Unsafe injecting practices among attendees of syringe exchange programmes in France

Aims. To describe syringe exchange programme attendees and their injection practices. Design. Cross-sectional study (one week in 1998). Data were coll ected through a standardized questionnaire. Setting. 60/74 syringe exchange programmes (SEPs) in France. Participants. Clients requesting syringes in 60 SEPs. Measurements. Self-reports of drug use, injecting behaviour, sexua l behaviour, serological status (HIV, HBV, HCV). Prevalence of unsafe injec ting practices in the previous month such as: syringe sharing; and sharing other injection paraphernalia. Findings. 1004 questionnaires were collected (response rate: 50%). The mean age of respondents was 30 years, and 70% we re males. Among individuals tested, HIV reported prevalence was 19.2%, HCV 58.4% and HBV 20.8%. The mean duration of drug use was 11 years. Eighty-fiv e percent were polydrug users and buprenorphine high-dosage was the substan ce most used (73%). In the previous month, 45% of the participants had re-u sed a syringe, 93% injected at least daily (mean 3.6 injections per day), 1 8% shared a syringe and 71% shared injection paraphernalia. In multivariate analyses, unsafe injecting practices were associated with heroin and cocai ne use and with living in a couple. The cluster analysis identified five ca tegories of IDUs: users of buprenorphine-HD (45% of the responders), morphi ne-sulphate (17%), benzodiazepines and other legal drugs (13%), methadone a ssociated with other legal drugs (13%) and crack-cocaine (13%). The bupreno rphine-HD group had better social status and safer injection practices. Con clusions. In France, despite an increase in the accessibility to syringes a nd substitution treatments, unsafe injecting practices persist among SEP at tenders. Interventions should stress the importance of using sterile materi al for each injection, even with a steady sex partner.