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By Alan Mozes
NEW YORK, Mar 07 (Reuters Health) - Over the past decade, needle exchange programs have been set up across the US as part of an attempt to halt the spread of infections such as HIV and hepatitis among injection drug users. Now researchers report that almost one fifth (17%) of users in one such program complicate these efforts by engaging in the high-risk behavior of sharing the needles they receive with others--most of the time with close friends.
"Drug users are like everybody else...they are strongly influenced by their close friends," said study co-author Dr. Thomas W. Valente. Currently an associate professor at the Institute for Prevention Research at the University of Southern California, Valente conducted his research with his colleague Dr. David Vlahov while at the School of Hygiene and Public Health at Johns Hopkins University in Baltimore, Maryland.
Their findings are published in the March issue of the American Journal of Public Health: Journal of the American Public Health Association.
Valente and Vlahov analyzed the risk behaviors of almost 1,200 injection drug users--mostly male and African American--who accessed a program providing one-for-one needle exchanges in Baltimore between 1995 and 1997.
Conducting four interviews over the 2-year period, the researchers elicited information on each addict's network of friends and then established the degree to which the user either injected, had sex, drank alcohol, and/or shared syringes with any friend.
The investigators also noted whether or not the addict had injected with a used needle in the prior 2 weeks.
The researchers found that over 80% of the drug users did not share needles, an improvement over the numbers found among the same population in 1990, which indicated that upwards of 70% were doing so at that time. However, Valente and Vlahov point out that among those who did share, nearly 4 out of 5 did so with a friend.
The authors conclude that by sharing in this manner, the users were taking a "selective risk"--meaning that their decision to share syringes solely amongst a group of friends arose out of both the peer pressure and the familiarity that friendship can afford.
Valente and Vlahov explain that in some cases, sharing with a closed grouping of friends can potentially pose less of a risk for the spread of disease--but only if the composition of that group remains the same, and each member of the group remains disease free.
However, the research team found that friends often rotated in the injection drug user community--undermining any safety in confining sharing to close friends. They therefore suggest that needle programs need to more actively discourage sharing needles among friends and strangers by emphasizing the health risks.
"The rate of sharing has dropped dramatically for people who visit a needle exchange," Valente told Reuters Health. "We find, however, that there is still some syringe sharing, and that this sharing is predominately among close friends. The message for counselors and those providing services is that every drug user needs to know that even close friends can pose some risk when they share syringes."
SOURCE: American Journal of Public Health 2001;91:1-6.
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