health
Prevalence and correlates of hepatitis C infection among users of North America's first medically supervised safer injection facility
Wood, E; Kerr, T; Stoltz, J; Qui, Z; Zhang, R; Montaner, JSG; Tyndall, MW
Public Health, 119(): 1111-1115.
10.1016/j.puhe.2005.05.006
CrossRef
International Journal of Drug Policy
Harm reduction by a "user-run" organization: A case study of the Vancouver Area Network of Drug Users (VANDU)
Kerr, T; Small, W; Peeace, W; Douglas, D; Pierre, A; Wood, E
International Journal of Drug Policy, 17(2): 61-69.
10.1016/j.drugpo.2006.01.003
CrossRef
International Journal of Drug Policy
What do you do when you hit rock bottom? Responding to drugs in the city of Vancouver
Wood, E; Kerr, T
International Journal of Drug Policy, 17(2): 55-60.
10.1016/j.drugpo.2005.12.007
CrossRef
International Journal of Drug Policy
Impacts of intensified police activity on injection drug users: Evidence from an ethnographic investigation
Small, W; Kerr, T; Charette, J; Schechter, MT; Spittal, PM
International Journal of Drug Policy, 17(2): 85-95.
10.1016/j.drugpo.2005.12.005
CrossRef
Social Science & Medicine
Coming 'down here': Young people's reflections on becoming entrenched in a local drug scene
Fast, D; Small, W; Wood, E; Kerr, T
Social Science & Medicine, 69(8): 1204-1210.
10.1016/j.socscimed.2009.07.024
CrossRef
Jaids-Journal of Acquired Immune Deficiency Syndromes
The potential public health and community impacts of safer injecting facilities: Evidence from a cohort of injection drug users
Wood, E; Kerr, T; Spittal, PM; Li, K; Small, W; Tyndall, MW; Hogg, RS; O'Shaughnessy, MV; Schechter, MT
Jaids-Journal of Acquired Immune Deficiency Syndromes, 32(1): 2-8.

AIDS Care-Psychological and Socio-Medical Aspects of AIDS/Hiv
Determinants of HAART discontinuation among injection drug users
Kerr, T; Marshall, A; Walsh, J; Palepu, A; Tyndall, M; Montaner, J; Hogg, R; Wood, E
AIDS Care-Psychological and Socio-Medical Aspects of AIDS/Hiv, 17(5): 539-549.
10.1080/09540120412331319778
CrossRef
AIDS Patient Care and Stds
At-Risk Drinking and Injection and Sexual Risk Behaviors of HIV-Positive Injection Drug Users Entering Drug Treatment in New York City
Arasteh, K; Jarlais, DCD
AIDS Patient Care and Stds, 23(8): 657-661.
10.1089/apc.2009.0027
CrossRef
Substance Use & Misuse
Injection risk behavior among women syringe exchangers in San Francisco
Lum, PJ; Sears, C; Guydish, J
Substance Use & Misuse, 40(): 1681-1696.
10.1080/108280500222834
CrossRef
Substance Use & Misuse
Binge drug use independently predicts HIV seroconversion among injection drug users: Implications for public health strategies
Miller, CL; Kerr, T; Frankish, JC; Spittal, PM; Li, K; Schechter, MT; Wood, E
Substance Use & Misuse, 41(2): 199-210.
10.1080/10826080500391795
CrossRef
Drug and Alcohol Dependence
Increasing use and associated harms of crystal methamphetamine injection in a Canadian setting
Fairbairn, N; Kerr, T; Buxton, JA; Li, K; Montaner, JS; Wood, E
Drug and Alcohol Dependence, 88(): 313-316.
10.1016/j.drugalcdep.2006.10.019
CrossRef
Social Science & Medicine
Social and structural violence and power relations in mitigating HIV risk of drug-using women in survival sex work
Shannon, K; Kerr, T; Allinott, S; Chettiar, J; Shoveller, J; Tyndall, MW
Social Science & Medicine, 66(4): 911-921.
10.1016/j.socscimed.2007.11.008
CrossRef
International Journal of Drug Policy
Effects of police confiscation of illicit drugs and syringes among injection drug users in Vancouver
Werb, D; Wood, E; Small, W; Strathdee, S; Li, K; Montaner, J; Kerr, T
International Journal of Drug Policy, 19(4): 332-338.
10.1016/j.drugpo.2007.08.004
CrossRef
Antiviral Therapy
Psychosocial determinants of adherence to highly active antiretroviral therapy among injection drug users in Vancouver
Kerr, T; Palepu, A; Barnes, G; Walsh, J; Hogg, R; Montaner, J; Tyndall, M; Wood, E
Antiviral Therapy, 9(3): 407-414.

