Accessing Medical Care After a Needlestick Injury: First Responders’ Perception of HIV Risk and Attitudes Toward Syringe Service Programs

  • Gregory CarterEmail author
  • Carrie Lawrence
  • Brennan Woodward
  • Anita Ohmit
Original Paper


First responders have an increased risk of occupational exposure to HIV as the result of a needlestick injury (NSI) because of the chaotic prehospital environment in which they provide care. Approximately 2.3 of every 1000 first responders (0.23%) who are exposed to HIV via a NSI risk seroconversion if left untreated. Participants completed a 28-question online survey examining level of concern about HIV, thoughts about injection drug use, number of accidental NSIs, and medical services received after a needlestick. First, all data were analyzed descriptively. Second, a multiple linear regression model was used to explore the level of concern about HIV as a function of the predictor variables. Nearly half of the respondents worked as paramedics (n = 141, 23.5%) or emergency medical technicians (n = 154, 25.7%), followed by 15.5% (n = 93) and 11.3% (n = 62) who indicated their primary first responder affiliation as “firefighter” or “police,” respectively. The majority of the study population identified as male (75%, n = 450); 24.8% identified as female (n = 149). Slightly more first responders reported receiving no medical services after a needlestick (9.8%, n = 59) than received an HIV screening (9.5%, n = 57), and only 3.2% (n = 19) of those who experienced a needlestick reported receiving post-exposure prophylaxis. The results suggest that perceived risk of HIV infection via needlestick ultimately influences follow-up medical screening. Greater concern about HIV is significantly associated with HIV screening and willingness to obtain post-exposure prophylaxis. Future research should examine the impact of continued HIV education and policies outlining medical evaluation and other post-exposures procedures.


HIV First responders Needlestick injury Syringe exchange 



The authors would like to thank Jennifer Holmes, ELS of Medical Editing Services for providing editorial support in accordance with Good Publication Practice (GPP3) guidelines (


