Injecting drug users sharing equipment at last injection

Export Indicator

Percent of injecting drug users active in the last month who report sharing injecting equipment the last time they injected drugs
What it measures

Sharing of injecting equipment is both the biggest risk factor for HIV transmission among drug injectors, and the most common focus of interventions. While equipment sharing is now relatively uncommon in industrialised countries with long histories of preventative interventions among drug injectors, the same is not true of many of the countries in which drug injecting populations are exploding. This indicator measures progress in program efforts to reduce the most risky practice – the sharing of injecting equipment – among people who continue to inject drugs. It is especially valuable for tracking trends over time for programmes that support needle-exchange initiatives, or that work to improve easy access to safe injecting equipment.

Rationale
Numerator

Number of survey respondents who report sharing needles, syringes or other injecting equipment the last time they injected drugs

Denominator

All respodents reporting injecting behavior in the last month

Calculation
Method of measurement

In a behavioural survey among injecting drug users, respondents are asked about their injecting habits. Those that report sharing needles, syringes or other injecting equipment the last time they injected drugs in the last month form the numerator. The denominator is all respondents reporting injecting behaviour in the last month. Drug injecting practices vary from place to place. In order to capture as wide a range of risk injection as possible, questionnaires should specify all the locally relevant types of “equipment” that may result in the exchange of body fluids. These will include needles and syringes, but other paraphernalia such as “cooking” equipment can also become contaminated, depending on local drug preparation methods.

Measurement frequency
Disaggregation

Condom type: N/A

Education: N/A

Gender: N/A

Geographic location: N/A

HIV status: N/A

Pregnancy status: N/A

Sector: N/A

Service Type: N/A

Target: N/A

Time period: N/A

Type of orphan: N/A

Vulnerability status: N/A

Explanation of the numerator
Explanation of the denominator
Strengths and weaknesses

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 ways that are often unpredictable. It is therefore difficult to determine the extent to which those surveyed are representative of the larger population of injecting drug users. Where the representativeness of the sample is variable, trends over time will be hard to interpret. It is assumed that these surveys take place among people identified as members of a community of drug injectors. It is possible that, in response to HIV-related interventions, some injectors stop taking drugs entirely or switch to non-injected drugs. Since the indicator is designed to track changes in risky injecting practices over time among people who continue to inject drugs, people who cease to inject will not be included in the denominator for the indicator. Some education programmes have focused on sterilising needles between users. Users may continue to inject drugs and even share needles, but may sterilise between uses. It is, however, difficult to know the success of individual efforts to sterilise equipment. Experience in some settings has demonstrated that inadequate cleaning of equipment is common, and many programmes have ceased to promote equipment cleaning as a prevention method, preferring to concentrate efforts on putting an end to the sharing of injecting equipment. This indicator includes in its numerator of those with risky behaviour injecting drug users who sterilise, 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 centres may lead to dramatic changes in injecting practices over a very short period of time. The indicator does not attempt to look at consistency in avoiding needle sharing. It asks only about a single recent act of injection. This method minimises recall bias and has proved very robust in other areas such as condom use at last sex. Issues of consistency are covered by the next indicator, Injecting drug users never sharing equipment in the last month.

Further information