Skip to main content
American Journal of Public Health logoLink to American Journal of Public Health
. 2001 Mar;91(3):406–411. doi: 10.2105/ajph.91.3.406

Selective risk taking among needle exchange participants: implications for supplemental interventions.

T W Valente 1, D Vlahov 1
PMCID: PMC1446573  PMID: 11236405

Abstract

OBJECTIVES: This study characterized social network context of HIV risk behavior among injection drug users who participated in a needle exchange program. METHODS: Interviews were conducted with 1184 injection drug users at the Baltimore Needle Exchange Program enrolled in an evaluation cohort. Analysis consisted of multiple logistic regression with statistical adjustment for the interdependence of observations. RESULTS: Of the 203 (17.1%) injection drug users who reported using a syringe after someone else, 78.3% reported sharing with close friends, and the adjusted odds ratio of any sharing and sharing with close friends was 30.9. Injection drug users were more likely to report sharing with a strong-tie close friend (adjusted odds ratio = 1.52) and less likely to report sharing with other close friends if those friends were weak ties and new to their network. Friendship ties were not stable, with fewer than 30% of the friends being repeat nominations. CONCLUSIONS: These data show that many injection drug users engage in selective risk taking that may minimize their disease risk exposure in the short term. The turnover in networks, however, suggests that programs need to emphasize the importance of exclusive use.