International Journal of Drug Policy
Association between neighbourhood socioeconomic characteristics and high-risk injection behaviour amongst injection drug users living in inner and other city areas in Montreal, Canada
Genereux, M; Bruneau, J; Daniel, M
International Journal of Drug Policy, 21(1): 49-55.
10.1016/j.drugpo.2009.01.004
CrossRef
International Journal of Drug Policy
Access to syringes in three Russian cities: Implications for syringe distribution and coverage
Saranga, A; Rhodes, T; Platt, L
International Journal of Drug Policy, 19(): S25-S36.
10.1016/j.drugpo.2007.11.008
CrossRef
Harm Reduction Journal
The Washington Needle Depot: fitting healthcare to injection drug users rather than injection drug users to healthcare: moving from a syringe exchange to syringe distribution model
Small, D; Glickman, A; Rigter, G; Walter, T
Harm Reduction Journal, 7(): -.
ARTN 1
CrossRef
Addiction
Evidence for the effectiveness of sterile injecting equipment provision in preventing hepatitis C and human immunodeficiency virus transmission among injecting drug users: a review of reviews
Palmateer, N; Kimber, J; Hickman, M; Hutchinson, S; Rhodes, T; Goldberg, D
Addiction, 105(5): 844-859.
10.1111/j.1360-0443.2009.02888.x
CrossRef
Lancet
The case for expanding access to highly active antiretroviral therapy to curb the growth of the HIV epidemic
Montaner, JSG; Hogg, R; Wood, E; Kerr, T; Tyndall, M; Levy, AR; Harrigan, PR
Lancet, 368(): 531-536.

International Journal of Drug Policy
Decline in needle exchange use in Vancouver, Canada coincides with the Australian heroin shortage
Small, W; Wood, E; Buchner, C; Fair, B; Kerr, T
International Journal of Drug Policy, 19(4): 291-292.
10.1016/j.drugpo.2008.02.007
CrossRef
Bmc Public Health
'I guess my own fancy screwed me over': transitions in drug use and the context of choice among young people entrenched in an open drug scene
Fast, D; Small, W; Krusi, A; Wood, E; Kerr, T
Bmc Public Health, 10(): -.
ARTN 126
CrossRef
Journal of Urban Health-Bulletin of the New York Academy of Medicine
An external evaluation of a. peer-run "unsanctioned" syringe exchange program
Wood, E; Kerr, T; Spittal, PM; Small, W; Tyndall, MW; O'Shaughnessy, V; Schechter, MT
Journal of Urban Health-Bulletin of the New York Academy of Medicine, 80(3): 455-464.

Substance Use & Misuse
Needle exchange and the HIV outbreak among injection drug users in Vancouver, Canada
Wood, E; Kerr, T
Substance Use & Misuse, 41(): 841-843.
10.1080/10826080600669595
CrossRef
American Journal of Medicine
Frequent needle exchange use and HIV incidence in Vancouver, Canada
Wood, E; Lloyd-Smith, E; Li, K; Strathdee, SA; Small, W; Tyndall, MW; Montaner, JSG; Kerr, T
American Journal of Medicine, 120(2): 172-179.
10.1016/j.amjmed.2006.02.030
CrossRef
Substance Use & Misuse
Prevalence of Infections, HIV Risk Behaviors and Factors Associated with HIV Infection Among Male Injecting Drug Users Attending a Needle/Syringe Exchange Program in Dhaka, Bangladesh
Azim, T; Chowdhury, EI; Reza, M; Faruque, MO; Ahmed, G; Khan, R; Rahman, M; Pervez, MM; Jana, S; Strathdee, SA
Substance Use & Misuse, 43(): 2124-2144.
10.1080/10826080802344583
CrossRef
Harm Reduction Journal
Worry as a window into the lives of people who use injection drugs: a factor analysis approach
Exner, H; Gibson, EK; Stone, R; Lindquist, J; Cowen, L; Roth, EA
Harm Reduction Journal, 6(): -.
ARTN 20
CrossRef
Jaids-Journal of Acquired Immune Deficiency Syndromes
The impact of a police presence on access to needle exchange programs
Wood, E; Kerr, T; Small, W; Jones, J; Schechter, MT; Tyndall, MW
Jaids-Journal of Acquired Immune Deficiency Syndromes, 34(1): 116-118.

