Changes in behaviors among people who inject drugs in San Diego, California during the SARS-CoV-2 pandemic

Author: Jordan Killion, Daniela Abramovitz, Annick Borquez , Britt Skaathun, Heather Bradley, Steffanie Strathdee, Carlos Vera, Tara Stamos-Buesig, Natasha Martin

Theme: Epidemiology & Public Health Research Year: 2023

Background: The impact of the SARS-CoV-2 pandemic on risk environments among people who inject drugs (PWID) is uncertain. This study aims to identify how risk among PWID in San Diego changed during the SARS-CoV-2 pandemic.

Methods: Data were obtained from participants in a longitudinal study of PWID, which enrolled PWID in San Diego (SD), California and Tijuana (TJ), Mexico, from October 2020 to October 2021. Cross-border drug users (CBDU) were specifically sampled, which are PWID from SD who crossed the border to inject in TJ, and their classification was established at baseline. This analysis was restricted to participants who resided in SD and who had a follow-up visit 12 months after enrollment. Adjusted negative binomial regressions were used to examine if there were changes in injecting behaviors and harm reduction access between baseline and the 12-month follow-up. Each outcome was modeled separately and adjusted for covariates based on the literature.

Results: Of 336 PWID enrolled in SD who had at least one follow-up, 76% were male, mean age was 43 years and 56% were CBDU. Between baseline and 12-month follow-up, PWID reported a decrease in receptive syringe use (adjusted Relative risk (aRR): 0.40, 0.28-0.56). There was an increase in accessing syringe services programs (SSPs) with a more pronounced uptake among non-CBDU (non-CBDU aRR: 6.42, 3.79-10.87; CBDU aRR: 3.07, 1.51-6.22). Injecting heroin decreased among those that reported smoking fentanyl at baseline (aRR: 0.78, 0.64-0.96).

Conclusion: During the SARS-CoV-2 pandemic, increased access to SSP and decreases in syringe sharing coincided with the initiation of a mobile SSP van in San Diego. Reductions in injecting among those smoking fentanyl mirror shifts observed in other U.S. settings. A better understanding of the determinants of risk reduction during this period will help inform harm reduction services for mobile PWID. 

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