Benjamin Junge

Reductions in high-risk drug use behaviors among participants in the Baltimore Needle Exchange Program

OBJECTIVE To determine whether enrollment in the Baltimore Needle Exchange Program (NEP) was associated with short-term reduction in risky injection practices. METHODS Demographic information was collected on NEP participants upon enrollment. A systematic sample of enrollees was interviewed at program entry, 2 weeks, and 6 months later on recent drug-related behaviors. Comparisons were performed using paired t-tests. RESULTS Among 221 NEP participants who completed baseline, 2-week and 6-month follow-up visits, significant reductions (p < .01) were reported in using a previously used syringe (21.6%, 11.0%, 7.8%, respectively), lending ones used syringe to a friend (26.7%, 18.4%, 12%, respectively), and several indirect sharing activities. Reductions were reported in the mean number of injections per syringe and the mean number of injections per day (p < .001). CONCLUSIONS These results show rapid and mostly large reductions in a variety of risky injection drug use behaviors. Study findings are consistent with earlier reports showing an association between behavioral risk reduction and participation in a needle exchange program.

Syringe use and reuse: effects of syringe exchange programs in four cities.

We determined the effect of syringe exchange programs (SEPs) on syringe reuse patterns. Five methods were employed to estimate injections per syringe made by exchange clients in four cities. In San Francisco, Chicago, and Baltimore, self-reported data on the number of injections per syringe were obtained. In New Haven, self-reported injection frequencies were combined with syringe tracking data to derive two methods for estimating the mean injections per syringe. The average number of injections per syringe declined by at least half after establishment of SEPs in New Haven, Baltimore, and Chicago, all cities where such an analysis could be made. There were significant increases in the percentages of exchangers reporting once-only use of their syringes in San Francisco, Baltimore, and Chicago, all cities where the data were amenable to this form of analysis. Self-report and syringe tracking estimates were in agreement that SEP participation was associated with decreases in syringe reuse by drug injectors. SEP participation was associated with increases in the once-only use of syringes. These findings add to earlier studies supporting the role of SEPs in reducing the transmission of syringe-borne infections such as HIV and hepatitis.

Health services utilization by injection drug users participating in a needle exchange program.

Objective: To determine the characteristics associated with health care and drug treatment utilization among a distinctly high-risk sub-population of injectors participating in a needle exchange program (NEP). Methods: Between June 1998 and May 1999, study staff collected demographic and health services utilization data on participants of the Baltimore NEP. Odds ratios and logistic regression were used to identify the participant characteristics associateds with utilizing primary health care and drug treatment during the prior 3 years. Results: Among 269 participants, 81% were African–American and 66% were male. Over half (56%) had not graduated from high school, 89% were unemployed, 70% did not have health insurance, and the median age was 39 years. Fifty-eight percent of the participants reported utilizing primary care (i.e., visited a physician or other health care provider) and 44% had utilized drug treatment during the prior 3 years. Primary care utilization was associated with age≥39 [adjusted odds ratio (AOR)=1.82], having health insurance (AOR=2.16), and exchanging a higher volume of syringes per NEP visit (AOR=2.45). Recent drug treatment utilization was associated with African–American race (AOR=0.41), unemployment (AOR=2.72), having health insurance (AOR=2.05), and exchanging a higher volume of syringes per NEP visit (AOR=0.60). Conclusions: Health insurance was significantly associated with the recent utilization of both primary care and drug treatment, yet only one-third of NEP attenders were insured. Facilitating the uptake of health insurance services at NEP sites may improve the access to health care for drug users who are currently not utilizing the health care system.

Needle-Exchange Participation, Effectiveness, and Policy: Syringe Relay, Gender, and the Paradox of Public Health

Needle-exchange programs (NEPs) have been politically controversial, and most studies have focused on evaluating their effectiveness on human immunodeficiency virus (HIV) transmission rates with little emphasis on the process of how they are used. This article shows that the way intravenous drug users use NEPs may influence their effectiveness. Using data from Baltimores NEP, participants (N=2,574) were classified as low, medium, and high users based on the volume, frequency, and duration of contact with the NEP. Higher NEP use was associated with shorter syringe circulation times and less syringe relay, returning syringes to the NEP originally acquired by someone else. For a subsample that was HIV tested (N=262), syringe relay among women was associated with HIV seroconversion (at a 95% confidence interval). We conclude that exclusive use of the NEP (no relay) provides greater HIV protection than NEP use involving syringe relay. The paradox is that public health goals will not be achieved by prohibiting syringe relay activities and promoting exclusive use. NEPs should broaden their education efforts to have participants understand the value of repeated visits to the NEP.

