Proximity to needle exchange programs and HIV-related risk behavior among injection drug users in Harlem

Abstract

The present study sought to determine whether proximity to a needle exchange program (NEP) was associated with lower levels of HIV-related risk behavior among 587 injection drug users (IDUs) in East Harlem. Three neighborhood samples were compared: IDUs recruited at a NEP; those recruited within 10 blocks (‘proximal access’) of the NEP site; and those recruited more than 10 blocks away (‘distal access’). Most respondents were Puerto Rican or African American single men, and receiving public assistance. Levels of HIV risk behavior—both injection- and sexual-related—reported by the three comparison groups were lower than in similar samples obtained in many earlier studies. Participants recruited at the NEP were less likely to share syringes and other injection paraphernalia, and more likely to use condoms with main sex partners. After adjusting for age, gender, ethnicity, education and injection frequency, analyses of covariance revealed that IDUs located at the NEP were less likely than other IDUs to inject with a syringe that someone else had squirted drugs into, use dirty needles by themselves, or share a cooker; and were more likely to use new sterile needles and use a condom with a steady partner and during vaginal sex. Although 90% of IDUs recruited within 10 blocks of the NEP were NEP attendees, this group had injection- and sexual-risk levels similar to the distal access group. However, lending support to the plausibility of NEPs as referral providers, IDUs with access to the NEP site were more likely to participate in drug abuse treatment at present and in the past six months. The substantially lower rates of risk-taking among respondents located at the NEP is consistent with existing evidence that such programs are important elements in the array of strategies to slow the spread of HIV.