Syringe Sharing and HIV Incidence Among Injection Drug Users and Increased Access to Sterile Syringes

Toward the goal of maximizing sterile syringe access and reducing rates of syringe sharing, between 2000 and 2003 the Vancouver, British Columbia, health authority modified its syringe exchange program (SEP) policies by shifting the focus from syringe exchange to syringe distribution. SEP services were decentralized, and the number of distribution sites was increased. Limits on the number of syringes available were removed. The health authority began requiring local health clinics to provide sterile syringes to injection drug users, and it asked IDU outreach programs to include syringe distribution in their work. IDUs were no longer required to bring in syringes to exchange, as the distribution and collection programs were separated. Also, a local organization for IDUs opened a peer-run SEP in the city's chief drug-using area.

In the current study, the team assessed the effects of these policy changes on the rate of HIV risk behavior and HIV incidence among IDUs. Multivariate generalized estimating equation and Cox regression methods were employed to examine syringe borrowing, syringe lending, and HIV incidence among a prospective cohort of 1,228 Vancouver IDUs.

When the researchers compared data from 1998 and 2003, they noted substantial declines in rates of syringe borrowing (from 20.1 percent to 9.2 percent) and syringe lending (from 19.1 percent to 6.8 percent) following the SEP policy changes. Coinciding with these declines was a statistically significant increase in the proportion of participants accessing sterile syringes from non-traditional SEP sources (P

Multivariate analyses showed the period following the change in SEP policy was independently associated with a greater than 40 percent reduction in syringe borrowing (adjusted odds ratio [AOR]=0.57; 95 percent confidence interval [CI]=0.49, 0.65) and syringe lending (AOR=0.52; 95 percent CI=0.45, 0.60), in addition to declining incidence of HIV (adjusted hazard ratio=0.13; 95 percent CI=0.06,0.31).

"Widespread syringe distribution appears to be a more effective SEP policy than do more restrictive SEP policies that limit syringe access," the authors concluded. "Efforts should be made to ensure that SEP policies and program design serve to maximize rather than hinder syringe access."

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