HIV Risk Behaviors Associated with the Injection Process: Multiperson Use of Drug Injection Equipment and Paraphernalia in Injection Drug User Networks

Needle, Richard; Coyle, Susan L.; Cesari, Helen; Trotter, Robert T.; Clatts, Michael C.; Koester, Stephen; Price, Laurie J.; McLellan, Elizabeth; Finlinson, Ann; Bluthenthal, Ricky N.; Pierce, Todd P.; Johnson, Jay; Jones, T. Stephen; Williams, Mark L.

doi:10.3109/10826089809059332

Cited by 108 publications

(42 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The potential link between drug sharing and blood-borne disease transmission has been described (Bourgois et al, 1997;Bourgois, 1999;Finlinson et al, 2000;Finlinson et al, 2005;Friedman et al, 1999;Grund et al, 1991;Grund et al, 1996;Inciardi and Page, 1991;Jose et al, 1993;Koester and Hoffer, 1994;Koester et al, 1996a;Koester 1998;Needle et al, 1998;Page et al, 1990;Page, 1999;Zule, 1992) and shown to occur more frequently than syringe sharing (Koester et al, 1996b;Friedman et al, 1997). Recently, a study by Colón and his colleagues found that jointly purchasing drugs was significantly associated with risky drug preparation behaviors among IDU in Puerto Rico and New York City (2001).…”

Section: Introductionmentioning

confidence: 91%

“…Indirect or syringe-mediated sharing practices that may facilitate human immunodeficiency virus (HIV), hepatitis B (HBV) and hepatitis C (HCV) transmission include the preparation and distribution of jointly purchased drugs for injection as well as the communal use of injection paraphernalia, such as drug mixing containers ("cookers" or "spoons"), cotton filters, and water for mixing the drug into solution and for rinsing syringes (Bourgois et al, 1997;Bourgois, 1999;Finlinson et al, 2000;Finlinson et al, 2005;Friedman et al 1999;Grund et al, 1991;Grund et al, 1996;Inciardi and Page, 1991;Jose et al, 1993;Koester et al, 1990;Koester and Hoffer, 1994;Koester et al, 1996b;Koester, 1998;Needle et al, 1998;Page, 1990;Page et al, 1990;Zule, 1992). While intervention programs have responded to these latter risks with prevention messages and intervention materials such as safer injection kits containing multiple vials of water, dental cottons, and metal caps for use as cookers, little has been done to address the transmission risks embedded within the process of preparing and apportioning shared drugs.…”

Section: Introductionmentioning

confidence: 98%

“…The drug is most frequently distributed by simply squirting the other participants' shares out of the syringe and back into the cooker. 5 Each participant then draws up his or her share (Finlinson et al, 2005;Koester and Hoffer, 1994;Koester, 1998;Needle et al, 1998). As will be shown, backloading is a less common method of distribution and frontloading is not possible with most insulin syringes that IDU in the United States use because the needles are not detachable.…”

Section: Introductionmentioning

confidence: 98%

See 2 more Smart Citations

Drug Sharing Among Heroin Networks: Implications for HIV and Hepatitis B and C Prevention

2005

Self Cite

View full text Add to dashboard Cite

Qualitative and quantitative findings from the baseline survey of a longitudinal, socially-focused blood-borne disease intervention study among 611 heroin IDU in Denver indicate that high risk injection practices-the sharing of contaminated drug solution in particular-often occur as a consequence of how heroin is obtained, the quantity obtained and the setting where it is injected. Contamination occurs if a contaminated syringe is used to liquefy and apportion the shared drug. In our cohort of 304 heroin injecting networks there was at least one member who, when asked to describe their last injection, reported dividing the drug as a liquid (82%), using a reservoir of water that syringes had been rinsed in to mix drugs (67%), using a common cooker (86%)-a proxy for drug sharing-and beating a shared cotton filter (58%). In contrast, only 22% reported syringe sharing. Variables associated with various injection practices included location of the last injection episode, quantity of drug injected, dope sickness, and years injecting. When compared to those who injected in a safe setting, those in an unsafe location had almost three times the odds (OR = 2.9; 95% CI: 1.9, 4.6) of being part of an injection episode where there was cooker sharing; and the smaller the quantity of heroin (< or =1/4 gram v. > 1/4 gram) present at the episode, the greater the odds that cooker sharing occurred (OR = 1.8; 95% CI: 1.2, 2.6). Use of a used, unbleached syringe to prepare shared drugs had twice the odds of occurring in "unsafe" v. safe settings (OR = 2.2; 95% CI: 1.3, 4.0) and in episodes in which a participant was dopesick (OR = 2.1; 95% CI: 1.2, 3.6). In summary, risky injection practices occur within an injection process that is, in part, a response to a structurally imposed risk environment. Lessening the blood-borne disease risks embedded within this process requires interventions designed to mitigate the environmental factors that influence it, including syringe accessibility, law enforcement strategies and the settings where IDU inject drugs.

