Injection Risk Behavior among Women Syringe Exchangers in San Francisco

Abstract

Women who inject drugs in cities where syringe exchange programs (SEPs) are well established may have different risks for HIV infection. In 1997, we interviewed 149 female syringe exchangers in San Francisco, CA, a city with high rates of injection drug use that is home to one of the largest and oldest SEPs in the United States. In this report, we describe their sociodemographics, health, and risk behavior, and we examine factors associated with recent syringe sharing. Fifty percent of respondents were women of color and the median age was 38 years. Most (86%) injected heroin and nearly half were currently homeless or had recently been incarcerated. One-third of all women reported needle sharing in the prior month. This was higher than the rate of needle sharing reported by a mixed gender sample of San Francisco exchangers in 1993, although it resembled the rate reported by a mixed gender sample in 1992. In a multivariate analysis, syringe sharing was associated with age, housing status, and sexual partnerships. Syringe sharers were more likely to be young, homeless, or have a sexual partner who was also an injection drug user. While wide access to sterile syringes is an important strategy to reduce HIV transmission among injection drug users (IDU), syringe exchange alone cannot eradicate risky injection by female IDU. Additional efforts to reduce risky injection practices should focus on younger and homeless female IDU, as well as address selective risk taking between sexual partners.

Keywords:

• AIDS
• HIV
• syringe exchange
• injection drug use
• women
• risk behavior

Notes

¹The journal's style utilizes the category substance abuse as a diagnostic category. Substances are used or misused; living organisms are and can be abused. Editor's note.

Additional information

Notes on contributors

Paula J. Lum

Paula J. Lum, M.D., M.P.H., is an Assistant Adjunct Professor of Medicine at the University of California, San Francisco (UCSF). She conducts clinical research on the epidemiology, prevention, and treatment of HIV and hepatitis in high-risk drug users and provides primary medical care to HIV-infected patients at San Francisco General Hospital.

Clare Sears

Clare Sears, Ph.D., received her doctorate in Sociology at the University of California, Santa Cruz. Her research in drug user treatment has included evaluation of needle exchange programs, treatment outcome studies, and assessment of broad system change initiatives.

Joseph Guydish

Joseph Guydish, Ph.D, M.P.H., is Professor of Medicine at the University of California, San Francisco. His research work is in the area of access, delivery, and organization of substance user treatment services. Dr. Guydish is affiliated with the UCSF Department of Psychiatry NIDA Treatment Research Center, the UCSF Institute for Health and Aging, and the Alcohol and Drug Policy Institute.