Beyond Needle Sharing: Meta-Analyses of Social Context Risk Behaviors of Injection Drug Users Attending Needle Exchange Programs

Abstract

This study gathered data from U.S. and international needle exchange programs (NEPs). Of particular interest were outcome measures of dependent variables related to behaviors within social contexts of injection drug users (IDUs), an area not well understood. Thirty-one studies, with a total of 86 separate measures of 36 dependent variables were included. Because combining all results into a single meta-analysis would be inappropriate, dependent variables were placed into five categories for five separate meta-analyses: risky contexts, injection frequency, sharing drug paraphernalia, drug preparation, and syringe use. NEP attendance was inversely related to declines in all categorical behaviors except for "risky context." NEP attenders are slightly more likely to be in a risky circumstance when injecting drugs than non-attenders. While injection frequency declined only slightly among NEP attenders, that result may be interpreted as a positive outcome, given the often-stated criticism that providing clean needles encourages increased drug use. NEP use was weakly associated with a decrease in the sharing of drug paraphernalia. Clean needles alone do not appear to be sufficient motivation to motivate major changes in contextual risk behaviors analyzed herein. Research is needed to assess the impact of interpersonal IDU relationships with other stakeholders (clinic employees, van drivers, medical personnel, nutritionists, sexual partners, etc.) on IDU drug-using behaviors at many levels.

Promoting HIV Testing and Condom Use Among Filipina Commercial Sex Workers: Findings from a Quasi-Experimental Intervention Study

“…Lastly, we observe that the results of this investigation are consistent with studies in the US and other countries focused on social networking and peer groups (Emerson et al 2005;Ksobiech 2006;Von Lengerke et al 2004). It is clear that those associated with a particular FCSW, whether manager or peer, significantly influence the behavior of the FCSW.…”

Racial/ethnic disparities in HIV infection among people who inject drugs: an international systematic review and meta‐analysis

“…Racial/ethnic group disparities in HIV infection among people who inject drugs (PWID) are particularly important, for several reasons: HIV, injecting drug use and racial/ethnic minority group membership are all stigmatized in many different cultures . Stigmatization may lead to higher stress among PWID, followed by anxiety and depression , followed by higher rates of risk behavior . The stigmatization of drug use may lead community leaders of both majority and minority communities to fail to acknowledge drug use in minority communities and thus not provide appropriate services . Mistrust between racial/ethnic minority and majority communities may generate conflict that impedes implementation of HIV prevention programs for PWID, particularly for controversial issues such as needle exchange programs . The higher rates of HIV infection among racial/ethnic minority PWID are generally not explained by high rates of risk behaviors. Minority PWID tend to report equal or lower rates of injecting risk behavior compared to racial/ethnic majority PWID .…”

Gender Differences in Social Network Influence among Injection Drug Users: Perceived Norms and Needle Sharing

“…As the context often varies, factors influencing risky behaviors may vary by gender. 31,32 Whereas research on gender differences in descriptive and injunctive norms among IDUs is scarce, several studies examining the role of perceived norms in sexual behavior has indicated that normative influence varies by gender. Buunk et al reported that descriptive norms predicted intention to use condoms for male and female heterosexual adults.…”