show abstract

Section: Introductionmentioning

confidence: 91%

Section: Introductionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 98%

See 1 more Smart Citation

Drug Sharing Among Heroin Networks: Implications for HIV and Hepatitis B and C Prevention

2005

Self Cite

View full text Add to dashboard Cite

show abstract

“…The 1-month timeframe of risk behavior assessment was used for questions most likely to be affected by recall. Questions were developed using information from the recruitment sites and expert opinion and were also modeled on several sources such as previously validated questionnaires about injection drug use and determinants of HCV risk among IDUs (Cox et al, 2002;Koester, Booth, and Zhang, 1996;Needle et al, 1998). The initial questionnaire was pilot tested with 86 subjects in the target population prior to the start of the study and adjusted according to participant feedback.…”

Section: Data Collectionmentioning

confidence: 99%

Access to Sterile Injecting Equipment is More Important Than Awareness of HCV Status for Injection Risk Behaviors Among Drug Users

Cox

Morissette

et al. 2009

Substance Use & Misuse

View full text Add to dashboard Cite

Awareness of hepatitis C virus (HCV) infection status is expected to influence risk behaviors. In 2004-2005, injection drug users (IDUs) recruited from syringe exchange programs (SEPs) and methadone clinics in Montreal, Canada, were interviewed on drug use behaviors (past 6 months) and HCV testing. Subjects (n = 230) were classified as low/intermediate risk (20.4% borrowed drug preparation equipment only) and high risk (19.6% borrowed syringes), and 54.5% reported being HCV positive. Logistic regression modeling showed that compared to no risk (60% borrowed nothing), low/intermediate risk was associated with fewer noninjecting social network members, poor physical health, and problems obtaining sterile injecting equipment. High risk was associated with all of these factors except social networks. HCV status was not associated with any level of risk. Improved access to sterile injecting equipment may be more important than knowledge of HCV status in reducing injection risks among this IDU population. The study limitations are noted and recommendations discussed.

show abstract

“…Joint preparation often includes the additional DPP of using a single syringe to measure the amount of water to be used in dissolving the drug and to divide and distribute the drug solution. Joint preparation has been found to be particularly common among IDUs preparing 'speedballs' (i.e., cocaine and heroin solutions) and has been linked to the practice of pooling money to procure drugs among two or more IDUs (Colon et al, 2001a;Grund et al, 1991;Koester and Hoffer, 1994;Needle et al, 1998).…”

Section: Introductionmentioning

confidence: 97%

Elicitation of Salient Beliefs Related to Drug Preparation Practices Among Injection Drug Users in Puerto Rico

et al. 2005

View full text Add to dashboard Cite

Even when IDUs use their own syringes, the common use of drug preparation materials can expose them to blood-borne pathogens. Notwithstanding the accumulated evidence about the riskiness of drug preparation practices (DPPs), the factors that lead IDUs to engage in DPPs have remained understudied. We conducted 80 semi-structured interviews to elicit salient beliefs about engaging in low-risk DPPs. Data were content analyzed for consequences, normative influences, and barriers. For the most part respondents described positive consequences of engaging in low-risk DPPs. The majority of respondents mentioned IDU peers as a major source of pressure to engage in high-risk DPPs. Lack of access to clean materials and the need to carry materials on oneself were the most salient barriers elicited. The results suggest that preventive interventions need to address the preference for re-using filters, help develop skills to fend off pressures from peers, and increase the accessibility of materials in ways that do not require IDUs to carry additional items.

show abstract

HIV Risk Behaviors Associated with the Injection Process: Multiperson Use of Drug Injection Equipment and Paraphernalia in Injection Drug User Networks

Cited by 108 publications

References 25 publications

Drug Sharing Among Heroin Networks: Implications for HIV and Hepatitis B and C Prevention

Drug Sharing Among Heroin Networks: Implications for HIV and Hepatitis B and C Prevention

Access to Sterile Injecting Equipment is More Important Than Awareness of HCV Status for Injection Risk Behaviors Among Drug Users

Elicitation of Salient Beliefs Related to Drug Preparation Practices Among Injection Drug Users in Puerto Rico

Contact Info

Product

Resources

About