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Clearer understanding of the correlates of receptive syringe\u2010sharing (RSS) is a critical step in preventing bloodborne infectious disease transmission among PWID in rural communities throughout the United States. This study aimed to measure the prevalence and correlates of RSS among PWID in a rural county in Appalachia.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Observational, cross\u2010sectional sample from a capture\u2013recapture parent study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Cabell County, West Virginia (WV), USA, June\u2013July 2018.<\/jats:p><\/jats:sec><jats:sec><jats:title>Participants<\/jats:title><jats:p>The sample was restricted to people who reported injecting drugs in the past 6\u00a0months (<jats:italic>n<\/jats:italic>\u00a0=\u00a0420). A total of 180 participants (43%) reported recent (past 6\u00a0months) RSS. Participants reported high levels of homelessness (56.0%), food insecurity (64.8%) and unemployment (66.0%).<\/jats:p><\/jats:sec><jats:sec><jats:title>Measurements<\/jats:title><jats:p>The main outcome was recent re\u2010use of syringes that participants knew someone else had used before them. Key explanatory variables of interest, selected from the risk environment framework, included: unemployment, arrest and receipt of sterile syringes from a syringe services program (SSP). Logistic regression was used to determine correlates of recent RSS.<\/jats:p><\/jats:sec><jats:sec><jats:title>Findings<\/jats:title><jats:p>PWID reporting recent RSS also reported higher prevalence of homelessness, food insecurity and unemployment than their non\u2010RSS\u2010engaging counterparts. In adjusted analyses, correlates of RSS included: engagement in transactional sex work [adjusted odds ratio (aOR) =\u00a02.27, 95% confidence interval (CI)\u00a0=\u00a01.26\u20134.09], unemployment (aOR\u00a0=\u00a01.67, 95% CI\u00a0=\u00a01.03\u20131.72), number of drug types injected (aOR\u00a0=\u00a01.33, 95% CI\u00a0=\u00a01.15\u20131.53) and injection in a public location (aOR\u00a0=\u00a02.59, 95% CI\u00a0=\u00a01.64\u20134.08). Having accessed sterile syringes at an SSP was protective against RSS (aOR\u00a0=\u00a00.57, 95% CI\u00a0=\u00a00.35\u20130.92).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The prevalence of receptive syringe\u2010sharing among people who inject drugs in a rural US county appears to be high and comparable to urban\u2010based populations. Receptive syringe\u2010sharing among people who inject drugs in a rural setting appears to be associated with several structural and substance use factors, including unemployment and engaging in public injection drug use. Having recently acquired sterile syringes at a syringe services program appears to be protective against receptive syringe sharing.<\/jats:p><\/jats:sec>","DOI":"10.1111\/add.15151","type":"journal-article","created":{"date-parts":[[2020,6,13]],"date-time":"2020-06-13T08:23:08Z","timestamp":1592036588000},"page":"328-336","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":28,"title":["Prevalence and correlates of receptive syringe\u2010sharing among people who inject drugs in rural Appalachia"],"prefix":"10.1111","volume":"116","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7894-4114","authenticated-orcid":false,"given":"Rebecca Hamilton","family":"White","sequence":"first","affiliation":[{"name":"Department of Health, Behavior, and Society, Bloomberg School of Public Health Johns Hopkins University  Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allison","family":"O'Rourke","sequence":"additional","affiliation":[{"name":"Department of Psychology; DC Center for AIDS Research George Washington University  Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael E.","family":"Kilkenny","sequence":"additional","affiliation":[{"name":"Cabell\u2010Huntington Health Department  Huntington WV USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristin E.","family":"Schneider","sequence":"additional","affiliation":[{"name":"Department of Mental Health, Bloomberg School of Public Health Johns Hopkins University  Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian W.","family":"Weir","sequence":"additional","affiliation":[{"name":"Department of Health, Behavior, and Society, Bloomberg School of Public Health Johns Hopkins University  Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suzanne M.","family":"Grieb","sequence":"additional","affiliation":[{"name":"Department of Health, Behavior, and Society, Bloomberg School of Public Health Johns Hopkins University  Baltimore MD USA"},{"name":"School of Medicine Johns Hopkins University  Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susan G.","family":"Sherman","sequence":"additional","affiliation":[{"name":"Department of Health, Behavior, and Society, Bloomberg School of Public Health Johns Hopkins University  Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sean T.","family":"Allen","sequence":"additional","affiliation":[{"name":"Department of Health, Behavior, and Society, Bloomberg School of Public Health Johns Hopkins University  Baltimore MD USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2020,7,14]]},"reference":[{"key":"e_1_2_8_2_1","volume-title":"Syringe Services Programs (SSPs)","author":"Centers for Disease Control and Prevention (CDC)","year":"2019"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(17)30375-3"},{"key":"e_1_2_8_4_1","volume-title":"HIV Infection, Risk, Prevention, and Testing Behaviors among Persons Who Inject Drugs\u2014National HIV Behavioral Surveillance: Injection Drug Use, 20 U.S. Cities, 2015","author":"Centers for Disease Control and Prevention (CDC)","year":"2018"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0097596"},{"key":"e_1_2_8_6_1","unstructured":"Centers for Disease Control and Prevention (CDC).HIV in the United States and Dependent Areas.Atlanta GA:CDC; April2020. 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