Reduction of Injection-Related Risk Behaviors After Emergency Implementation of a Syringe Services Program During an HIV Outbreak

Patel, Monita R.; Foote, C.E.; Duwve, Joan; Chapman, Erika; Combs, Brittany; Fry, Alexandra; Hall, Patti; Roseberry, Jeremy C.; Brooks, John T.; Broz, Dita

doi:10.1097/qai.0000000000001615

Cited by 37 publications

(35 citation statements)

References 23 publications

(28 reference statements)

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“…We also found that using syringes from a safe source was associated with lower injection risk and finding it difficult to access sterile syringes was associated with elevated injection risk. These findings underscore the importance of harm reduction programs in reducing injection risk by providing free access to sterile injection equipment, offering risk reduction counselling and providing referrals to health and social services [35–37]. Unfortunately, in February of 2013 the Global Fund for HIV, Tuberculosis and Malaria withdrew support for NEPs in Mexico due to their rising gross domestic product [38].…”

Section: Discussionmentioning

confidence: 99%

Sex differences in the multilevel determinants of injection risk behaviours among people who inject drugs in Tijuana, Mexico

Jain

Strathdee

West

et al. 2020

Drug and Alcohol Review

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Introduction and Aims. HIV and hepatitis C virus transmission among people who inject drugs (PWID) is fuelled by personal and environmental factors that vary by sex. We studied PWID in Mexico to identify sex differences in multilevel determinants of injection risk. Design and Methods. From 2011 to 2013, 734 PWID (female: 277, male: 457) were enrolled into an observational cohort study in Tijuana. Participants completed interviews on injection and sexual risks. Utilising baseline data, we conducted multiple generalised linear models stratified by sex to identify factors associated with injection risk scores (e.g. frequency of injection risk behaviours). Results. For both sexes, difficult access to sterile syringes was associated with elevated injection risk (b = 1.24, 95% confidence interval [CI] 1.16-1.33), using syringes from a safe source (e.g. needle exchange programs) was associated with lower injection risk (b = 0.87, 95% CI 0.82-0.94), and for every oneunit increase in safe injection self-efficacy we observed a 20% decrease in injection risk (b = 0.80, 95% CI 0.76-0.84). Females had a higher safe injection self-efficacy score compared to males (median 2.83, interquartile range 2.2-3 vs. median 2.83, interquartile range 2-3; P = 0.01). Among females, incarceration (b = 1.22, 95% CI 1.09-1.36) and police confiscation of syringes in the past 6 months (b = 1.16, 95% CI 1.01-1.33) were associated with elevated injection risk. Among males, sex work (b = 1.16, 95% CI 1.04-1.30) and polysubstance use in the past 6 months (b = 1.22, 95% CI 1.13-1.31) were associated with elevated injection risk. Discussion and Conclusions. Interventions to reduce HIV and hepatitis C virus transmission among PWID in Tijuana should be sex-specific and consider multilevel determinants of injection risk to create safer drug use environments. [Jain JP,

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Section: Discussionmentioning

confidence: 99%

Sex differences in the multilevel determinants of injection risk behaviours among people who inject drugs in Tijuana, Mexico

Jain

Strathdee

West

et al. 2020

Drug and Alcohol Review

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“…However, a state US law prohibiting non-medical use of needles (a felony punishable by up to 3 years in prison) was suspended during the 2015 HIV outbreak in Scott County, Indiana, which contributed to significantly decreased injection risk behaviours. 17,69 The restrictive needle and syringe programme policy in Scott County delayed the implementation of an effective HIV prevention strategy until after an outbreak had already occurred. Temporary suspension of the ban is an admission that policy makers recognised the effectiveness of needle and syringe programmes, but the unwillingness to fund these programmes as a prevention strategy reaffirms misconceptions and stigma.…”

Section: Policy Environment Interventionsmentioning

confidence: 99%

Elimination of HIV transmission through novel and established prevention strategies among people who inject drugs

2019

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Despite the effectiveness of existing HIV prevention strategies for people who inject drugs (PWID), uncontrolled outbreaks of HIV among this group are common and occur around the world. In this Review, we summarise recent evidence for novel and established HIV prevention approaches to eliminate HIV transmission among PWID. Effective HIV prevention strategies include mobile needle and syringe programmes, pre-exposure prophylaxis, supervised injection facilities, and, to a lesser extent, some behavioural interventions. Studies have also shown the costeffectiveness of long-standing HIV prevention strategies including needle and syringe programmes, opioid agonist therapy, and antiretroviral therapy for prevention. Although each individual intervention can reduce the risk of HIV acquisition among PWID, there is a consensus that a combination of approaches is required to achieve substantial and durable reductions in HIV transmission. Unfortunately, in many settings, the implementation of these interventions is often limited by public and political opposition that manifests as structural barriers to HIV prevention, such as the criminalisation of drug use. Given that there is ample evidence showing the effectiveness of several HIV prevention methods, social and political advocacy will be needed to overcome these barriers and integrate innovative HIV prevention approaches with addiction science to create effective drug policies.

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“…9 In a recent article, researchers from ISDH, Indiana University, the Scott County Health Department and CDC suggest that “proactive establishment of SSPs in nonurban communities with PWID might help to prevent future outbreaks of HIV”. 12 In response to claims that the outbreak would have been prevented had a SEP been implemented earlier, Jerome Adams, Indiana State Health Commissioner at the time, pointed to evidence that many cities with active SEP also have high HIV prevalence: “My colleagues and I will never know — though HIV infection remains rampant in many urban areas that have needle-exchange programs”. 13…”

Section: Introductionmentioning

confidence: 99%

Dynamics of the HIV outbreak and response in Scott County, IN, USA, 2011–15: a modelling study

Gonsalves

Crawford

2018

The Lancet HIV

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Reduction of Injection-Related Risk Behaviors After Emergency Implementation of a Syringe Services Program During an HIV Outbreak

Abstract: Analyses of an SSP program and in-depth qualitative interview data showed rapid reduction of injection-related HIV risk behaviors among PWID post-SSP implementation. Sterile syringe access as part of comprehensive HIV prevention is an important tool to control and prevent HIV outbreaks.

Cited by 37 publications

References 23 publications

Sex differences in the multilevel determinants of injection risk behaviours among people who inject drugs in Tijuana, Mexico

Sex differences in the multilevel determinants of injection risk behaviours among people who inject drugs in Tijuana, Mexico

Elimination of HIV transmission through novel and established prevention strategies among people who inject drugs

Dynamics of the HIV outbreak and response in Scott County, IN, USA, 2011–15: a modelling study

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