SUPPLEMENT ARTICLE Correlates of Lending Needles/Syringes Among HIV-Seropositive Injection Drug Users Lisa R. Metsch, PhD,* Margaret Pereyra, DrPH,* David W. Purcell, JD, PhD,† Carl A. Latkin, PhD,‡ Robert Malow, PhD,§ Cynthia A. Go ´mez, PhD, k and Mary H. Latka, PhD¶ for the INSPIRE Study Team Summary: Among HIV-positive injection drug users (IDUs), we examined the correlates of lending needles/syringes with HIV- negative and unknown status injection partners. HIV-positive IDUs (N = 738) from 4 cities in the United States who reported injection drug use with other IDUs in the past 3 months participated in an audio computer-assisted self-administered interview. Eighteen percent of study participants self-reported having lent their needles to HIV- negative or unknown status injection partners. Multivariate analyses showed that 6 variables were significantly associated with this high- risk injecting practice. Older IDUs, high school graduates, and those reporting more supportive peer norms for safer drug use were less likely to lend needles/syringes. Admission to a hospital for drug treat- ment in the past 6 months, having injected with .1 person in the past 3 months, and having more psychiatric symptoms were all associated with more risk. These findings underscore the need for a continued prevention focus on HIV-positive IDUs that recognizes the com- bination of drug use, mental health factors, and social factors that might affect this high-risk injecting practice, which could be associated with HIV and hepatitis C transmission. Key Words: HIV, injection drug use, injection drug use equipment, injection risk behavior, seropositive (J Acquir Immune Defic Syndr 2007;46:S72–S79) I njection drug use continues to contribute to the global HIV epidemic, including in the United States, where approxi- mately one third of all new HIV cases are related to injection drug use. 1,2 Injection practices associated with HIV trans- mission among injection drug users (IDUs) include sharing of needles/syringes and drug use equipment such as cookers, cottons, and rinse water. Researchers have focused on the correlates of these risk behaviors since the beginning of the epidemic in the United States in cross-sectional studies with HIV-negative and HIV-positive injectors 3–6 and in cohort studies that examined risk factors for seroincidence for HIV and other infectious diseases. 7–10 Factors associated with unsafe injection practices include individual characteristics, drug use history, psychosocial characteristics, and health care services factors. 11–15 Age 16–18 and type of drug injected have also been demonstrated as risk factors for HIV seroconversion in previous cohort studies with IDUs. 19 Fewer studies have specifically focused on lending needles/syringes with HIV-negative and unknown status part- ners. The studies conducted have shown that after an HIV- positive test result or an AIDS-related illness, IDUs tend to reduce their injection risk behaviors but that some continue to engage in high-risk behaviors. 20–28 For HIV-positive IDUs, the most serious injection risk behaviors are those that involve lending needles/syringes with HIV-negative and unknown status partners. In a series of cross-sectional studies conducted in New York City from 1990 to 2001, Des Jarlais and col- leagues 29 reported that IDUs who knew they were HIV- positive were significantly less likely to report lending of needles/syringes than their HIV-negative counterparts. The authors characterized this behavior as ‘‘informed altruism.’’ They also found that when there were not sufficient needles and syringes for everyone in a group setting, the HIV-negative individuals were allowed to inject first, followed by the HIV- positive individuals. Unfortunately, there may be a sizeable number of HIV- positive IDUs who are aware of their HIV-positive serostatus, but continue to engage in lending needles/syringes to HIV- negative and unknown status partners. Within this context, the present study examined the correlates of HIV-positive persons who engaged in high-risk injection practices (ie, lending needles/syringes to HIV-negative and unknown status partners). Individual, drug use, psychosocial, and health services factors potentially associated with these behaviors were investigated. METHODS This analysis used baseline data from a randomized controlled trial of a 10-session HIV prevention intervention designed for HIV-positive IDUs (Intervention for Seropositive Received for publication July 20, 2006; accepted August 3, 2007. From the *Department of Epidemiology and Public Health, Leonard M. Miller School of Medicine, University of Miami, Miami, FL; †Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA; ‡Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD; §Department of Health Promotion and Disease Prevention, Stempel School of Public Health, Florida International University, Miami, FL; k Department of Medicine, University of California at San Francisco, San Francisco, CA; and the {Center for Urban Epidemiologic Studies, New York Academy of Medicine, New York, NY. Supported by the Centers for Disease Control and Prevention and the Health Resources and Services Administration. The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention. The authors report no conflicts of interest in connection with this article. Correspondence to: Lisa R. Metsch, PhD, Department of Epidemiology and Public Health, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Suite 917, Miami, FL 33136 (e-mail: lmetsch@med.miami.edu). Copyright Ó 2007 by Lippincott Williams & Wilkins S72 J Acquir Immune Defic Syndr  Volume 46, Supplement 2, November 1, 2007 Copyright © Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.