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Greater Drug Injecting Risk for HIV, HBV, and HCV Infection in a City Where Syringe Exchange and Pharmacy Syringe Distribution are Illegal

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Abstract

Comparing drug-injecting risk between cities that differ in the legality of sterile syringe distribution for injection drug use provides a natural experiment to assess the efficacy of legalizing sterile syringe distribution as a structural intervention to prevent human immunodeficiency virus (HIV) and other parenterally transmitted infections among injection drug users (IDUs). This study compares the parenteral risk for HIV and hepatitis B (HBV) and C (HCV) infection among IDUs in Newark, NJ, USA, where syringe distribution programs were illegal during the period when data were collected, and New York City (NYC) where they were legal. IDUs were nontreatment recruited, 2004–2006, serotested, and interviewed about syringe sources and injecting risk behaviors (prior 30 days). In multivariate logistic regression, adjusted odds ratios (AOR) and 95% confidence intervals (95% CI) for city differences are estimated controlling for potential city confounders. IDUs in Newark (n = 214) vs. NYC (n = 312) were more likely to test seropositive for HIV (26% vs. 5%; AOR = 3.2; 95% CI = 1.6, 6.1), antibody to the HBV core antigen (70% vs. 27%; AOR = 4.4; 95% CI = 2.8, 6.9), and antibody to HCV (82% vs. 53%; AOR = 3.0; 95% CI = 1.8, 4.9), were less likely to obtain syringes from syringe exchange programs or pharmacies (AOR = 0.004; 95% CI = 0.001, 0.01), and were more likely to obtain syringes from street sellers (AOR = 74.0; 95% CI = 29.9, 183.2), to inject with another IDU’s used syringe (AOR = 2.3; 95% CI = 1.1, 5.0), to reuse syringes (AOR = 2.99; 95% CI = 1.63, 5.50), and to not always inject once only with a new, sterile syringe that had been sealed in a wrapper (AOR = 5.4; 95% CI = 2.9, 10.3). In localities where sterile syringe distribution is illegal, IDUs are more likely to obtain syringes from unsafe sources and to engage in injecting risk behaviors. Legalizing and rapidly implementing sterile syringe distribution programs are critical for reducing parenterally transmitted HIV, HBV, and HCV among IDUs.

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Acknowledgments

The study was funded by the US National Institute on Drug Abuse, grant R01 DA014515 “HIV Risk and Neighborhood Networks of IDUs” (Principal Investigator: Alan Neaigus). We would like to thank Vera Frajzyngier for assisting in directing the data collection and other members of our research staff at the National Development and Research Institutes who worked on the study. The North Jersey Community Research Initiative (NJCRI) in Newark, NJ, USA, and their outreach staff provided major support for data collection in Newark, and Corey Rosmarin and the phlebotomy staff at NJCRI provided assistance in the collection of blood specimens for the Newark participants. This research would not have been possible without the consent of the drug users who agreed to participate in this study.

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Correspondence to Alan Neaigus.

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Neaigus, Zhao, Gyarmathy, and Cisek are with the Institute for International Research on Youth at Risk, National Development and Research Institutes, New York, NY, USA; Neaigus is with the Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA; Gyarmathy is with the Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Friedman is with the Institute for AIDS Research, National Development and Research Institutes, New York, NY, USA; Friedman is with the Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA; Baxter is with the North Jersey Community Research Initiative, Newark, NJ, USA.

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Neaigus, A., Zhao, M., Gyarmathy, V.A. et al. Greater Drug Injecting Risk for HIV, HBV, and HCV Infection in a City Where Syringe Exchange and Pharmacy Syringe Distribution are Illegal. J Urban Health 85, 309–322 (2008). https://doi.org/10.1007/s11524-008-9271-1

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