Multiperson use of syringes among injection drug users in a needle exchange program: A gene-based molecular epidemiologic analysis

Sadeep Shrestha, Michael W. Smith, Karl W. Broman, Homayoon Farzadegan, David Vlahov, Steffanie A. Strathdee

Research output: Contribution to journalArticlepeer-review

Abstract

Syringe-sharing behaviors among injection drug users (IDUs) are typically based on self-reports and subject to socially desirable responding. We used 3 short tandem repeat (STR) genetic biomarkers to detect sharing in 2512 syringes exchanged by 315 IDUs in the Baltimore needle exchange program (NEP; 738 person-visits). Demographic characteristics as well as direct and indirect needle-sharing behaviors corresponding to the closest AIDS Link to Intravenous Experience (ALIVE) study visits were examined for association with multiperson use (MPU) of syringes. Overall, 56% of the syringes exchanged at the Baltimore NEP had evidence of MPU. Less MPU of syringes (48% vs. 71%; P < 0.0001) was seen with more rapid syringe turnaround (<3 days). IDUs always exchanging their own syringes ("primary" syringes) were less likely to return syringes with evidence of MPU (52%) than those who exchanged syringes for others ("secondary" syringes; 64%; P = 0.0001) and those exchanging primary and secondary syringes (58%; P = 0.004). In a multivariate analysis restricted to primary exchangers, MPU of syringes was associated with sharing cotton (adjusted odds ratio [AOR] = 2.06, 95% confidence interval [CI]: 1.30 to 3.28), lending syringes (AOR = 1.70, 95% CI: 1.24 to 2.34), and injecting less than daily (AOR = 0.64, 95% CI: 0.43 to 0.95). These findings support additional public health interventions such as expanded syringe access to prevent HIV and other blood-borne infections. Testing of STRs represents a promising approach to examining and accessing complex behavioral data, including syringe sharing.

Original languageEnglish (US)
Pages (from-to)335-343
Number of pages9
JournalJournal of acquired immune deficiency syndromes
Volume43
Issue number3
DOIs
StatePublished - Nov 2006

Keywords

  • Genetic biomarkers
  • Needle circulation theory
  • Needle exchange program
  • Syringe sharing
  • Syringe-sharing risk factors

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

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