Unstable housing as a factor for increased injection risk behavior at US syringe exchange programs

Area of Science:

• Public Health
• Epidemiology
• Addiction Research

Background:

• Unstably housed/homeless injecting drug users (IDUs) face elevated risks for HIV and other infections.
• Syringe exchange programs (SEPs) aim to reduce injection risk behaviors, but their effectiveness may vary across populations.

Purpose of the Study:

• To examine variations in injection risk behaviors, specifically receptive sharing, among unstably housed IDUs participating in US-based SEPs.
• To compare risk behaviors between unstably housed and stably housed IDUs within these programs.

Main Methods:

• A national sample of 15 moderate to very large US SEPs were selected.
• Audio-computer assisted self-interviewing (A-CASI) was used to collect data on risk behaviors from randomly sampled participants.
• Unstable housing was defined as experiencing homelessness or living in shelters/SROs in the prior 6 months; receptive sharing involved using previously used needles/syringes in the prior 30 days.

Main Results:

• Significant variation existed in the proportion of unstably housed participants across SEPs (35-74%) and in their reported receptive sharing rates (8-52%).
• Unstably housed IDUs were consistently approximately twice as likely to report receptive sharing compared to stably housed IDUs across all programs (OR=2.02).
• There was no significant variation in the odds ratios for receptive sharing between housed and unhoused groups, indicating consistent risk elevation.

Conclusions:

• SEPs vary in their success at engaging unstably housed IDUs.
• The consistent finding of higher injection risk among unstably housed IDUs suggests current SEP models may not effectively mitigate risks for this population.
• Effective risk reduction for unstably housed IDUs may necessitate integrated housing support or novel intervention strategies.