Distributive Syringe Sharing and Use of Syringe Services Programs (SSPs) Among Persons Who Inject Drugs

  • Monica AdamsEmail author
  • Qian An
  • Dita Broz
  • Janet Burnett
  • Cyprian Wejnert
  • Gabriela Paz-Bailey
  • For the NHBS Study Group
Original Paper


Monitoring distributive syringe sharing (DSS) and syringe services program (SSP) use among persons who inject drugs (PWID) is important for HIV prevention. PWID aged ≥ 18 in 20 US cities were recruited for National HIV Behavioral Surveillance in 2015 using respondent-driven sampling, interviewed and offered HIV testing. Bivariate and multivariable analyses via log-linked Poisson regression with generalized estimating equations were conducted to examine associations between demographic and behavioral variables and DSS. Effect of SSP use on DSS by HIV sero-status was assessed by including an interaction between SSP and sero-status. Analyses were adjusted for sampling design. Among 10,402 PWID, 42% reported DSS. DSS was less likely to be reported among HIV-positive compared to HIV-negative PWID (aPR = 0.51, CI 0.45–0.60), and among those who primarily obtained syringes from SSPs versus those who did not (aPR = 0.82, 95% CI 0.77–0.88). After adjustment, those who primarily used SSPs were less likely to report DSS than those who did not among both HIV-negative PWID (aPR = 0.84, 95% CI 0.78–0.90) and HIV-positive PWID (aPR = 0.54, 95% CI 0.39–0.75). Findings support expansion of SSPs, and referrals to SSPs by providers working with PWID.


Syringe services programs Distributive syringe sharing Injection drug 



The Funding was provided by Centers for Disease Control and Prevention.