Full Text

The Full Text of this article is available as a PDF (89.3 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aral S. O., Hughes J. P., Stoner B., Whittington W., Handsfield H. H., Anderson R. M., Holmes K. K. Sexual mixing patterns in the spread of gonococcal and chlamydial infections. Am J Public Health. 1999 Jun;89(6):825–833. doi: 10.2105/ajph.89.6.825. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Burris S., Finucane D., Gallagher H., Grace J. The legal strategies used in operating syringe exchange programs in the United States. Am J Public Health. 1996 Aug;86(8):1161–1166. doi: 10.2105/ajph.86.8_pt_1.1161. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Connors M. M. Risk perception, risk taking and risk management among intravenous drug users: implications for AIDS prevention. Soc Sci Med. 1992 Mar;34(6):591–601. doi: 10.1016/0277-9536(92)90187-u. [DOI] [PubMed] [Google Scholar]
  4. Des Jarlais D. C., Friedmann P., Hagan H., Friedman S. R. The protective effect of AIDS-related behavioral change among injection drug users: a cross-national study. WHO Multi-Centre Study of AIDS and Injecting Drug Use. Am J Public Health. 1996 Dec;86(12):1780–1785. doi: 10.2105/ajph.86.12.1780. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Firlik A. D., Schreiber K. AIDS prevention by needle exchange. N Y State J Med. 1992 Oct;92(10):426–430. [PubMed] [Google Scholar]
  6. Friedman S. R., Neaigus A., Jose B., Curtis R., Goldstein M., Ildefonso G., Rothenberg R. B., Des Jarlais D. C. Sociometric risk networks and risk for HIV infection. Am J Public Health. 1997 Aug;87(8):1289–1296. doi: 10.2105/ajph.87.8.1289. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Jones T. S., Vlahov D. Use of sterile syringes and aseptic drug preparation are important components of HIV prevention among injection drug users. J Acquir Immune Defic Syndr Hum Retrovirol. 1998;18 (Suppl 1):S1–S5. doi: 10.1097/00042560-199802001-00002. [DOI] [PubMed] [Google Scholar]
  8. Klovdahl A. S., Potterat J. J., Woodhouse D. E., Muth J. B., Muth S. Q., Darrow W. W. Social networks and infectious disease: the Colorado Springs Study. Soc Sci Med. 1994 Jan;38(1):79–88. doi: 10.1016/0277-9536(94)90302-6. [DOI] [PubMed] [Google Scholar]
  9. Klovdahl A. S. Social networks and the spread of infectious diseases: the AIDS example. Soc Sci Med. 1985;21(11):1203–1216. doi: 10.1016/0277-9536(85)90269-2. [DOI] [PubMed] [Google Scholar]
  10. Koopman J. S., Lynch J. W. Individual causal models and population system models in epidemiology. Am J Public Health. 1999 Aug;89(8):1170–1174. doi: 10.2105/ajph.89.8.1170. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Latkin C., Mandell W., Oziemkowska M., Vlahov D., Celentano D. The relationships between sexual behavior, alcohol use, and personal network characteristics among injecting drug users in Baltimore, Maryland. Sex Transm Dis. 1994 May-Jun;21(3):161–167. doi: 10.1097/00007435-199405000-00006. [DOI] [PubMed] [Google Scholar]
  12. Laumann E. O., Youm Y. Racial/ethnic group differences in the prevalence of sexually transmitted diseases in the United States: a network explanation. Sex Transm Dis. 1999 May;26(5):250–261. doi: 10.1097/00007435-199905000-00003. [DOI] [PubMed] [Google Scholar]
  13. Magura S., Grossman J. I., Lipton D. S., Siddiqi Q., Shapiro J., Marion I., Amann K. R. Determinants of needle sharing among intravenous drug users. Am J Public Health. 1989 Apr;79(4):459–462. doi: 10.2105/ajph.79.4.459. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Mandell W., Vlahov D., Latkin C., Oziemkowska M., Cohn S. Correlates of needle sharing among injection drug users. Am J Public Health. 1994 Jun;84(6):920–923. doi: 10.2105/ajph.84.6.920. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Morris M., Podhisita C., Wawer M. J., Handcock M. S. Bridge populations in the spread of HIV/AIDS in Thailand. AIDS. 1996 Sep;10(11):1265–1271. doi: 10.1097/00002030-199609000-00013. [DOI] [PubMed] [Google Scholar]
  16. Morris M. Sexual networks and HIV. AIDS. 1997;11 (Suppl A):S209–S216. [PubMed] [Google Scholar]
  17. Neaigus A., Friedman S. R., Curtis R., Des Jarlais D. C., Furst R. T., Jose B., Mota P., Stepherson B., Sufian M., Ward T. The relevance of drug injectors' social and risk networks for understanding and preventing HIV infection. Soc Sci Med. 1994 Jan;38(1):67–78. doi: 10.1016/0277-9536(94)90301-8. [DOI] [PubMed] [Google Scholar]
  18. Rothenberg R. B., Sterk C., Toomey K. E., Potterat J. J., Johnson D., Schrader M., Hatch S. Using social network and ethnographic tools to evaluate syphilis transmission. Sex Transm Dis. 1998 Mar;25(3):154–160. doi: 10.1097/00007435-199803000-00009. [DOI] [PubMed] [Google Scholar]
  19. Valente T. W., Watkins S. C., Jato M. N., van der Straten A., Tsitsol L. P. Social network associations with contraceptive use among Cameroonian women in voluntary associations. Soc Sci Med. 1997 Sep;45(5):677–687. doi: 10.1016/s0277-9536(96)00385-1. [DOI] [PubMed] [Google Scholar]
  20. Vlahov D., Junge B., Brookmeyer R., Cohn S., Riley E., Armenian H., Beilenson P. Reductions in high-risk drug use behaviors among participants in the Baltimore needle exchange program. J Acquir Immune Defic Syndr Hum Retrovirol. 1997 Dec 15;16(5):400–406. doi: 10.1097/00042560-199712150-00014. [DOI] [PubMed] [Google Scholar]
  21. Woodhouse D. E., Rothenberg R. B., Potterat J. J., Darrow W. W., Muth S. Q., Klovdahl A. S., Zimmerman H. P., Rogers H. L., Maldonado T. S., Muth J. B. Mapping a social network of heterosexuals at high risk for HIV infection. AIDS. 1994 Sep;8(9):1331–1336. doi: 10.1097/00002030-199409000-00018. [DOI] [PubMed] [Google Scholar]

Articles from American Journal of Public Health are provided here courtesy of American Public Health Association

RESOURCES