Exploring the role of needle selling in a drug-using community in Baltimore, Maryland

Needle exchange programs (NEPs) play a critical role in reducing the spread of HIV in injection drug users (IDUs). However, many IDUs do not access NEPs and rely on needle sellers. This study examined differences between needle sellers and others in a drug-using community and assessed sources and quantity of needles sold by needle sellers. The study also explored factors associated with needle selling. Compared with nonsellers, needle sellers were more likely to be homeless, HIV-positive, and unemployed. The NEP was the most frequent source of needles for needle sellers. Needle sellers were more likely to share their needles with sex partners and strangers than were nonsellers. Within the whole sample, needle selling was associated with injecting drugs and the number of roles in the drug economy. For injectors, needle selling was associated with obtaining needles from the NEP and having >1 role in the drug economy. Because needle sellers frequently interact with IDUs, training needle sellers may be an effective strategy for risk reduction and HIV prevention. However, because some needle sellers disseminate used needles, all injectors need to be educated about proper disposal techniques.