  1. 1.
    Palmateer N, Kimber J, Hickman M, Hutchinson S, Rhodes T, Goldberg D. Evidence for the effectiveness of sterile injecting equipment provision in preventing hepatitis C and human immunodeficiency virus transmission among injecting drug users: a review of reviews. Addiction (Abingdon, England). 2010;105(5):844–59.CrossRefGoogle Scholar
  2. 2.
    Centers for Disease Control and Prevention. Diagnoses of HIV infection in the United States and dependent areas, 2016. 2017.Google Scholar
  3. 3.
    Centers for Disease Control and Prevention. Viral hepatitis surveillance—United States, 2016. Atlanta: US Department of Health and Human Services, Centers for Disease Control and Prevention; 2018.Google Scholar
  4. 4.
    Suryaprasad AG, White JZ, Xu F, Eichler BA, Hamilton J, Patel A, et al. Emerging epidemic of hepatitis C virus infections among young nonurban persons who inject drugs in the United States, 2006–2012. Clin Infect Dis. 2014;59(10):1411–9.CrossRefGoogle Scholar
  5. 5.
    Golub ET, Strathdee SA, Bailey SL, Hagan H, Latka MH, Hudson SM, et al. Distributive syringe sharing among young adult injection drug users in five U.S. cities. Drug Alcohol Depend. 2007;91(Suppl 1):S30–8.CrossRefGoogle Scholar
  6. 6.
    Metsch LR, Pereyra M, Purcell DW, Latkin CA, Malow R, Gomez CA, et al. Correlates of lending needles/syringes among HIV-seropositive injection drug users. J Acquir Immune Defic Syndr. 1999;2007(46 Suppl 2):S72–9.Google Scholar
  7. 7.
    Kapadia F, Latka MH, Hagan H, Golub ET, Campbell JV, Coady MH, et al. Design and feasibility of a randomized behavioral intervention to reduce distributive injection risk and improve health-care access among hepatitis C virus positive injection drug users: the study to reduce intravenous exposures (STRIVE). J Urban Health. 2007;84(1):99–115.CrossRefGoogle Scholar
  8. 8.
    Institute of Medicine. Preventing HIV infection among injecting drug users in high-risk countries: an assessment of the evidence: Institute of Medicine (U.S.). 2007.Google Scholar
  9. 9.
    Holtzman D, Barry V, Ouellet LJ, Des Jarlais DC, Vlahov D, Golub ET, et al. The influence of needle exchange programs on injection risk behaviors and infection with hepatitis C virus among young injection drug users in select cities in the United States, 1994–2004. Prev Med. 2009;49(1):68–73.CrossRefGoogle Scholar
  10. 10.
    Kim NJ, Jin H, McFarland W, Raymond HF. Trends in sources and sharing of needles among people who inject drugs, San Francisco, 2005–2012. Int J Drug Policy. 2015;26(12):1238–43.CrossRefGoogle Scholar
  11. 11.
    Ksobiech K. A meta-analysis of needle sharing, lending, and borrowing behaviors of needle exchange program attenders. AIDS Educ Prev. 2003;15(3):257–68.CrossRefGoogle Scholar
  12. 12.
    Aspinall EJ, Nambiar D, Goldberg DJ, Hickman M, Weir A, Van Velzen E, et al. Are needle and syringe programmes associated with a reduction in HIV transmission among people who inject drugs: a systematic review and meta-analysis. Int J Epidemiol. 2014;43(1):235–48.CrossRefGoogle Scholar
  13. 13.
    Wodack A, Cooney A. Effectiveness of sterile needle and syringe programmes. Int J Drug Policy. 2005;16S:S31–44.CrossRefGoogle Scholar
  14. 14.
    WHO. Effectiveness of sterile needle and syringe programming in reducing HIV/AIDS among injecting drug users. 2004.Google Scholar
  15. 15.
    Des Jarlais DC, Perlis T, Arasteh K, Torian LV, Hagan H, Beatrice S, et al. Reductions in hepatitis C virus and HIV infections among injecting drug users in New York City, 1990–2001. AIDS (London, England). 2005;19(Suppl 3):S20–5.CrossRefGoogle Scholar
  16. 16.
    Huo D, Ouellet LJ. Needle exchange and injection-related risk behaviors in Chicago: A longitudinal study. J Acquir Immune Defic Syndr Hum Retrovirol. 2007;45(1):108–14.CrossRefGoogle Scholar
  17. 17.
    Quinn B, Chu D, Wenger L, Bluthenthal RN, Kral AH. Syringe disposal among people who inject drugs in Los Angeles: the role of sterile syringe source. Int J Drug Policy. 2014;25(5):905–10.CrossRefGoogle Scholar
  18. 18.
    Wenger LD, Martinez AN, Carpenter L, Geckeler D, Colfax G, Kral AH. Syringe disposal among injection drug users in San Francisco. Am J Public Health. 2011;101(3):484–6.CrossRefGoogle Scholar
  19. 19.
    Coffin P. Syringe availability as HIV prevention: a review of modalities. J Urban Health. 2000;77(3):306–30.CrossRefGoogle Scholar
  20. 20.
    Coffin PO, Latka MH, Latkin C, Wu Y, Purcell DW, Metsch L, et al. Safe syringe disposal is related to safe syringe access among HIV-positive injection drug users. AIDS Behav. 2007;11(5):652–62.CrossRefGoogle Scholar
  21. 21.
    Lansky A, Abdul-Quader AS, Cribbin M, Hall T, Finlayson TJ, Garfein RS, et al. Developing an HIV behavioral surveillance system for injecting drug users: the national HIV behavioral surveillance system. Public Health Rep (Washington, DC: 1974). 2007;122(Suppl 1):48–55.CrossRefGoogle Scholar
