Peer-to-peer injection: Demographic, drug use, and injection-related risk factors

Abstract

Background: Peer-to-peer injection (either providing or receiving an injection to/from a person who injects drugs [PWID]) is common (19%-50%) among PWID. Most studies of peer-to-peer injection have focused on receiving injection assistance, with fewer examining providing injection assistance and none considering characteristics of PWID who do both. We examined characteristics of PWID by peer-to-peer injection categories (receiving, providing, both, and neither) and determined if these behaviors were associated with receptive and distributive syringe sharing.Methods: Los Angeles and San Francisco PWID (N = 777) were recruited using targeted sampling methods and interviewed during 2011-2013. Multinomial logistic regression was used to determine characteristics associated with peer-to-peer injection categories and logistic regression was used to examine if peer-to-peer categories were independently associated with distributive and receptive syringe sharing.Results: Recent peer-to-peer injection was reported by 42% of PWID (18% provider; 14% recipient; 10% both). In multinomial regression analysis, PWID reporting any peer-to-peer injection were more likely to inject with others than those who did neither. Injection providers and those who did both were associated with more frequent injection, illegal income source, and methamphetamine injection while injection recipients were associated with fewer years of injection. Injection providers were younger, had more years of injecting, and were more likely to inject heroin than PWID who did neither. In multivariate analyses, we found that providers and *

Factors Associated with Frequency of Recent Initiation of Others into Injection Drug Use Among People Who Inject Drugs in Los Angeles and San Francisco, CA, USA, 2016–17

“…In addition, we found that providing injection assistance was also associated with both low and high frequency initiation; only one study has reported this association previously (Bluthenthal et al, 2014). Peer-to-peer injection assistance is common in populations of PWID (Kral et al, 1999;Lamb et al, 2018) and is likely related to injection initiation due to the skill that PWID who provide injections to others possess (Simpson et al, 2018). A focus on working directly with PWID who provide injection assistance is warranted.…”

“…We were also interested in drug use factors that might be associated with injection initiation frequency. We collected information on peer-to-peer injection assistance which includes injecting another PWID (but not for their first inject) and receiving an injection from another PWID (Kral et al, 1999;Lamb et al, 2018). In addition, we collected information on frequency of injecting with other PWID and injecting in public spaces.…”

“…In samples of PWID, reports of ever assisting with injection initiation has been as low as 14% and as high as 38% (This behavior is different than peer-to-peer injection which involves an established PWID assisting an established PWID with an injection) (Kral et al, 1999;Lamb et al, 2018;Mittal et al, 2017;Uusküla et al, 2018). Recent injection initiation assistance (in the last 6 to 12 months) is typically much lower and ranges from 1% to 7% in published studies (Bluthenthal et al, 2014;Uusküla et al, 2018).…”

Peer-Assisted Injection as a Harm Reduction Measure in a Supervised Consumption Service: A Qualitative Study of Client Experiences

“…Formalized PAIPs are intended to bene t SCS clients through safe injection education and expert assistance, while protecting recipients from exploitive or unsafe relationships with would-be injection providers (16) and the risks associated with sharing equipment and drugs. Public health leaders and researchers have recommended peer assist be a standard part of supervised consumption services in Canada for years (5,6). Research continues to emerge to inform the implementation of PAIP on a large scale.…”

“…This prohibition effectively barred PWID who wished to access the SCS but were unable to self-inject. These individuals were left to inject in hurried, unsafe, and unclean conditions, leading public health leaders and researchers to call on government to allow peer assist within supervised consumption settings (5,6).…”