This study examined factors associated with people who inject drugs (PWID) receiving injection assistance from others in Los Angeles and San Francisco between 2011-2013. The sample included 777 active PWID, defined as injecting in the last 30 days. 23% reported receiving injection assistance in the last 30 days. Multivariate analysis found that occasionally injecting with others, being injected by another at first injection, non-injection methamphetamine use, providing injection assistance to others, and having a casual sex partner who is a PWID were independently associated with receiving injection assistance. Receiving assistance could elevate risks of transmitting HIV and HCV. Interventions may need to provide safer injection training or alternative administration methods for those needing assistance.

1. Correlates of receiving injection assistance among people who inject drugs in Los Angeles
and San Francisco, CA, 2011-13.
Karina Dominguez Gonzalez1, Alex H. Kral2, Shona Lamb3, Lynn Wenger2, Ricky N. Bluthenthal1
(1) Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA;
(2) Urban Health Program, RTI International, San Francisco, CA; (3) Keck School of Medicine, University of Southern California, Los Angeles, CA
• Active PWID (N = 777) were recruited using targeted
sampling methods in Los Angeles and San Francisco, CA
between April 2011- April 2013.
• Interviewers administered a survey that included
demographics, drug use history, and injection practices.
• Descriptive statistics were examined for all study
variables.
• Bivariate comparison of categorical variables used chi-
square test and continuous variables used t-test to
assess statistical significance, set at p < 0.05.
• Multivariate analysis used logistic regression to
determine variables independently associated with
having received injection assistance in the last 30 days.
Background
Purpose
Results
Discussions
• People who inject drugs (PWID) are at an elevated risk
for HIV, HCV, skin and soft tissue infections, overdose,
sexually transmitted infections, and mental health
disorders among other health problems.
• Peer-to-peer injection, defined as giving or receiving an
injection to/from someone else, has been reported to
range from 19% - 49% among PWID.
• Receiving assistance injecting drugs has been
associated with HIV risk and incidence among PWID.
• Needing assistance with injection may inhibit the
effectiveness of HIV/HCV prevention strategies such as
syringe exchange program and safer injection facilities
that assume that PWID can safely and consistently
inject themselves.
• To describe factors associated with receiving injection
assistance among active (in the last 30 days) PWID.
• Receiving injections assistance from other PWID could
elevate risk for HIV and HCV.
• Interventions such as syringe exchange programs and
safer injection facilities may not be sufficient to reduce
blood borne infectious disease risk among this
subpopulation.
• Training in safer injection or route administration
interventions appear needed for this subpopulation.
Conclusions
• Life events (e.g., needing help at first injection), social
and sexual networks (e.g. injecting with others and
having a casual PWID sexual partner), and drug use
characteristics (e.g., non-injection methamphetamine
use) were associated with needing assistance injecting
in the last 30 days.
• Study limitations include self-reported data which may
be subject to recall biases and social desirable
responding. The sample may not be representative of
PWID in Los Angeles and San Francisco, CA.
• Causality is unable to be determined due to the cross-
sectional study design.
• Providing assisted injections in the last 30 days was reported by 23%
(N = 182) of participants.
• The sample was diverse with 26% female, 50% ≥ 50 years old, 34% white,
30% African American, and 25% Latino. 51% were recruited in Los
Angeles. Study participants were low income with 81% reporting a total
monthly income of <$1,350 and 62% were homeless.
Table 1: Selected characteristics by receiving injection assistance in the last 30 days.
Table 2: Multivariate analysis of factors associated with receiving injection assistance
in the last 30 days (N = 777).
For further information, contact: Ricky Bluthenthal, Ph.D.
Institute for Prevention Research, Department of
Preventive Medicine 2001 N. Soto Street, 3rd Floor, MC
9239, Los Angeles, CA 90033
Phone: (323) 442-8236; Email: rbluthen@usc.edu
Acknowledgements
Contact Information
• Research supported by NIDA (grant # RO1DA027689:
Program Official, Elizabeth Lambert).
• The authors have no conflicts of interest to disclose.
Variable Adjusted Odds
Ratio
95% Confidence
Interval
Occasionally injecting with others,
last 30 days
Injected by another at first injection
Non-injection methamphetamine
use, last 30 days
Provided injection assistance, last 30
days
Any casual sex partner was PWID,
last 6 months
3.37
3.02
2.52
1.73
1.58
1.74, 2.41
1.61, 5.68
1.72, 3.67
1.19, 2.50
1.04, 2.41
Data Collection and Analysis
Variable Total
(N = 777)
N (%)
Received injection
assistance, last 30 d.
(N = 182) N (%)
P =
Homeless
Gay, lesbian, or bisexual
Years of injection
<10 years
10 to 19 years
20 years or more
Steady sex partner is PWID, last 6 mos
Casual sex partner is PWID, last 6 mos
Non-injection meth use, last 30 days
Injected meth use, last 30 days
Frequency of injecting with others
Occasionally or more
Provided injection assistance, last 30 d
Distributive syringe sharing, last 30 d
483 (62%)
117 (15%)
126 (16%)
128 (16%)
522 (67%)
212 (27%)
139 (18%)
192 (25%)
290 (37%)
627(81%)
215 (28%)
114 (15%)
126 (69%)
37 (20%)
38 (21%)
35(19%)
109 (60%)
66 (36%)
51 (28%)
75 (41%)
97 (53%)
171 (94%)
75 (41%)
40 (22%)
0.02
0.03
0.05
0.003
0.001
0.001
0.001
0.001
0.001
0.003