Correlates of Unsafe Syringe Acquisition and Disposal Among Injection Drug Users in Baltimore, Maryland

Abstract

Because multi-person syringe use is the most common vehicle for HIV and hepatitis C virus transmission among injection drug users (IDUs), safe sources of sterile syringes and safe methods of disposal are necessary to curb these epidemics. We examined syringe acquisition and disposal in a cohort of IDUs in Baltimore. Between January 1, 1998 and December 31, 2001, 1034 participants reported on syringe acquisition at 3492 visits, and 953 reported on disposal at 2569 visits. Participants were 69.9% male, 93.9% African-American, and median age was 44. Syringes were acquired exclusively from unsafe sources at 32.3% of visits, while exclusively unsafe disposal was reported at 59.3% of visits. Significant correlates of unsafe acquisition were: attending shooting galleries, anonymous sex, sharing needles, smoking crack, and emergency room visits. Significant correlates of unsafe disposal were: injecting speedball, no methadone treatment, acquiring safely, and frequent injection. Having a primary source of medical care was associated with safe acquisition, but unsafe disposal. IDUs continue to acquire safely but dispose unsafely, especially among those with a primary source of care; this suggests that messages about safe disposal are not being disseminated as widely as those about acquisition. These data suggest the need for a more active program involving pharmacists, an expanded syringe access program, and better efforts to enhance safe disposal.

Keywords:

• injection drug use
• epidemiology
• syringe acquisition
• syringe disposal
• NEP

Additional information

Notes on contributors

Elizabeth T. Golub

Elizabeth T. Golub, Ph.D. is as Assistant Scientist at the Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Infectious Diseases Program. She serves as co-Investigator on two multi-center behavioral intervention studies, addressing primary and secondary prevention of HIV and HCV among young injection drug users.

Joseph C. Bareta

Joseph C. Bareta, is an Advanced Epidemiologist in the Infectious Disease Bureau, Epidemiology and Response Division, New Mexico Department of Health. He was formerly Biostatistical Research Coordinator with the ALIVE Study, Johns Hopkins University School of Public Health.

Shruti H. Mehta

Shruti H. Mehta, Ph.D. is an Assistant Professor in the Department of Epidemiology at the Johns Hopkins School of Public Health. Her work primarily focuses on HIV and HCV coinfection and specifically access to care and treatment for these infections among injection drug users. She also collaborates with the National AIDS Research Institute in Pune, India on projects related to HIV and access to antiretroviral therapy.

David Vlahov

David Vlahov, Ph.D. is Director of the Center for Urban Epidemiologic Studies at the New York Academy of Medicine. Over the past 20 years, he has conducted studies of medical consequences of drug use, and the NIH recognized this work with a MERIT Award.

Steffanie A. Strathdee

Steffanie A. Strathdee, Ph.D. is an infectious disease epidemiologist who has spent the last two decades focusing on underserved, marginalized populations in developed and developing countries. Her recent work has focused on the prevention of blood borne infections and barriers to care among injection drug using populations, specifically HIV and viral hepatitis. In the last decade, she has published over 145 peer-reviewed publications on HIV prevention and the natural history of HIV infection.