TY - JOUR
T1 - Prevalence and correlates of receptive syringe-sharing among people who inject drugs in rural Appalachia
AU - White, Rebecca Hamilton
AU - O'Rourke, Allison
AU - Kilkenny, Michael E.
AU - Schneider, Kristin E.
AU - Weir, Brian W.
AU - Grieb, Suzanne M.
AU - Sherman, Susan G.
AU - Allen, Sean T.
N1 - Funding Information:
S.G.S. is an expert witness for plaintiffs in opioid litigation. The other authors have no conflicts of interest to declare. This research was supported by a grant from the Bloomberg American Health Initiative at the Johns Hopkins Bloomberg School of Public Health to S.T.A. S.T.A. is also supported by the National Institutes of Health (K01DA046234). This research was supported in part by the National Institute on Drug Abuse (T32DA007292, K.E.S. supported).
Funding Information:
This research was facilitated by the infrastructure and resources provided by the Johns Hopkins University Center for AIDS Research (P30AI094189) and the District of Columbia Center for AIDS Research (AI117970). The funders had no role in study design, data collection or in analysis and interpretation of the results, and this paper does not necessarily reflect the views or opinions of the funders. We are grateful to the collaboration of the Cabell-Huntington Health Department, without whom this project would not have been possible. We are especially grateful to Tim Hazelett, Thommy Hill, Tyler Deering, Kathleen Napier, Jeff Keatley, Michelle Perdue, Chad Heilig and Charles ?CK? Babcock for all their support throughout the study implementation. We are also grateful for the hard work of the West Virginia COUNTS! research team: Megan Keith, Anne Maynard, Aspen McCorkle, Terrance Purnell, Ronaldo Ramirez, Kayla Rodriguez, Lauren Shappell, Kristin Schneider, Brad Silberzahn, Dominic Thomas, Kevin Williams and Hayat Yusuf. We gratefully acknowledge the West Virginia Department of Health and Human Resources. We also wish to acknowledge Josh Sharfstein, Michelle Spencer, Dori Henry and Akola Francis for their support throughout each phase of this research. Most importantly, we are grateful to our study participants. Data from this study are not available due to privacy concerns.
Publisher Copyright:
© 2020 Society for the Study of Addiction
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/2
Y1 - 2021/2
N2 - Background and Aims: Syringe-sharing significantly increases the risk of HIV and viral hepatitis acquisition among people who inject drugs (PWID). Clearer understanding of the correlates of receptive syringe-sharing (RSS) is a critical step in preventing bloodborne infectious disease transmission among PWID in rural communities throughout the United States. This study aimed to measure the prevalence and correlates of RSS among PWID in a rural county in Appalachia. Design: Observational, cross-sectional sample from a capture–recapture parent study. Setting: Cabell County, West Virginia (WV), USA, June–July 2018. Participants: The sample was restricted to people who reported injecting drugs in the past 6 months (n = 420). A total of 180 participants (43%) reported recent (past 6 months) RSS. Participants reported high levels of homelessness (56.0%), food insecurity (64.8%) and unemployment (66.0%). Measurements: The main outcome was recent re-use of syringes that participants knew someone else had used before them. Key explanatory variables of interest, selected from the risk environment framework, included: unemployment, arrest and receipt of sterile syringes from a syringe services program (SSP). Logistic regression was used to determine correlates of recent RSS. Findings: PWID reporting recent RSS also reported higher prevalence of homelessness, food insecurity and unemployment than their non-RSS-engaging counterparts. In adjusted analyses, correlates of RSS included: engagement in transactional sex work [adjusted odds ratio (aOR) = 2.27, 95% confidence interval (CI) = 1.26–4.09], unemployment (aOR = 1.67, 95% CI = 1.03–1.72), number of drug types injected (aOR = 1.33, 95% CI = 1.15–1.53) and injection in a public location (aOR = 2.59, 95% CI = 1.64–4.08). Having accessed sterile syringes at an SSP was protective against RSS (aOR = 0.57, 95% CI = 0.35–0.92). Conclusion: The prevalence of receptive syringe-sharing among people who inject drugs in a rural US county appears to be high and comparable to urban-based populations. Receptive syringe-sharing among people who inject drugs in a rural setting appears to be associated with several structural and substance use factors, including unemployment and engaging in public injection drug use. Having recently acquired sterile syringes at a syringe services program appears to be protective against receptive syringe sharing.
AB - Background and Aims: Syringe-sharing significantly increases the risk of HIV and viral hepatitis acquisition among people who inject drugs (PWID). Clearer understanding of the correlates of receptive syringe-sharing (RSS) is a critical step in preventing bloodborne infectious disease transmission among PWID in rural communities throughout the United States. This study aimed to measure the prevalence and correlates of RSS among PWID in a rural county in Appalachia. Design: Observational, cross-sectional sample from a capture–recapture parent study. Setting: Cabell County, West Virginia (WV), USA, June–July 2018. Participants: The sample was restricted to people who reported injecting drugs in the past 6 months (n = 420). A total of 180 participants (43%) reported recent (past 6 months) RSS. Participants reported high levels of homelessness (56.0%), food insecurity (64.8%) and unemployment (66.0%). Measurements: The main outcome was recent re-use of syringes that participants knew someone else had used before them. Key explanatory variables of interest, selected from the risk environment framework, included: unemployment, arrest and receipt of sterile syringes from a syringe services program (SSP). Logistic regression was used to determine correlates of recent RSS. Findings: PWID reporting recent RSS also reported higher prevalence of homelessness, food insecurity and unemployment than their non-RSS-engaging counterparts. In adjusted analyses, correlates of RSS included: engagement in transactional sex work [adjusted odds ratio (aOR) = 2.27, 95% confidence interval (CI) = 1.26–4.09], unemployment (aOR = 1.67, 95% CI = 1.03–1.72), number of drug types injected (aOR = 1.33, 95% CI = 1.15–1.53) and injection in a public location (aOR = 2.59, 95% CI = 1.64–4.08). Having accessed sterile syringes at an SSP was protective against RSS (aOR = 0.57, 95% CI = 0.35–0.92). Conclusion: The prevalence of receptive syringe-sharing among people who inject drugs in a rural US county appears to be high and comparable to urban-based populations. Receptive syringe-sharing among people who inject drugs in a rural setting appears to be associated with several structural and substance use factors, including unemployment and engaging in public injection drug use. Having recently acquired sterile syringes at a syringe services program appears to be protective against receptive syringe sharing.
KW - HIV
KW - Hepatitis C
KW - people who inject drugs
KW - polysubstance use
KW - receptive syringe sharing
KW - rural health
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U2 - 10.1111/add.15151
DO - 10.1111/add.15151
M3 - Article
C2 - 32533612
AN - SCOPUS:85087833584
VL - 116
SP - 328
EP - 336
JO - Addiction
JF - Addiction
SN - 0965-2140
IS - 2
ER -