OBJECTIVES: We assessed the effects of syringe exchange program (SEP) policy on rates of HIV risk behavior and HIV incidence among injection drug users. METHODS: Using a multivariate generalized estimating equation and Cox regression methods, we examined syringe borrowing, syringe lending, and HIV incidence among a prospective cohort of 1228 injection drug users in Vancouver, British Columbia. RESULTS: We observed substantial declines in rates of syringe borrowing (from 20.1% in 1998 to 9.2% in 2003) and syringe lending (from 19.1% in 1998 to 6.8% in 2003) following SEP policy change. These declines coincided with a statistically significant increase in the proportion of participants accessing sterile syringes from nontraditional SEP sources (P < .001). In multivariate analyses, the period following the change in SEP policy was independently associated with a greater than 40% reduction in syringe borrowing (adjusted odds ratio [AOR] = 0.57; 95% confidence interval [CI] = 0.49, 0.65) and lending (AOR = 0.52; 95% CI = 0.45, 0.60), as well as declining HIV incidence (adjusted hazard ratio = 0.13; 95% CI = 0.06, 0.31). CONCLUSIONS: Widespread syringe distribution appears to be a more effective SEP policy than do more restrictive SEP policies that limit syringe access. Efforts should be made to ensure that SEP policies and program design serve to maximize rather than hinder syringe access.
OBJECTIVES: We assessed the effects of syringe exchange program (SEP) policy on rates of HIV risk behavior and HIV incidence among injection drug users. METHODS: Using a multivariate generalized estimating equation and Cox regression methods, we examined syringe borrowing, syringe lending, and HIV incidence among a prospective cohort of 1228 injection drug users in Vancouver, British Columbia. RESULTS: We observed substantial declines in rates of syringe borrowing (from 20.1% in 1998 to 9.2% in 2003) and syringe lending (from 19.1% in 1998 to 6.8% in 2003) following SEP policy change. These declines coincided with a statistically significant increase in the proportion of participants accessing sterile syringes from nontraditional SEP sources (P < .001). In multivariate analyses, the period following the change in SEP policy was independently associated with a greater than 40% reduction in syringe borrowing (adjusted odds ratio [AOR] = 0.57; 95% confidence interval [CI] = 0.49, 0.65) and lending (AOR = 0.52; 95% CI = 0.45, 0.60), as well as declining HIV incidence (adjusted hazard ratio = 0.13; 95% CI = 0.06, 0.31). CONCLUSIONS: Widespread syringe distribution appears to be a more effective SEP policy than do more restrictive SEP policies that limit syringe access. Efforts should be made to ensure that SEP policies and program design serve to maximize rather than hinder syringe access.
Authors: D Vlahov; D C Des Jarlais; E Goosby; P C Hollinger; P G Lurie; M D Shriver; S A Strathdee Journal: Am J Epidemiol Date: 2001-12-15 Impact factor: 4.897
Authors: Evan Wood; Mark W Tyndall; Patricia M Spittal; Kathy Li; Robert S Hogg; Julio S G Montaner; Michael V O'Shaughnessy; Martin T Schechter Journal: AIDS Date: 2002-04-12 Impact factor: 4.177
Authors: Evan Wood; Elisa Lloyd-Smith; Kathy Li; Steffanie A Strathdee; Will Small; Mark W Tyndall; Julio S G Montaner; Thomas Kerr Journal: Am J Med Date: 2007-02 Impact factor: 4.965
Authors: Ricky N Bluthenthal; Greg Ridgeway; Terry Schell; Rachel Anderson; Neil M Flynn; Alex H Kral Journal: Addiction Date: 2007-02-06 Impact factor: 6.526
Authors: Mahboobeh Safaeian; Ron Brookmeyer; David Vlahov; Carl Latkin; Melissa Marx; Steffanie A Strathdee Journal: Am J Epidemiol Date: 2002-01-15 Impact factor: 4.897
Authors: Patricia M Spittal; Kevin J P Craib; Evan Wood; Nancy Laliberté; Kathy Li; Mark W Tyndall; Michael V O'Shaughnessy; Martin T Schechter Journal: CMAJ Date: 2002-04-02 Impact factor: 8.262
Authors: S A Strathdee; D D Celentano; N Shah; C Lyles; V A Stambolis; G Macalino; K Nelson; D Vlahov Journal: J Urban Health Date: 1999-12 Impact factor: 3.671
Authors: Linda Drach; Jessica Guernsey; Julie E Maher; Maureen Rumptz; Mike Stark; Kathryn Pranian; Carol Casciato Journal: Am J Public Health Date: 2011-03 Impact factor: 9.308
Authors: Anees Bahji; Evan Wood; Keith Ahamad; Huiru Dong; Kora DeBeck; M-J Milloy; Thomas Kerr; Kanna Hayashi Journal: Int J Drug Policy Date: 2015-09-30
Authors: Tanner Nassau; Alia Al-Tayyib; William T Robinson; Jennifer Shinefeld; Kathleen A Brady Journal: Public Health Rep Date: 2020 Jul/Aug Impact factor: 2.792
Authors: Kora DeBeck; Tessa Cheng; Julio S Montaner; Chris Beyrer; Richard Elliott; Susan Sherman; Evan Wood; Stefan Baral Journal: Lancet HIV Date: 2017-05-14 Impact factor: 12.767
Authors: Susan G Sherman; Shivani A Patel; Daesha V Ramachandran; Noya Galai; Patrick Chaulk; Chris Serio-Chapman; Renee M Gindi Journal: Drug Alcohol Rev Date: 2015-04-28