Decreased Odds of Injection Risk Behavior Associated With Direct Versus Indirect Use of Syringe Exchange: Evidence From Two California Cities

Addressing the problem of sterile drug injecting supply acquisition for people who inject drugs.

“…Syringes represent a common piece of equipment shared or reused; however, cookers, cotton filters, and tourniquets are also susceptible to misuse and may spread infectious disease (Kim, Jin, McFarland, & Raymond, 2015;Palmateer et al, 2014). Although many SEPs across the United States support sharing of sterile equipment through peers (secondary exchange), it is not a formally endorsed practice at any of Kentucky's SEPs (Behrends et al, 2017).…”

“…When not participating in a SEP, PWID engage in a number of ways to secure sterile injecting supplies. Strategies include purchasing syringes and other needed supplies from a pharmacy, receiving supplies from a peer who is involved in SEP (secondary or peer exchange), trading drugs for sterile supplies, obtaining sterile equipment from their drug dealer, diverting syringes from patients with medical needs (like a diabetic on insulin), and more (Behrends, Li, & Gibson, 2017). How PWID obtain their sterile supplies influences their degree of syringe reuse, as described in the following paragraphs.…”

“…This practice is known as secondary exchange or peer exchange. Secondary exchange is common across the United States and serves as an opportunity for SEP harm reduction principles to reach PWID who might not directly engage in SEP services (Behrends et al, 2017). Brothers (2016) suggests there are a number of reasons PWID may not visit SEP, including distance, operating hours, disability, fear of police, fear of being identified, and feelings such as shame, anxiety, and stigma.…”

“…Brothers (2016) suggests there are a number of reasons PWID may not visit SEP, including distance, operating hours, disability, fear of police, fear of being identified, and feelings such as shame, anxiety, and stigma. PWID attending SEP who provide sterile supplies to other PWID serve important role in sterile supply access solutions (Behrends et al, 2017;Brothers, 2016). The SEP participants providing secondary exchange are often friends, family members, or intimate partners of those receiving supplies as part of secondary exchange (Behrends et al, 2017).…”

“…PWID attending SEP who provide sterile supplies to other PWID serve important role in sterile supply access solutions (Behrends et al, 2017;Brothers, 2016). The SEP participants providing secondary exchange are often friends, family members, or intimate partners of those receiving supplies as part of secondary exchange (Behrends et al, 2017). Secondary exchange helps improve health equity because of its ability to reach PWID who might not otherwise have access to sterile drug injecting supplies and harm reduction education.…”