International Journal of Drug Policy 21 (2010) 507–510 Contents lists available at ScienceDirect International Journal of Drug Policy journal homepage: www.elsevier.com/locate/drugpo Short report Correlates of sharing injection equipment among male injecting drug users in Kathmandu, Nepal Krishna C. Poudel a,* , Kalpana Poudel-Tandukar b , Junko Yasuoka a , Anand B. Joshi c , Masamine Jimba a a Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan b Department of Epidemiology and International Health, Research Institute, International Medical Center of Japan, Japan c Institute of Medicine, Tribhuvan University, Kathmandu, Nepal article info Article history: Received 17 August 2009 Received in revised form 14 January 2010 Accepted 16 March 2010 Keywords: Injecting drug use Sharing injection equipment HIV prevention Nepal abstract Background: HIV prevalence is high and risky injection practices occur frequently among injecting drug users (IDUs) in Nepal. We explored the correlates of sharing injection equipment (having injected with a needle or syringe previously used by another) among male IDUs in Kathmandu, Nepal. Methods: From August to September 2007, we anonymously interviewed 296 male IDUs in Kathmandu, Nepal, using a structured questionnaire. We performed bivariate and multivariable logistic regression analysis and identified variables associated with sharing injection equipment. Results: Over half (n = 152) of the participants reported injecting drugs with a needle or syringe previously used by another in the past year. Of these, 70% reported engaging in sharing injection equipment with multiple persons. The unavailability of new needles and drinking alcohol were independently associated with sharing injection equipment among the study participants. Conclusions: IDUs who drank alcohol or who could not obtain new needles when needed were more likely to share injection equipment. Our results suggest that reducing alcohol use and increasing the availability of new needles and syringes might improve safer injection practices among male IDUs in Kathmandu, Nepal. © 2010 Elsevier B.V. All rights reserved. Introduction A considerable proportion of HIV infections in Nepal, a resource- poor country in South Asia, occur among injecting drug users (IDUs). According to the Nepalese Ministry of Health and Population (2009), IDUs accounted for about 18% of all reported HIV infections as of 14 May 2009. In Kathmandu, the capital city of the country, HIV prevalence among IDUs increased from 1.6% in 1991 (Ministry of Health & Population, 2007) to 59.7% in 2002 (FHI/New ERA/SACTS, 2002). Although HIV prevalence declined to 34.7% in 2007 (FHI/New ERA/SACTS, 2008), IDUs are the subgroup of the population that has the highest HIV prevalence in Nepal. To reduce the risk of HIV infection among IDUs, Nepal adopted a harm reduction strategy in the early 1990s. In 1991, a non-governmental organization (NGO) began a harm reduction programme of distributing sterile injection equipment in exchange for contaminated equipment among IDUs in Kathmandu (Peak, Rana, Maharjan, Jolley, & Crofts, 1995; Singh, 1998). Over a three- year period, HIV prevalence remained low (1.6% in 1991 and 0% in 1994) and unsafe injection practices fell among IDUs in regular * Corresponding author. Tel.: +81 3 5841 3698; fax: +81 3 5841 3422. E-mail addresses: krishna@m.u-tokyo.ac.jp, kcpoudel@hotmail.com (K.C. Poudel). contact with this programme (Peak et al., 1995). Despite the continuation of the harm reduction programme, the practice of sharing injection equipment was common among male IDUs in Kathmandu, particularly after 2000. A study in 2002 reported that 46% of the 303 male IDUs in the study shared needles in the past week; 38% shared them with multiple persons (FHI/New ERA/SACTS, 2002). A study in 2007 found that only 12% of the 300 male IDUs shared needles in the past week. However, in the same period, 40% shared injection tools and 54% shared containers for drawing the solution (FHI/New ERA/SACTS, 2008). Despite these numbers, little attention has been paid to examining the corre- lates of sharing injection equipment among IDUs in Kathmandu. Such information would be useful to the design of specific HIV prevention interventions. Therefore, the objective of this study was to explore the corre- lates of sharing injection equipment (having injected with a needle or syringe previously used by another) among male IDUs in Kath- mandu, Nepal. Methods Participants The participants in this study were male IDUs residing in Kath- mandu and Lalitpur districts in the Kathmandu Valley of Nepal. 0955-3959/$ – see front matter © 2010 Elsevier B.V. All rights reserved. doi:10.1016/j.drugpo.2010.03.006