Syringe sharing significantly increases the risk of HIV and viral hepatitis acquisition among people who inject drugs (PWID). Better understanding correlates of receptive syringe sharing (RSS) is a critical step in preventing bloodborne infectious disease transmission among PWID in rural communities throughout the United States. This study aimed to measure the prevalence and correlates of RSS among PWID in a rural county in Appalachia DESIGN: Observational, cross-sectional sample from a capture-recapture parent study.
Cabell County, West Virginia (WV), USA, June-July 2018.
Sample was restricted to people who reported injecting drugs in the past 6 months (n=420). A total of 180 participants (43%) reported recent (past 6 months) RSS. Participants reported high levels of homelessness (56%), food insecurity (65%), and unemployment (66%).
The main outcome was recent reuse of syringes that participants knew someone else had used before them. Key explanatory variables of interest, selected from the risk environment framework, included: unemployment, arrest, and receipt of sterile syringes from a syringe services program (SSP). Logistic regression was used to determine correlates of recent RSS.
PWID reporting recent RSS also reported higher prevalence of homelessness, food insecurity, and unemployment than their non-RSS-engaging counterparts. In adjusted analyses, correlates of RSS included: engagement in transactional sex work (adjusted odds ratio [aOR] 2.27, 95% CI: 1.26-4.09), unemployment (aOR 1.67, 95% CI: 1.03-1.72), number of drug types injected (aOR 1.33, 95% CI: 1.15-1.53), and injection in a public location (aOR 2.59, 95% CI: 1.64-4.08). Having accessed sterile syringes at a SSP was protective against RSS (aOR 0.57, 95% CI: 0.35-0.92).
The prevalence of receptive syringe sharing among people who inject drugs (PWID) in a rural US county appears to be high and comparable to urban-based populations. Receptive syringe sharing among PWID in a rural setting appears to be associated with several structural and substance use factors, including unemployment and engaging in public injection drug use. Having recently acquired sterile syringes at a syringe services program appears to be protective against receptive syringe sharing.

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