Social Network-Related Risk Factors for Bloodborne Virus Infections Among Injection Drug Users Receiving Syringes through Secondary Exchange

Abstract

Secondary syringe exchange (SSE) refers to the exchange of sterile syringes between injection drug users (IDUs). To date there has been limited examination of SSE in relation to the social networks of IDUs. This study aimed to identify characteristics of drug injecting networks associated with the receipt of syringes through SSE. Active IDUs were recruited from syringe exchange and methadone treatment programs in Montreal, Canada, between April 2004 and January 2005. Information on each participant and on their drug-injecting networks was elicited using a structured, interviewer-administered questionnaire. Subjects' network characteristics were examined in relation to SSE using regression models with generalized estimating equations. Of 218 participants, 126 were SSE recipients with 186 IDUs in their injecting networks. The 92 non-recipients reported 188 network IDUs. Networks of SSE recipients and non-recipients were similar with regard to network size and demographics of network members. In multivariate analyses adjusted for age and gender, SSE recipients were more likely than non-recipients to self-report being HIV-positive (OR=3.56 [1.54-8.23]); require or provide help with injecting (OR=3.74 [2.01-6.95]); have a social network member who is a sexual partner (OR=1.90 [1.11-3.24]), who currently attends a syringe exchange or methadone program (OR=2.33 [1.16-4.70]), injects daily (OR=1.77 [1.11-2.84]), and shares syringes with the subject (OR=2.24 [1.13-4.46]). SSE is associated with several injection-related risk factors that could be used to help focus public health interventions for risk reduction. Since SSE offers an opportunity for the dissemination of important prevention messages, SSE-based networks should be used to improve public health interventions. This approach can optimize the benefits of SSE while minimizing the potential risks associated with the practice of secondary exchange.

Decreased Odds of Injection Risk Behavior Associated With Direct Versus Indirect Use of Syringe Exchange: Evidence From Two California Cities

“…Secondary exchange occurs most frequently within established injecting networks comprised of close friends, sexual partners and family members (Brothers, 2016; Bryant and Hopwood, 2009; Craine et al, 2010; De et al, 2008; Fisher et al, 2013; Green et al, 2010; Huo et al, 2005; Lenton et al, 2006; Lorvick et al, 2006; Marshall et al, 2015; Murphy et al, 2004; Newland et al, 2016; Snead et al, 2003; Tyndall et al, 2002) but it may also involve PWID who acquire large numbers of syringes to sell or distribute outside their personal networks often at some distance from a fixed-site SEP (Lenton et al, 2006; Newland et al, 2016; Valente et al, 1998; Valente et al, 2001). In Baltimore, for example, it was estimated such high-volume “satellite” exchangers, representing less than 10% of SEP clients, accounted for nearly 65% of syringes distributed (Valente et al 1998).…”

The North American Opiate Medication Initiative (NAOMI): Profile of Participants in North America’s First Trial of Heroin-Assisted Treatment

“…Although the "street" availability of prescription analgesic opioids such as hydromorphone and morphine has increased in recent years, 7,8 intravenous use of heroin prevails in Vancouver and Montreal. 5,[9][10][11] Injectors are exposed to life-threatening health risks such as drug overdoses, bloodborne viral infections, endocarditis, and others. [12][13][14] Those who remain untreated or who are outside the social and health care system are known to experience higher rates of morbidity and mortality.…”

Change in injecting behaviour among people treated for hepatitis C virus: The role of intimate partnerships

“…The most common transmission route in Western countries remains injecting drug use, with an estimated 60%‐80% of the HCV‐positive population having acquired the virus via injecting risk behaviour . A variety of psychosocial factors have been associated with injecting risk behaviour: injecting frequency, poly‐drug use, having a sexual partner who also injects, trust and risk perception to name a few . Despite the continued injecting risks carried out by people who inject drugs, many studies have shown that fears of non‐adherence and low sustained virological response (SVR) rates are unjustified, with people who inject drugs (PWID) showing both successful adherence and high SVR rates …”