  22. 22.
    Centers for Disease Control and Prevention. HIV Surveillance Report, 2015. 2015.Google Scholar
  23. 23.
    Heckathorn DD. Respondent-driven sampling II: deriving valid population estimates from chain-referral samples of hidden populations. Soc Probl. 2002;49(1):11–34.CrossRefGoogle Scholar
  24. 24.
    Centers for Disease Control and Prevention. Guidelines for Defining Public Health Research and Public Health Non-Research. Revised October 4, 1999. 1999.Google Scholar
  25. 25.
    Department of Health and Human Services. Protection of Human Subjects, CFR 45, Part 46. Revised January 2009. 2009.Google Scholar
  26. 26.
    Department of Health and Human Services. Annual Update of the HHS Poverty Guidelines. Report No.: Fed. Reg. 3236. 2015.Google Scholar
  27. 27.
    Kral AH, Lorvick J, Ciccarone D, Wenger L, Gee L, Martinez A, et al. HIV prevalence and risk behaviors among men who have sex with men and inject drugs in San Francisco. J Urban Health. 2005;82(1 Suppl 1):i43–50.CrossRefGoogle Scholar
  28. 28.
    Broz D, Pham H, Spiller M, Wejnert C, Le B, Neaigus A, et al. Prevalence of HIV infection and risk behaviors among younger and older injecting drug users in the United States, 2009. AIDS Behav. 2014;18(Suppl 3):284–96.CrossRefGoogle Scholar
  29. 29.
    Deren S, Beardsley M, Coyle S, Singer M, Kang S-Y. HIV risk behaviors among injection drug users in low, medium, and high seroprevalence communities. AIDS Behav. 2001;5(1):45–50.CrossRefGoogle Scholar
  30. 30.
    Milloy MJS, Buxton J, Wood E, Li K, Montaner JSG, Kerr T. Elevated HIV risk behaviour among recently incarcerated injection drug users in a Canadian setting: a longitudinal analysis. BMC Public Health. 2009;9:156.CrossRefGoogle Scholar
  31. 31.
    Milloy MJ, Kerr T, Salters K, Samji H, Guillemi S, Montaner J, et al. Incarceration is associated with used syringe lending among active injection drug users with detectable plasma HIV-1 RNA: a longitudinal analysis. BMC Infect Dis. 2013;13:565.CrossRefGoogle Scholar
  32. 32.
    Boodram B, Mackesy-Amiti ME, Latkin C. The role of social networks and geography on risky injection behaviors of young persons who inject drugs. Drug Alcohol Depend. 2015;154:229–35.CrossRefGoogle Scholar
  33. 33.
    Unger JB, Kipke MD, De Rosa CJ, Hyde J, Ritt-Olson A, Montgomery S. Needle-sharing among young IV drug users and their social network members: The influence of the injection partner’s characteristics on HIV risk behavior. Addict Behav. 2006;31(9):1607–18.CrossRefGoogle Scholar
  34. 34.
    Riehman KS, Kral AH, Anderson R, Flynn N, Bluthenthal RN. Sexual relationships, secondary syringe exchange, and gender differences in HIV risk among drug injectors. J Urban Health. 2004;81(2):249–59.CrossRefGoogle Scholar
  35. 35.
    Latkin CA, Vlahov D, Anthony JC. Socially desirable responding and self-reported HIV infection risk behaviors among intravenous drug users. Addiction (Abingdon, England). 1993;88(4):517–26.CrossRefGoogle Scholar
  36. 36.
    Sherman S, Rusch M, Golub ET. Correlates of safe syringe acquisition and disposal practices among young IDUs: broadening our notion of risk. J Drug Issues. 2004;34(4):895–912.CrossRefGoogle Scholar
  37. 37.
    Zibbell JE, Iqbal K, Patel RC, Suryaprasad A, Sanders KJ, Moore-Moravian L, et al. Increases in hepatitis C virus infection related to injection drug use among persons aged ≤30 years—Kentucky, Tennessee, Virginia, and West Virginia, 2006–2012. MMWR Morb Mortal Wkly Rep. 2015;64(17):453–8.Google Scholar
  38. 38.
    Zibbell JE, Asher AK, Patel RC, Kupronis B, Iqbal K, Ward JW, et al. Increases in acute hepatitis C virus infection related to a growing opioid epidemic and associated injection drug use, United States, 2004 to 2014. Am J Public Health. 2018;108(2):175–81.CrossRefGoogle Scholar
  39. 39.
    Peters PJ, Pontones P, Hoover KW, Patel MR, Galang RR, Shields J, et al. HIV infection linked to injection use of oxymorphone in Indiana, 2014-2015. N Engl J Med. 2016;375(3):229–39.CrossRefGoogle Scholar
  40. 40.
    Novelli LA, Sherman SG, Havens JR, Strathdee SA, Sapun M. Circumstances surrounding the first injection experience and their association with future syringe sharing behaviors in young urban injection drug users. Drug Alcohol Depend. 2005;77(3):303–9.CrossRefGoogle Scholar
  41. 41.
    Des Jarlais DC, McKnight C, Goldblatt C, Purchase D. Doing harm reduction better: syringe exchange in the United States. Addiction (Abingdon, England). 2009;104(9):1441–6.CrossRefGoogle Scholar

Copyright information

© This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2019

Authors and Affiliations

  1. 1.Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB PreventionCenters for Disease Control and PreventionAtlantaUSA

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