Injection Drug Use and Syringe Sharing Among Sexually Transmitted Disease Clinic Patients in the U.S

Background:  Little is known about the efficacy of risk-reduction counseling at the time of HIV testing in reducing syringe sharing among injection drug users.

Methods:  Project AWARE randomized 5012 participants from 9 STD clinics to receive a rapid HIV test with (1) brief risk-reduction counseling or (2) information only, complete a behavioral risk assessment, and be assessed for STDs at baseline and 6-month follow-up.  A GEE model was used to examine the change of syringe sharing between visits.  Predictors were: treatment group, participant and partner gender, visit and the interaction of treatment group and visit. 

Results:  In the counseling group, 145 (5.79%) and 112 (5.14%) participants reported injection drug use (IDU) at baseline and follow-up, respectively.  In the information only group, 160 (6.38%) and 113 (5.17%) participants reported IDU at baseline and follow-up, respectively.  There was a decrease in the number of injectors across time (χ²=5.33, p=0.0210), but there was no difference in the decrease between groups (χ²=0.56, p=0.4552). Among injectors at baseline, 31 (21.4%) in the counseling group and 28 (17.5%) in the information only group shared syringes; at follow-up, 16 (14.3%) in the counseling group and 6 (5.3%) in the information only group shared syringes. There was a decrease in the rate of syringe sharing across time (χ²=21.45, p<0.0001); the rate in the information group decreased more than in the counseling group (χ²=4.33, p=0.0375).

Discussion: Brief risk-reduction counseling may not be appropriate in addressing IDU and syringe sharing among STD clinic patients at the time of HIV testing.