Injection Behaviors and Use of Syringe Service Programs over Time among People Who Inject Drugs in Baltimore, Maryland

Abstract

Introduction: People who inject drugs (PWID) are at increased risk for infectious disease transmission, including hepatitis C and HIV. Understanding trends in injection risk behaviors and syringe service program (SSP) use over time can help improve infectious disease prevention and other harm reduction services. Methods: Using National HIV Behavioral Surveillance System data from Baltimore, Maryland, we examined changes in receptive sharing of (1) syringes, (2) injection equipment, (3) syringes to divide drugs; and (4) receipt of syringes from SSPs among PWID from 2009 to 2018 (n = 518 in 2009, n = 638 in 2012, n = 586 in 2015, and n = 575 in 2018) using unadjusted and adjusted logistic models calculated across time for the total sample. Results: The conditional probability of receptive sharing of syringes and receipt of syringes from SSPs remained relatively stable, while receptive sharing of injection equipment and receptive sharing of syringes to divide drugs dropped substantially after 2009. White race and daily injection frequency were positively associated with sharing syringes and injection equipment and negatively associated with SSP use over time. In 2015, there was a notable shift such that women were twice as likely as men to receive syringes from SSPs and less likely than men to report the use of shared syringes or equipment. Conclusion: Findings indicate overall steady or decreasing trends in injection risk and steady trends in SSP usage over time, with some notable improvements among women and indications of shifting drug market patterns. Injection-related risk behaviors remain high among White PWID and may require targeted outreach and interventions.

Keywords:

• People who inject drugs (PWID)
• injection behaviors
• syringe service programs (SSPs)
• Baltimore

Acknowledgments

The authors express their gratitude to the BESURE study staff over the years for their hard work and dedication and to all of the people who participated in this study. We also appreciate contributions from Xuhao Yang and Caroline Winter in the development of this manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

Data may be available upon request.

Additional information

Funding

This work was supported by the Centers for Disease Control and Prevention (grant number 6NU62PS924769) via contract to Johns Hopkins from the Maryland Department of Health; and the Johns Hopkins University Center for AIDS Research (P30AI094189).