This work was supported by grant funding from the Indiana Minority Health Coalition.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Harris, S. A., & Nicolai, L. A. (2010). Occupational exposures in emergency medical service providers and knowledge of and compliance with universal precautions. American Journal of Infection Control, 38(2), 86–94.CrossRefGoogle Scholar
  2. 2.
    Leiss, J. K., Ratcliffe, J. M., Lyden, J. T., et al. (2006). Blood exposure among paramedics: Incidence rates from the national study to prevent blood exposure in paramedics. Annals of Epidemiology, 16(9), 720–725.CrossRefGoogle Scholar
  3. 3.
    Centers for Disease Control and Prevention (2019). HIV and occupational exposure. U.S. department of health & human services. HIV in the workplace web site. Retrieved July 12, 2019 from
  4. 4.
    Panlilio, A. L., Cardo, D. M., Grohskopf, L. A., Heneine, W., & Ross, C. S. (2005). Updated U.S. public health service guidelines for the management of occupational exposures to HIV and recommendations for postexposure prophylaxis. Morbidity and Mortality Weekly Report: Recommendations and Reports, 54(9), 1–17.Google Scholar
  5. 5.
    Canadian Paediatric Society. (2008). Needle stick injuries in the community (Vol. 13). Ottawa, ON: Canadian Paediatric Society.Google Scholar
  6. 6.
    White, E.F., Garfein, R.S., Brouwer, K.C., Lozada, R., Ramos, R., Firestone-Cruz, M., et al. (2007). Prevalence of hepatitis C virus and HIV infection among injection drug users in two Mexican cities bordering the U.S. Salud publica de Mexico, 49(3), 165–172. Scholar
  7. 7.
    Strader, D. B. (2005). Coinfection with HIV and hepatitis C virus in injection drug users and minority populations. Clinical Infectious Diseases, 41(Suppl 1), S7–S13.CrossRefGoogle Scholar
  8. 8.
    Centers for Disease Control and Prevention (2019). HIV in the United States and Dependent Areas. Retrieved July 12, 2019 from
  9. 9.
    Lorentz, J., Hill, L., & Samimi, B. (2000). Occupational needlestick injuries in a metropolitan police force. American Journal of Preventive Medicine, 18(2), 146–150.CrossRefGoogle Scholar
  10. 10.
    Boal, W. L., Leiss, J. K., Ratcliffe, J. M., et al. (2010). The national study to prevent blood exposure in paramedics: Rates of exposure to blood. International Archives of Occupational and Environmental Health, 83(2), 191–199.CrossRefGoogle Scholar
  11. 11.
    Sohn, S., Eagan, J., & Sepkowitz, K. A. (2004). Safety-engineered device implementation: Does it introduce bias in percutaneous injury reporting? Infection Control and Hospital Epidemiology, 25(7), 543–547.CrossRefGoogle Scholar
  12. 12.
    Centers for Disease Control and Prevention (2019). Syringe service programs. NCHHSTP web site. Retrieved July 13, 2019 from
  13. 13.
    Tempalski, B. (2007). Placing the dynamics of syringe exchange programs in the United States. Health and Place, 13(2), 417–431.CrossRefGoogle Scholar
  14. 14.
    Paquette, C. E., Syvertsen, J. L., & Pollini, R. A. (2018). Stigma at every turn: Health services experiences among people who inject drugs. International Journal of Drug Policy, 57, 104–110.CrossRefGoogle Scholar
  15. 15.
    Davis, C. S., Johnston, J., de Saxe, Zerden L., Clark, K., Castillo, T., & Childs, R. (2014). Attitudes of North carolina law enforcement officers toward syringe decriminalization. Drug and Alcohol Dependence, 144, 265–269.CrossRefGoogle Scholar
  16. 16.
    Centers for Disease Control and Prevention (2019). Vulnerable counties and Jurisdictions experiencing or at-risk of outreaks. Retrieved from
  17. 17.
    Falck, R. S., Siegal, H. A., Wang, J., & Carlson, R. G. (1995). Usefulness of the health belief model in predicting HIV needle risk practices among injection drug users. AIDS Education and Prevention, 7(6), 523–533.PubMedGoogle Scholar
  18. 18.
    Faul, F., Erdfelder, E., Lang, A. G., & Buchner, A. (2007). G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods, 39(2), 175–191.CrossRefGoogle Scholar
  19. 19.
    Schnall, R., Rojas, M., & Travers, J. (2016). Understanding HIV testing behaviors of minority adolescents: A health behavior model analysis. Journal of the Association of Nurses in AIDS Care, 26(3), 246–258.CrossRefGoogle Scholar
  20. 20.
    Indiana Department of Homeland Security (2019). Indiana emergency medical services commission levels of EMS personnel certification. Retrieved June 20, 2019 from
  21. 21.
    Wonder, A. H., & Spurlock, D. (2019). A national study across levels of nursing education: Can nurses and nursing students accurately estimate their knowledge of evidence based practice. Nursing Education Perspectives, 26(5), 55–58. Scholar
  22. 22.
    Strike, C. J., Myers, T., & Millson, M. (2004). Finding a place for needle exchange. Critical Public Health, 14(3), 261–275.CrossRefGoogle Scholar
  23. 23.
    Shaw, S. J. (2006). Public citizens, marginalized communities: The struggle for syringe exchange in Springfield, Massachusetts. Medical Anthropology, 25(1), 31–63.CrossRefGoogle Scholar
  24. 24.
    Des Jarlais, D. C., Arasteh, K., McKnight, C., Ringer, M., & Friedman, S. R. (2010). Syringe exchange, injecting and intranasal drug use. Addiction, 105(1), 155–158.CrossRefGoogle Scholar
  25. 25.
    Takahashi, L. (1998). Homelessness, AIDS, and stigmatization: The NIMBY syndrome in the United States at the end of the twentieth century. New York: Clarendon Press.Google Scholar
  26. 26.
    Tempalski, B., Friedman, R., Keem, M., Cooper, H., & Friedman, S. R. (2007). NIMBY localism and national inequitable exclusion alliances: The case of syringe exchange programs in the United States. Geoforum, 38(6), 1250–1263.CrossRefGoogle Scholar
  27. 27.
    Ivsins, A., Vancouver Area Network Of Drug U, Benoit, C., Kobayashi, K., & Boyd, S. (2019). From risky places to safe spaces: Re-assembling spaces and places in Vancouver’s Downtown Eastside. Health and Place, 59, 102164.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Indiana University School of Nursing BloomingtonBloomingtonUSA
  2. 2.Indiana University School of Public Health BloomingtonBloomingtonUSA
  3. 3.Indiana Minority Health CoalitionIndianapolisUSA

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