Syringe exchange programs have become standard approaches to HIV prevention for injection drug users in many communities in the US. Early research on needle exchange program reported strong protective effects against injection risk behavior and infection with blood-borne viruses 1-4. Several recent studies, however, have reported negative or null effects of the programs 5-7. Our analysis of the RAVEN Study (an epidemiologic study of the Seattle Needle Exchange) did not show a protective effect of the program against hepatitis B virus (HBV) or hepatitis C virus (HCV) infection 8. In fact, incidence was highest among users of the exchange. In this continuation of RAVEN, we propose to further study factors that may be working against the needle exchange in prevention of HIV and other blood-borne viruses.
The specific aims of the continuation are: 1. Examine time-related influences on the association between needle exchange and HIV risk. We will follow a fixed cohort of 850 RAVEN participants for an additional two years, and, using the method of birth cohort' analysis, study whether the apparent effect of the exchange has been influenced by changes in the prevalence of risk behavior, migration of low-risk IDUs out of the needle exchange, or by the waning of a cohort-effect that led to more substantial effects in early years of exchange operations. 2. Systematically assess linkages to high-prevalence populations as a risk factor for HIV infection among Seattle area injectors. We will monitor targeted IDU groups who inject in the company of or have sexual contact with members of high HIV-prevalence populations to detect changes in HIV infection. 3. Evaluate the impact of needle exchange operations characteristics on factors associated with the risk of blood borne viruses. The needle exchange environment and operations will be studied in detail to understand whether other factors at work in the vicinity of the exchange, or service-delivery aspects of the program impede the ability of some IDUs to benefit from needle exchange. The significance of this research will be to understand more fully what is accomplished by needle exchange, and what may be needed to achieve better results.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Research Project (R01)
Project #
2R01DA008023-06
Application #
2649765
Study Section
Human Development Research Subcommittee (NIDA)
Project Start
1993-04-01
Project End
2000-06-30
Budget Start
1998-03-10
Budget End
1999-02-28
Support Year
6
Fiscal Year
1998
Total Cost
Indirect Cost
Name
Seattle-King County Public Health Department
Department
Type
DUNS #
City
Seattle
State
WA
Country
United States
Zip Code
98104
Burt, Richard D; Hagan, Holly; Sabin, Keith et al. (2010) Evaluating respondent-driven sampling in a major metropolitan area: Comparing injection drug users in the 2005 Seattle area national HIV behavioral surveillance system survey with participants in the RAVEN and Kiwi studies. Ann Epidemiol 20:159-67
Brewer, Devon D; Hagan, Holly; Hough, Eileen S (2008) Improved injection network ascertainment with supplementary elicitation techniques. Int J STD AIDS 19:188-91
Burt, Richard D; Hagan, Holly; Garfein, Richard S et al. (2007) Trends in hepatitis B virus, hepatitis C virus, and human immunodeficiency virus prevalence, risk behaviors, and preventive measures among Seattle injection drug users aged 18-30 years, 1994-2004. J Urban Health 84:436-54
Brewer, Devon D; Hagan, Holly; Sullivan, Daniel G et al. (2006) Social structural and behavioral underpinnings of hyperendemic hepatitis C virus transmission in drug injectors. J Infect Dis 194:764-72
Zunt, Joseph R; Tapia, Ken; Thiede, Hanne et al. (2006) HTLV-2 infection in injection drug users in King County, Washington. Scand J Infect Dis 38:654-63
Hagan, Holly; Thiede, Hanne; Des Jarlais, Don C (2004) Hepatitis C virus infection among injection drug users: survival analysis of time to seroconversion. Epidemiology 15:543-9
Perdue, Thomas; Hagan, Holly; Thiede, Hanne et al. (2003) Depression and HIV risk behavior among Seattle-area injection drug users and young men who have sex with men. AIDS Educ Prev 15:81-92
Hagan, Holly; Snyder, Nadine; Hough, Eileen et al. (2002) Case-reporting of acute hepatitis B and C among injection drug users. J Urban Health 79:579-85
Hagan, H; Thiede, H; Weiss, N S et al. (2001) Sharing of drug preparation equipment as a risk factor for hepatitis C. Am J Public Health 91:42-6
O'Driscoll, P T; McGough, J; Hagan, H et al. (2001) Predictors of accidental fatal drug overdose among a cohort of injection drug users. Am J Public Health 91:984-7

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