The effect of syringe exchange use on high-risk injection drug users: a cohort study

Objective: To determine whether syringe exchange program use is associated with cessation of syringe sharing among high-risk injection drug users. Design and methods: Between 1992 and 1996, street-recruited injection drug users were interviewed and received HIV testing and counseling semi-annuall y, as part of a dynamic cohort study. We examined a cohort of 340 high-risk injection drug users for whom two observations, 6-months apart, were avail able and who reported syringe sharing at the first interview. Multivariate logistic regression analysis was performed to determine the relationship be tween syringe exchange program use and cessation of syringe sharing, while controlling for confounding factors. Results: At follow-up interview, 60% (204 of 340) reported quitting syringe sharing. High-risk injection drug users who began using the syringe exchan ge program were more likely to quit sharing syringes [adjusted odds ratio ( AOR), 2.68; 95% confidence interval (Cl), 1.35-5.33], as were those who con tinued using the syringe exchange program (AOR,1.98; 95% Cl, 1.05-3.75) in comparison with non-syringe exchange program users, while controlling for c onfounding factors. Conclusions: The initiation and continuation of syringe exchange program us e among high-risk injection drug users is independently associated with ces sation of syringe sharing. Syringe exchange program use can be an important component in reducing the spread of blood-borne infectious diseases among high-risk injection drug users. (C) 2000 Lippincott Williams & Wilkins.