The etiquette of needlesharing

The prevalence of hepatitis- and HIV-related risk-taking behavior, including the sharing of injecting equipment by injecting drug users (IDUs), has declined markedly in Australia over the last decade. This decrease reflects widespread improvements in the availability of injecting equipment over recent years, but the prevalence of needlesharing remains an ongoing concern, with up to 20% of IDUs reporting this practice within the month prior to interview (Feachem, 1995). Although the extent of sharing and reasons for sharing have received much attention, little is known about the order in which IDUs use shared equipment. However, if we are to succeed in eradicating the spread of blood-borne viruses via needlesharing, we need to know not just why needlesharing occurs, but who is most at risk when it does occur. A variety of factors have been proposed as determining eligibility for first use of a shared needle and syringe. These include gender (Barnard, 1993; Crofts and Hay, 1991; Marsh and Loxley, 1991) and contributing the most money or effort to obtain the drugs (Johnson and Williams, 1993; Zule, 1992) or the injecting equipment (Zule, 1992). Those who supply their home as a venue for injecting may also be rewarded with first use (Johnson and Williams, 1993). There is also evidence that those perceived to be in the lowest risk category inject first, while those who are HIV infected, or potentially so, inject last (Sharp et al., 1991). Others found to have last use include those who are unable to inject themselves (Zule, 1992) and "hangers on" who "contribute nothing to the acquisition of the drugs, but hope that by just being present, they will be invited to share the drugs" (Johnson and Williams, 1993: 1008-1009). In addition to these more objective factors, interpersonal considerations such as differences in self-efficacy and communication skills may also be important in determining the order of usage of shared injecting equipment (Gibson et al., 1993). Although previous research has been helpful in identifying a range of factors that may influence the order of injecting with a shared needle and syringe, these have been found in an ad hoc manner while researching other aspects of needle usage rather than from a systematic attempt to ascertain how IDUs determine precedence. The study reported here sought to cast light on this situation by establishing the full range of variables that IDUs themselves claim determine the order of use. Method Respondents Respondents were required to meet two eligibility criteria: (a) they had either shared a needle or been present when others were sharing and (b) the sharing incident(s) had taken place within the last 12 months. These criteria were determined after consultation with workers from some of the agencies at which respondents were recruited. It was thought that any further restrictions, such as limiting the study to those who had actually shared at some time or had shared very recently (e.g., within the last month), would render it impossible to obtain a large enough sample for this study. Recruitment was by means of brochures that outlined the aims of the research, detailed eligibility criteria, emphasized confidentiality, and offered a $20 interview payment. The brochures were distributed through drug treatment agencies, needle and syringe exchanges, community health centers, a sexually transmitted diseases clinic, youth agencies, and a pharmacy as well as peer agencies of IDUs and people affected by HIV/AIDS. A brief article that included information similar to that in the brochure was published in SA Voice for Intravenous Education (SAVIVE)'s quarterly newsletter, Pure S. While it was not possible to obtain a random sample of IDUs who would discuss their needlesharing practices, by recruiting respondents from this range of sources we hoped to obtain a sample of IDUs with a diverse range of injecting experiences. A total of 32 persons were interviewed for this study, including 13 females age 17-45, and 19 males age 21-43. …