Evaluating Needle Exchange: A Description of Client Characteristics, Health Status, Program Utilization, and HIV Risk Behavior

Abstract

This study was designed to describe demographic and drug use characteristics, health status, and HIV-related risk behavior among clients attending the San Francisco needle exchange program (NEP), and to assess the relationship between NEP utilization and risk behavior. Randomly selected clients were interviewed when they visited the NEP. Participants were of diverse ethnicity, had a mean age of 38.2, and 72% were male. Many reported being homeless (25%), unemployed (34%), uninsured (52%), and having an episode of infectious disease in the past 2 years (36%). Clients who received a higher proportion of their needles from the exchange were less likely to report sharing of needles or rinse water. Clients who attended the exchange more frequently were more likely to clean their skin prior to injecting and less likely to use the same needle repeatedly. Frequency of visiting the NEP was not associated with the likelihood of sharing needles or rinse water. Efforts to evaluate needle exchange in the United States will benefit from descriptive reports from other NEP programs, and the use of nonexchange comparison groups.

Injection Risk Behavior among Women Syringe Exchangers in San Francisco

“…Despite regular and frequent SEP use, one-third (35%) reported sharing a used syringe for drug injection in the prior month. This was higher than the rate of needle sharing (21%) reported by a mixed gender sample of San Francisco exchangers in 1993 (Sears et al, 2001), although it resembled the rate (36%) reported by a mixed gender sample in 1992 (Guydish et al, 1998). In our study, female syringe sharers were more likely to be young, homeless, and have a sexual partner who was also an IDU.…”

“…Questions were based on variables used in prior studies of SEP participants in San Francisco (Guydish et al, 1998;Guydish et al, 1995) with additional variables of interest submitted by an all-female community advisory board. The survey was pre-tested with 5 female IDU using the study procedures described above.…”

Healthcare Barriers among Severely Mentally Ill Homeless Adults: Evidence from the Five-site Health and Risk Study

“…Rates of infectious diseases have also been found to be higher among individuals with chronic problems such as substance abuse or serious mental illness compared to the general population (Bourgois, Prince, & Moss, 2004;D'Amore, Hung, Chiang, & Goldfrank, 2001;Guydish, Bucardo, Clark, & Bernheim, 1998;Rosenberg et al, 2004;Rosenberg et al, 2001). Authors have cited prevalence estimates ranging from 23.9% testing positive for hepatitis B in a state psychiatric hospital sample (Pirl, Greer, Weissgarber, Liverant, & Safren, 2005); to 33.2% positive for hepatitis A or B in a sample with serious mental illness (Bender, 2006).…”

Politique de réduction des risques : programmes d’échange de seringues

“…Dans la plupart des études portant sur la clientèle des PES [5][6][7][8][9], les usagers de drogues ont entre 27 et 38 ans. Il s'agit dans environ trois quart des cas d'hommes, pour lesquels la durée moyenne de consommation de drogues illicites varie entre 7 et 11 ans.…”

“…Il est toutefois très difficile d'entrer en contact avec des souspopulations qui n'éprouvent pas les problèmes poussant leurs aînés à fréquenter les structures de prévention et qui, ne se considérant pas comme toxicomanes, ne se reconnaissent sans doute même pas dans les messages de réduction des risques. Les résul-tats de nombreuses études, obtenus en France [9] comme à l'étranger [5,8,7], confirment que les jeunes UDI ne fréquentent pas ou très peu les PES, pourtant destinés à constituer un service de première ligne facilement accessible. Des pratiques innovantes doivent donc être mises en place, en utilisant le travail des pairs ou peut-être des dispositifs non étiquetés «toxicomanie».…”