PUBLIC HEALTH BRIEFS

Changes in Needle Sharing Behavior among Intravenous Drug Users: San Francisco, 1986-88 JOSEPH R. GUYDISH, PHD, AL ABRAMOWITZ, MS, WILLIAM WOODS, PHD, DENNIS M. BLACK, PHD, AND JAMES L. SORENSEN, PHD Abstract: We analyzed data for San Francisco intravenous drug users entering treatment, April 1986-September 1988 (N = 7,660). The proportion of cases reporting any needle sharing in the month preceding treatment decreased from 50 percent in 1986 to 28 percent in 1988. Similar decreases were reported by two longitudinal cohorts (needle sharing by the same individuals) admitted in 1986 and 1987 (n = 303), and in 1986 and 1988 (n = 205). In a multiple logistic regression model four variables predicted needle sharing: earlier time of admission, cocaine use, younger age, and being White rather than Black. (Am J Public Health 1990; 80:995-997.)

Introduction Successful and sustained risk reduction among intravenous drug users (IVDUs) is vital in slowing the spread of the human immunodeficiency virus (HIV) in the United States. Injectable drug use is implicated in 27 percent of adult acquired immunodeficiency syndrome (AIDS) cases, and this figure is substantially higher for Blacks (45 percent) and Hispanics (47 percent). Well over half of all heterosexually transmitted cases and pediatric cases are among sexual partners and children of IVDUs.1 HIV prevention strategies targeting IVDUs, in addition to drug abuse treatment, now include grassroots efforts,2 clinic-based interventions,3-4 street outreach projects,5 community-based information and awareness campaigns,6 and publicly supported,7 and unsanctioned needle exchanges.8 In New York City, where seroprevalence among IVDUs reached about 60 percent,9 cross-sectional and ethnographic studies report decreased needle sharing, increased needle cleaning, and increased demand for sterile needles on the streets. 10-13 In San Francisco, one study found no change in needle sharing for cross-sectional samples drawn in 1985 and 1987,'4 while in three other studies IVDUs self-reported some decrease in sharing.15-'7 We report changes in needle sharing behavior for two samples of IVDUs entering drug detoxification programs in San Francisco for successive time periods from 1986 to 1988, and for two retrospective cohorts repeating treatment during the study period. We also evaluated correlates of needle sharing behavior. Methods

Study respondents were IVDUs consecutively entering outpatient drug detoxification clinics (San Francisco General From the Center for AIDS Prevention Studies, University of California, San Francisco (Guydish, Woods, Black, Sorensen); and the Community Substance Abuse Services, San Francisco Department of Public Health (Abramowitz, Woods). Address reprint requests to Joseph R. Guydish, PhD, Center for AIDS Prevention Studies, University of California at San Francisco, 74 New Montgomery Street, Suite 600, San Francisco, CA 94105. This paper, submitted to the Journal October 20, 1989, was revised and accepted for publication February 22, 1990.

© 1990 American Journal of Public Health 0090-0036/90$1.50

AJPH August 1990, Vol. 80, No. 8

Hospital and Haight Ashbury Free Medical Clinic) from April 1986 through September 1988 (N = 7,660). Participants were interviewed on admission concerning demographics, drug use, drug treatment, and the number of needle sharing occasions for the 30-day period preceding admission to treatment. To evaluate change over time, the data were partitioned into consecutive six-month calendar periods, giving a total of five time blocks. The proportion of participants reporting any needle sharing was compared across time periods. The two largest cohorts of treatment repeaters within non-adjacent six-month periods were identified in 1986-87 (n = 303), and in 1986-88 (n = 205). Logistic regression modeling was applied to identify correlates of needle sharing, using only the first admission for each individual during the study period (n = 5,610). The outcome variable was number of needle sharing occasions in the past month, coded dichotomously to reflect any sharing versus no sharing. Sex, age, education, ethnicity, cocaine use, number of prior admissions to drug treatment (

Changes in needle sharing behavior among intravenous drug users: San Francisco, 1986-88.

We analyzed data for San Francisco intravenous drug users entering treatment, April 1986-September 1988 (N = 7,660). The proportion of cases reporting...
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