Addiction Research & Theory
Needle exchange: The Vancouver experience
Ashton, M
Addiction Research & Theory, 12(5): 445-460.
10.1080/16066350410001729513
CrossRef
Journal of Urban Health-Bulletin of the New York Academy of Medicine
Potential uptake and, correlates of willingness to use a supervised smoking facility for noninjection illicit drug use
Collins, CLC; Kerr, T; Kuyper, LM; Li, K; Tyndall, MW; Marsh, BC; Montaner, JS; Wood, E
Journal of Urban Health-Bulletin of the New York Academy of Medicine, 82(2): 276-284.
10.1093/jurban/jti051
CrossRef
International Journal of Drug Policy
Examining barriers to syringe access among injection drug users
Small, W
International Journal of Drug Policy, 16(5): 291-292.
10.1016/j.drugpo.2005.07.003
CrossRef
Journal of Urban Health-Bulletin of the New York Academy of Medicine
Social network-related risk factors for bloodborne virus infections among injection drug users receiving syringes through secondary exchange
De, P; Cox, J; Boivin, JF; Platt, RW; Jolly, AM
Journal of Urban Health-Bulletin of the New York Academy of Medicine, 85(1): 77-89.
10.1007/s11524-007-9225-z
CrossRef
Drug and Alcohol Dependence
High dead-space syringes and the risk of HIV and HCV infection among injecting drug users
Zule, WA; Bobashev, G
Drug and Alcohol Dependence, 100(3): 204-213.
10.1016/j.drugalcdep.2008.08.017
CrossRef
AIDS Care-Psychological and Socio-Medical Aspects of AIDS/Hiv
The relative risk of HIV among IDUs not in treatment in Malaysia
Vicknasingam, B; Narayanan, S; Navaratnam, V
AIDS Care-Psychological and Socio-Medical Aspects of AIDS/Hiv, 21(8): 984-991.
10.1080/09540120802657530
CrossRef
Canadian Medical Association Journal
Risk factors for elevated HIV incidence among Aboriginal injection drug users in Vancouver
Craib, KJP; Spittal, PM; Wood, E; Laliberte, N; Hogg, RS; Li, K; Heath, K; Tyndall, MW; O'Shaughnessy, MV; Schechter, MT
Canadian Medical Association Journal, 168(1): 19-24.

Lancet
Safer injection facility use and syringe sharing in injection drug users
Kerr, T; Tyndall, M; Li, K; Montaner, J; Wood, E
Lancet, 366(): 316-318.

