Marseille 2007
| Abstract #499 - Indirect sharing and HIV risk: An event level analysis | ||||
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Session: 50.8: Transmission and social epidemiology (Parallel) on Wednesday @ 08.30-10.30 in PR Chaired by Brenda Spencer, Helene Sylvain Authors: Presenting Author: Dr William Zule - RTI International, United States |
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| Additional Authors: Dr Elizabeth Costenbader, Mr Curtis Coomes, Dr Wendee Wechsberg, | ||||
| Aim: Although many injecting drug users (IDUs) have stopped using syringes after someone else has used them, many IDUs continue to share cookers, cottons, water, and liquefied drug solutions. This presentation examines event-level predictors of these practices, which are commonly referred to as indirect sharing. | ||||
| Method / Issue: 855 out-of-treatment IDUs were enrolled in an intervention study to reduce HIV risk behaviors. Participants were recruited using street outreach in North Carolina between July 2003 and Jan 2006. Following a baseline interview and testing for HIV, HBV, and HCV participants were randomly assigned to an educational or a motivational intervention. Follow-up interview were completed at 6 and 12-months post enrollment. At each interview, participants were asked detailed questions regarding the last time that they injected. This analysis is based on a total of 1746 injection episodes. Bivariate analyses were performed to identify variables that were correlated with indirect sharing. Person and event level variables that were correlated with indirect sharing were entered into a multiple logistic regression model using a generalized estimating equations (GEE) to identify independent predictors. | ||||
| Results / Comments: The sample was 74% male, 63% African-American and 29% non-Hispanic white. The mean age was age 41 years. HIV prevalence was 8% and HCV prevalence was 53%. At the last injection, 40% reported injecting heroin, 34% inject cocaine, 19% speedball, and 7% injected other drugs. 88% used a new syringe the last time they injected, but 45% reported at least one potentially risky indirect sharing practice. The two most common practices were dividing liquefied drugs with a used syringe (28%) and using a used cooker (15%) of episodes. In bivariate analyses, women and younger people were most likely to report indirect sharing, while African-Americans were less likely to report it. Injection of either heroin or cocaine and participants mixing their own drugs were associated with less indirect sharing. Injecting at a friends, a dealers or in a car was associated with indirect sharing. In multivariate analyses, African-Americans were less likely than other groups to engage in indirect sharing at last injection. Event level variables associated with indirect sharing included injecting at a friends house, a dealers house, or a in a car. Event level variable that were associated with decreased likelihood of indirect sharing included injecting heroin by itself or injecting cocaine by itself and preparing the drug yourself. | ||||
| Discussion: Although direct sharing of syringes was uncommon in this sample, nearly half of all injection episodes in our sample put participants at risk of acquiring or transmitting HIV and hepatitis C. It was most likely to occur when people were injecting at a friends, dealers, or in a car. Injection of either heroin or cocaine was associated with decreased indirect sharing. A substantial proportion of IDUs continue to engage in injection practices that place them at risk of HIV and hepatitis C. Additional research is needed to understand why IDUs continue to engage in these behaviors despite prolonged education efforts and to develop interventions for reducing them. Funded by NIDA grant DA13763 | ||||
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