Greater Drug Injecting Risk for HIV, HBV, and HCV Infection in a City Where Syringe Exchange and Pharmacy Syringe Distribution are Illegal

Abstract

Comparing drug-injecting risk between cities that differ in the legality of sterile syringe distribution for injection drug use provides a natural experiment to assess the efficacy of legalizing sterile syringe distribution as a structural intervention to prevent human immunodeficiency virus (HIV) and other parenterally transmitted infections among injection drug users (IDUs). This study compares the parenteral risk for HIV and hepatitis B (HBV) and C (HCV) infection among IDUs in Newark, NJ, USA, where syringe distribution programs were illegal during the period when data were collected, and New York City (NYC) where they were legal. IDUs were nontreatment recruited, 2004-2006, serotested, and interviewed about syringe sources and injecting risk behaviors (prior 30 days). In multivariate logistic regression, adjusted odds ratios (AOR) and 95% confidence intervals (95% CI) for city differences are estimated controlling for potential city confounders. IDUs in Newark (n=214) vs. NYC (n=312) were more likely to test seropositive for HIV (26% vs. 5%; AOR=3.2; 95% CI=1.6, 6.1), antibody to the HBV core antigen (70% vs. 27%; AOR=4.4; 95% CI=2.8, 6.9), and antibody to HCV (82% vs. 53%; AOR=3.0; 95% CI=1.8, 4.9), were less likely to obtain syringes from syringe exchange programs or pharmacies (AOR=0.004; 95% CI=0.001, 0.01), and were more likely to obtain syringes from street sellers (AOR=74.0; 95% CI=29.9, 183.2), to inject with another IDU's used syringe (AOR=2.3; 95% CI=1.1, 5.0), to reuse syringes (AOR=2.99; 95% CI=1.63, 5.50), and to not always inject once only with a new, sterile syringe that had been sealed in a wrapper (AOR=5.4; 95% CI=2.9, 10.3). In localities where sterile syringe distribution is illegal, IDUs are more likely to obtain syringes from unsafe sources and to engage in injecting risk behaviors. Legalizing and rapidly implementing sterile syringe distribution programs are critical for reducing parenterally transmitted HIV, HBV, and HCV among IDUs.

HIV Heterosexual Sexual Risk From Injecting Drug Users Among HIV-Seronegative Noninjecting Heroin Users

“…Moreover, NIUs who use heroin may be more likely to have sexual partnerships with IDUs because the main drug of choice among many IDUs is also heroin. In NYC, for example, 90% of IDUs in one study reported that they injected heroin (Neaigus et al, 2008). Drug users who use the same drug of choice may be more likely to develop social and sexual relationships with each other.…”

Hepatitis C virus infection in the Middle East and North Africa “MENA” region: injecting drug users (IDUs) is an under-investigated population

“…The information generated through these bio-behavioral studies would be of great importance in estimating the future burden of HCV in the MENA region, in addition to its impact on the introduction of intervention programs, such as needle/syringe exchange programs. Needle/syringe exchange programs have been shown to reduce the risk of transmission of HIV, HCV, and hepatitis B virus (HBV), and are now being implemented in many parts of the world, including developing countries, such as China and India [149][150][151]. The introduction of such programs in the MENA region presents a formidable challenge due to religious and social factors.…”

Low dead-space syringes for preventing HIV among people who inject drugs

“…Although ecological data are subject to the ecological fallacy [37], the biobehavioral surveys that have linked a history sharing HDSS to testing positive for HIV antibodies provide preliminary evidence of a link at the individual level. Comparisons of HIV prevalence among PWID in cities where all PWID use LDSS exclusively and in cities where substantial numbers of PWID use HDSS can serve as natural experiments, if sufficient data are available to rule out alternative explanations [38].…”