Substance Use & Misuse
Sociodemographic disparities in access to addiction treatment among a cohort of Vancouver injection drug users
Wood, E; Li, K; Palepu, A; Marsh, DC; Schechter, MT; Hogg, RS; Montaner, JSG; Kerr, T
Substance Use & Misuse, 40(8): 1153-1167.
10.1081/JA-200042287
CrossRef
International Journal of Drug Policy
Safer injecting education for HIV prevention within a medically supervised safer injecting facility
Wood, E; Tyndall, MW; Stoltz, JA; Small, W; Zhang, R; O'Connell, J; Montaner, JSG; Kerr, T
International Journal of Drug Policy, 16(4): 281-284.
10.1016/j.drugpo.2005.07.004
CrossRef
Journal of Child & Adolescent Substance Abuse
Addiction Treatment Experience among a Cohort of Street-Involved Youths and Young Adults
Wong, J; Marshall, BDL; Kerr, T; Lai, C; Wood, E
Journal of Child & Adolescent Substance Abuse, 18(4): 398-409.
10.1080/10678280903185567
CrossRef
Substance Use & Misuse
Secondary syringe exchange among users of 23 California syringe exchange programs
Lorvick, J; Bluthenthal, RN; Scott, A; Gilbert, ML; Riehman, KS; Anderson, RL; Flynn, NM; Kral, AH
Substance Use & Misuse, 41(): 865-882.
10.1080/10826080600669041
CrossRef
Substance Use & Misuse
Factors associated with buying and selling syringes among injection drug users in a setting of one of North America's largest syringe exchange programs
Kuyper, LM; Kerr, T; Li, K; Hogg, RS; Tyndall, MW; Montaner, JSG; Wood, E
Substance Use & Misuse, 41(): 883-899.
10.1080/10826080600668712
CrossRef
Addiction
Determinants of injection drug user (IDU) syringe sharing: the relationship between availability of syringes and risk network member characteristics in Winnipeg, Canada
Shaw, SY; Shah, L; Jolly, AM; Wylie, JL
Addiction, 102(): 1626-1635.
10.1111/j.1360-0443.2007.01940.x
CrossRef
American Journal of Public Health
Identifying heterogeneity among injection drug users: A cluster analysis approach
Shaw, SY; Shah, L; Jolly, AM; Wylie, JL
American Journal of Public Health, 98(8): 1430-1437.
10.2105/AJPH.2007.120741
CrossRef
International Journal of Epidemiology
Baseline self-perceived risk of HIV infection independently predicts the rate of HIV seroconversion in a prospective cohort of injection drug users
Wood, E; Li, K; Miller, CL; Hogg, RS; Montaner, JSG; Schechter, MT; Kerr, T
International Journal of Epidemiology, 34(1): 152-158.
10.1093/ije/dyh357
CrossRef
International Journal of Drug Policy
Nurse-delivered safer injection education among a cohort of injection drug users: Evidence from the evaluation of Vancouver's supervised injection facility
Wood, RA; Wood, E; Lai, C; Tyndall, MW; Montaner, JSG; Kerr, T
International Journal of Drug Policy, 19(3): 183-188.
10.1016/j.drugpo.2008.01.003
CrossRef
Substance Abuse Treatment Prevention and Policy
Assisted injection among people who inject drugs in Thailand
Lee, WK; Ti, LP; Hayashi, K; Kaplan, K; Suwannawong, P; Wood, E; Kerr, T
Substance Abuse Treatment Prevention and Policy, 8(): -.
ARTN 32
CrossRef
Social Science & Medicine
The impact of social, structural and physical environmental factors on transitions into employment among people who inject drugs
Richardson, L; Wood, E; Kerr, T
Social Science & Medicine, 76(): 126-133.
10.1016/j.socscimed.2012.10.015
CrossRef
JAIDS Journal of Acquired Immune Deficiency Syndromes
The Future Face of Coinfection: Prevalence and Incidence of HIV and Hepatitis C Virus Coinfection Among Young Injection Drug Users
Miller, CL; Wood, E; Spittal, PM; Li, K; Frankish, JC; Braitstein, P; Montaner, JS; Schechter, MT
JAIDS Journal of Acquired Immune Deficiency Syndromes, 36(2): 743-749.

PDF (83)
JAIDS Journal of Acquired Immune Deficiency Syndromes
Inability to Access Addiction Treatment and Risk of HIV Infection Among Injection Drug Users
Wood, E; Spittal, P; Li, K; Kerr, T; Miller, CL; Hogg, RS; Montaner, JS; Schechter, MT
JAIDS Journal of Acquired Immune Deficiency Syndromes, 36(2): 750-754.

PDF (93)
JAIDS Journal of Acquired Immune Deficiency Syndromes
Model Projections on the Required Coverage of Syringe Distribution to Prevent HIV Epidemics Among Injecting Drug Users
Vickerman, P; Hickman, M; Rhodes, T; Watts, C
JAIDS Journal of Acquired Immune Deficiency Syndromes, 42(3): 355-361.
10.1097/01.qai.0000219788.73539.47
PDF (210) | CrossRef
JAIDS Journal of Acquired Immune Deficiency Syndromes
A Prognostic Model for HIV Seroconversion Among Injection Drug Users as a Tool for Stratification in Clinical Trials
Boileau, C; Bruneau, J; Al-Nachawati, H; Lamothe, F; Vincelette, J
JAIDS Journal of Acquired Immune Deficiency Syndromes, 39(4): 489-495.

PDF (220)
JAIDS Journal of Acquired Immune Deficiency Syndromes
Requiring Help Injecting Independently Predicts Incident HIV Infection Among Injection Drug Users
O'Connell, JM; Kerr, T; Li, K; Tyndall, MW; Hogg, RS; Montaner, JS; Wood, E
JAIDS Journal of Acquired Immune Deficiency Syndromes, 40(1): 83-88.

PDF (94)
JAIDS Journal of Acquired Immune Deficiency Syndromes
Elevated Syringe Borrowing Among Men Who Have Sex With Men: A Prospective Study
Marshall, BD; Wood, E; Li, K; Kerr, T
JAIDS Journal of Acquired Immune Deficiency Syndromes, 46(2): 248-252.
10.1097/QAI.0b013e31814a5533
PDF (86) | CrossRef
Back to Top | Article Outline

© 2002 Lippincott Williams & Wilkins, Inc.

Login