The effect of syringe exchange use on high-risk injection drug users: a cohort study

Bluthenthal, Ricky N.a,b,c; Kral, Alex H.c; Gee, Laurenc; Erringer, Elizabeth A.c; Edlin, Brian R.c

Epidemiology & Social

Objective: To determine whether syringe exchange program use is associated with cessation of syringe sharing among high-risk injection drug users.

Design and methods: Between 1992 and 1996, street-recruited injection drug users were interviewed and received HIV testing and counseling semi-annually, as part of a dynamic cohort study. We examined a cohort of 340 high-risk injection drug users for whom two observations, 6-months apart, were available and who reported syringe sharing at the first interview. Multivariate logistic regression analysis was performed to determine the relationship between syringe exchange program use and cessation of syringe sharing, while controlling for confounding factors.

Results: At follow-up interview, 60% (204 of 340) reported quitting syringe sharing. High-risk injection drug users who began using the syringe exchange program were more likely to quit sharing syringes [adjusted odds ratio (AOR), 2.68; 95% confidence interval (CI), 1.35–5.33], as were those who continued using the syringe exchange program (AOR,1.98; 95% CI, 1.05–3.75) in comparison with non-syringe exchange program users, while controlling for confounding factors.

Conclusions: The initiation and continuation of syringe exchange program use among high-risk injection drug users is independently associated with cessation of syringe sharing. Syringe exchange program use can be an important component in reducing the spread of blood-borne infectious diseases among high-risk injection drug users.

From the aDrug Policy Research Center and Health Program, RAND, Santa Monica, the bPsychiatry Department, Charles R. Drew University, Los Angeles and the cUrban Health Study, Department of Family and Community Medicine and Institute for Health Policy Studies, University of California, San Francisco, California, USA.

Sponsorship: This study was supported by National Institute on Drug Abuse (grants RO1-DA09532 & UO1-DA06908).

Note: <An earlier version of this paper was presented at the 125th American Public Health Association Meetings in Indianapolis, Indiana, November 9–13, 1997 (Session 2085).>

Correspondence to Ricky N. Bluthenthal, PhD, RAND, 1700 Main Street, P.O. Box 2138, Santa Monica, California 90407-2138, USA. Tel: +1 310 393 0411 ext. 6642; fax: + 1 310 451 7063; E-mail: Ricky

Received: 14 June 1999;

revised: 10 December 1999; accepted: 22 December 1999.

© 2000 Lippincott Williams & Wilkins, Inc.