Gender differences in syringe exchange program use in Oslo, Norway

Aims. To examine gender differences in syringe exchange program (SEP) use, particularly frequent SEP use, within and across survey years. Design. Thre e consecutive, anonymous cross-sectional surveys. Setting. The SEP in Oslo, Norway. Participants. Two hundred and eighty-eight, 449 and 523 SEP partic ipants interviewed during comparable 1-week periods in 1992, 1994 and 1997, respectively. Measurements. Brief structured questionnaires assessed SEP u se, HIV risk behaviors and self-reported HIV status. Chi square statistics, t-tests and analysis of variance were used to identify gender differences; logistic regression was used to identify independent correlates of frequen t SEP use. Findings. Women reported injecting more frequently than men, but neither reported more frequent SEP use nor acquiring more syringes during an exchange. Although syringe sharing decreased significantly over time, in 1997, 51% of SEP participants continued to share. HIV prevalence remained low (3-5%) over time. After controlling for gender, age and HIV risk factor s, frequent SEP use was significantly correlated with frequent injection fo r both women (OR = 1.4) and men (OR = 1.5). A lack of income or benefits in dependently increased the likelihood of being a frequent SEP user (OR = 3.0 ), while having shared a syringe at last injection independently decreased this likelihood (OR = 0.5). Conclusions. Gender was not associated with fre quent SEP use; rather, the single most important correlate of frequent SEP use was injection frequency. Women's need for sterile syringes may not be f ully addressed, despite the existence of a well-established and well-utiliz ed SEP.