Syringe exchange not associated with social network formation : results from baltimore

ObjectiveTo examine possible formation of new social contacts at the Baltimore Syringe Exchange Program (SEP). DesignSystematic sub-sample of new SEP participants recruited into evaluation cohort for biannual interviews. This analysis used 6-month interview data. MethodsParticipants were interviewed for behavioral and network characteristics, and number of new social contacts formed at the SEP. Variables were cross-tabulated using χ2 statistics. ResultsOf 413 participants interviewed, 32 (8%) said they had made at least one social contact at the SEP. These 32 individuals were more likely to have engaged in commercial sex (16 versus 3%, P = 0.005) and, among active injectors, were more likely to have used syringes obtained from other drug users (22 versus 8%, P = 0.026). ConclusionsFindings argue against the formation of new social networks (and therefore new disease transmission networks) in the context of syringe exchange participation.

Pharmacy Access to Sterile Syringes for Injection Drug Users: Attitudes of Participants in a Syringe Exchange Program

OBJECTIVE To examine attitudes of participants of a van-based syringe exchange program (SEP) toward the hypothetical prospect of pharmacy-based syringe access. DESIGN One-time, cross-sectional survey. SETTING Baltimore, Maryland. PARTICIPANTS 206 injection drug users who participate in the Baltimore SEP. INTERVENTIONS Face-to-face interviews. MAIN OUTCOME MEASURES Location preferred for obtaining syringes, drug and syringe use, past experience with pharmacies, and willingness to pay. RESULTS The sample was 67% men, 95% African American, and 95% unemployed; mean age was 39.8 years. A total of 19% of respondents had bought syringes at a pharmacy during the prior six months. Some 37% reported having been turned down when asking for syringes at a pharmacy, most commonly due to lack of identification to prove diabetic status (50%). If legal restrictions were lifted, 92% of respondents would obtain syringes from pharmacies, and would be willing to pay a mean price of

Community support for needle exchange programs and pharmacy sale of syringes : A household survey in Baltimore, Maryland

0.80 (median =

A matter of convenience: factors influencing secondary syringe exchange in Baltimore, Maryland, USA

1.00) per syringe. Women were more likely than men to report the intention to switch from van-based SEP to pharmacy (57% versus 38%, p = .045). CONCLUSION If current legal restrictions were lifted, pharmacies would be a viable syringe source appealing particularly to women, suggesting gender-specific access issues that should be addressed. The per-syringe price that study participants would be willing to pay exceeds typical retail prices, suggesting that pharmacists could charge enough per syringe to recoup operational costs.

A Focus Group Evaluation of Drop Boxes for Safe Syringe Disposal

In October 1995, community attitudes toward needle exchange programs were assessed in Baltimore, Maryland. Household interviews were conducted with a random sample of residents living within six contiguous census tracts. Multivariate logistic regression was used to determine which factors were independently associated with acceptance of needle exchange programs. Of 274 eligible respondents contacted, 138 (50%) completed the interview. Respondents were statistically similar to the 1990 census population by income but were more likely to be female, black, between the ages of 35 and 44 years, and to have attended college or be a college graduate. Although 72% of respondents thought needle exchange programs would attract injection drug users to the neighborhood, 65% favored needle exchange, and 47% favored selling needles in a pharmacy without a prescription. Factors independently associated with acceptance of needle exchange programs included the perceptions that needle exchange programs decrease the number of discarded needles on the street, that needle exchange programs do not encourage a persons injection drug use, and that needle exchange programs decrease HIV incidence. Despite concern about attracting injection drug users to the neighborhood, support for needle exchange programs was high.

The role of needle exchange programs in HIV prevention

Abstract Distribution of sterile syringes to reduce the circulation of HIV-infection among injection drug user (IDU) communities is vital in curbing the spread of HIV among IDUs. In addition to other methods of distribution, syringe exchange programmes (SEPs) have been shown to be necessary in the dissemination of sterile syringes. Secondary syringe exchange (SSE) is an organic process by which IDUs distribute syringes to other IDUs and is an important complement to SEPs. This paper examines the motivations for people who provide SSE to other IDUs and the reasons why some IDUs do not use the Baltimore Needle Exchange Program (BNEP). Approximately 5000 individuals had obtained clean syringes from the BNEP between 1994 and 1997. In 1997, qualitative interviews were conducted in Baltimore with 20 providers of SSE and 10 SSE recipients who had never used the BNEP. Data from qualitative interviews were transcribed, coded and compiled. SSE providers reported economic gain and altruism as incentives. SSE recipients reported privacy, convenience of location and time, force of habit, and concern for carrying paraphernalia around as reasons influencing them to obtain syringes from secondary syringe exchangers rather than the needle exchange programme. Results from this study illuminate the social context in which SSE occurs and indicate the importance of SSE as a method for distributing sterile syringes.