“Dopers” Talk about Needle Sharing: HIV/HCV Prevention at Syringe Exchange and Beyond

Issues

Syringe exchange programs (SEP) provide clean needles and other HIV/HCV prevention resources to people who use injection drugs (PWID) that present for services. However, some PWID receive clean needles from other PWID instead (secondary exchange).

Description

In 2008, we conducted four focus groups with 27 PWID in Oregon to explore reasons for attending or avoiding SEP, the mechanics and social networks involved in secondary exchange, and ideas for HIV/HCV prevention.

Lessons

PWID use SEP because they value their personal health, safety, and comfort; SEP is free, and they lack viable alternatives for needle acquisition and disposal. Barriers to using SEP include fear of the police, being “too high” or living in the moment, lack of information about or access to SEP, and secretiveness or denial about injecting. Some PWID rarely or never use SEP because they have alternative sources of clean needles, either through secondary exchange or from diabetics.

Most participants reported regular engagement in secondary exchange, either as an exchanger or a recipient, and these roles were fluid. PWID cited practical and altruistic reasons for sharing clean needles. Many arrangements involved highly organized, collaborative systems for needle collection and disbursement among networks. Traits shared by exchangers with structured systems and large networks included leadership qualities (e.g. self-confidence, trustworthiness, resourcefulness), normalization of injection, and promotion of social norms around never sharing needles.

Recommendations

Participants recommended increased information distribution and expanded SEP services, and were willing to use secondary exchange networks to deliver prevention messages and promote SEP use.