Percent of injecting drug users never sharing equipment in the last month

Percent of injecting drug users never sharing equipment in the last month

Percent of injecting drug users never sharing equipment in the last month

The percent of active injecting drug users surveyed who report never sharing injecting equipment during the last month

In a behavioral survey among injecting drug users, re­spondents are asked about their injecting habits. The indicator excludes those who report sharing needles, syringes, or other injecting equipment at any time in the last month. The denominator is all respondents re­porting injecting behavior in the last month.

Questionnaires should specify all the locally relevant types of “equipment“ that may result in the exchange of body fluids.

This indicator is calculated as:

(Number of active injecting drug users who report never sharing injecting equipment during the last month / Total number of respondents who report injecting behavior in the last month) x 100

Data Requirement(s):

Self-reported data from survey respondents

FHI BSS (injecting drug users)

Sharing injecting equipment between HIV-infected and uninfected drug injectors is an extraordinarily effective way of spreading HIV. Because the risk of contracting infection per single act of risky injection is so high, pro­grams must aim for a complete halt to this behavior, not just for a reduction in the sharing of equipment between drug users.

This indicator measures trends in consistently safe be­havior among drug users who continue to inject drugs.

As with all indicators measured among drug injectors, the biggest difficulty is access. Random sampling is all but impossible, and convenience samples are biased in often unpredictable ways. It is therefore difficult to de­termine the extent to which those surveyed represent the larger population of injecting drug users. Where the representativeness of the sample is variable, trends over time will be hard to interpret.

These surveys yield information from people identified as members of a community of drug injectors. In re­sponse to HIV-related interventions, some injectors may possibly stop taking drugs entirely or switch to non-injected drugs. Since the indicator tracks changes in risky injecting practices over time among people who continue to inject drugs, the denominator excludes people who cease to inject.

Some education programs have focused on sterilizing needles between users. Users may continue to inject drugs and even share needles, but may sterilize between uses. However, knowing the success of individual ef­forts to sterilize equipment is difficult. Experience in some settings has demonstrated that inadequate clean­ing of equipment is common, and many programs have ceased to promote equipment cleaning as a prevention method, preferring to concentrate efforts on ending to the sharing of injecting equipment. This indicator in­cludes in its numerator of those with risky behavior all injecting drug users who sterilize, but still share, their equipment.

Because it restricts those included in the indicator to those who have injected in the last month, this indica­tor is very sensitive to recent trends in injecting prac­tices. Countries with inconsistent policies supporting safe drug injection may see large variations in this indi­cator. Police crackdowns on users, distributors, or sup­port services such as needle exchange centers may lead to dramatic changes in injecting practices over a very short period of time.

In addition, the indicator is subject to high recall bias. Depending on the local drug scene, drug users may be injecting several times each day. Recalling the circum­stances of every act of injection over the past 30 days may be problematic.