Year of Publication



Public Health

Degree Name

Master of Public Health (M.P.H.)

Committee Chair

Dr. April Young

Committee Member

Dr. Jennifer Havens

Committee Member

Dr. Rachel Vickers-Smith


Aim: To describe the prevalence of secondary syringe exchange (SSE) in a sample of syringe service program (SSP) clients in rural Appalachian Kentucky and to identify the correlates of SSE.

Methods: Participants (n=338) completed interviewer-administered questionnaires. Only those who reported having ever exchanged syringes at a SSP (n=140) were included in analysis. SSE was measured through self-report of obtaining syringes for someone else at a SSP in the past 6 months. Prevalence and correlates of SSE were examined using bivariate analysis and multiple logistic regression.

Results: Overall, 30% of participants reported SSE. Participants in the second [aOR= 3.83; 95% CI: 1.15-12.72] and third [aOR= 4.64; 95% CI: 1.33-16.26] tertiles of degree centrality had higher odds of SSE, controlling for gender, age, frequency of injection. Participants in the second [aOR= 2.99; 95% CI: 0.93-9.66] and third [aOR 3.92; 95% CI: 1.29-11.96] tertiles of betweenness also had higher odds of SSE, controlling for gender, age, frequency of injection.

Conclusions: Nearly one third of SSP clientele reported SSE. Network centrality was associated with SSE participation. Based on our findings, SSE should be promoted in SSPs, especially among highly connected PWID. Subsequently, the influence of harm reduction programs could be expanded.

Available for download on Saturday, April 22, 2023