Interpersonal and structural factors associated with receptive syringe-sharing among a prospective cohort of female sex workers who inject drugs

Ju Nyeong Park, Katherine H.A. Footer, Michele R. Decker, Catherine Tomko, Sean T. Allen, Noya Galai, Susan G. Sherman

Research output: Contribution to journalArticlepeer-review


Aims: To determine the interpersonal and structural factors associated with receptive syringe sharing (RSS) among female sex workers who inject drugs (FSW-IDU), a group at high risk of HIV/hepatitis C virus (HCV) acquisition. Design: Sex workers And Police Promoting Health In Risky Environments (SAPPHIRE) study, a prospective cohort study. Setting: Baltimore, MD, USA. Participants: One hundred and eighty FSW-IDU; mean age = 33 years, 77.1% white and 62.9% in a relationship/married. Measurements: Surveys were conducted between April 2016 and February 2018. The main outcome was recent RSS (past 3 months). In addition to socio-demographic characteristics and drug use behaviors, we assessed factors at the interpersonal level, including injection practices, intimate partner and client drug use and exposure to violence. Structural-level factors included methods of syringe access. Findings: Nearly all FSW-IDU used heroin (97.1%) or crack cocaine (89.7%). Recent RSS was reported by 18.3%. Syringes were accessed from needle exchange programs (64.6%), pharmacies (29.7%), street sellers (30.3%) or personal networks (29.1%). Some FSW-IDU had clients or intimate partners who injected drugs (26.3 and 26.9%, respectively). Longitudinal factors independently associated with RSS in the multi-level mixed-effects model were recent client violence [adjusted odds ratio (aOR) = 2.17, 95% confidence interval (CI) = 1.09–4.33], having an intimate partner who injected drugs (aOR = 2.18, 95% CI = 0.98–4.85), being injected by others (aOR = 4.95, 95% CI = 2.42–10.10) and obtaining syringes from a street seller (aOR = 1.88, 95% CI = 0.94–3.78) or from a member of their personal network (aOR = 4.43, 95% CI = 2.21–8.90). Conclusions: Client violence, intimate partner injection drug use, being injected by others and obtaining syringes from personal connections appear to increase parenteral HIV/HCV risk among female sex workers who inject drugs.

Original languageEnglish
Pages (from-to)1204-1213
Number of pages10
Issue number7
StatePublished - Jul 2019

Bibliographical note

Publisher Copyright:
© 2019 Society for the Study of Addiction


  • HIV risk
  • injection drug use
  • intimate partners
  • sex work
  • substance use
  • women

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Medicine (miscellaneous)

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