October 2021 Client Characteristics Research Brief

Client characteristics associated with desire for additional services at syringe exchange programs
Daschel J. Franz, M.Ed. and Camille C. Cioffi, Ph.D.

Link To ARticleDownload PDF

In North America, about 2.6 million people inject drugs. Of those, about 30% are women who inject drugs (WWID). WWID have higher rates of death and human immunodeficiency virus (HIV) and tend to engage in higher levels of risky injection and sexual risk behaviors compared to their male counterparts. Compared to women in the general population, WWID are more likely to experience intimate partner violence and loss of custody of a child. Further, WWID are more likely to experience stigma and unintended pregnancies. WWID tend to have complex health needs, yet, WWID tend to underuse health care services outside of emergency services. Additionally, WWID tend to underuse basic needs services such as food, housing, and employment services. 

Syringe exchange programs (SEPs) use harm reduction strategies that reduce the risk of overdose and the spread of HIV. In 2014, there were about 204 SEPs in the United States. Many of these SEPs provided HIV counseling and HIV and hepatitis C and B testing services. Less than half of these SEPs offered sexually transmitted infection testing services or basic needs services such as food distribution services. Further, many of these services were inconsistently offered across SEPs. There are opportunities to leverage SEPs to implement strategies to address unmet needs for WWID. There is little research that examines how client characteristics (e.g., age, education, housing status, polysubstance use, previous pregnancies) relate to desired services at SEPs among WWID. As a result, understanding the individual characteristics of WWID is critical to improving service access and delivery for this population.

This brief reports on a recent study in which 69 women who were syringe exchange clients completed a survey about adding services to SEPs. The study investigated whether a desire for additional services at SEPs varied as a function of client characteristics.


  • The most requested services were: hygiene products (e.g., tampons, wipes), help accessing local resources, and help applying for welfare benefits (e.g., social security)
  • If a client injected multiple substances, they desired a greater number of services
  • For every additional past pregnancy, clients desired 1.14 times more services.
  • Those who inject multiple substances desired a greater number of basic needs services.

Policymakers, clinical professionals, and case managers should consider leveraging SEP sites to provide additional services for WWID. In doing so, SEP sites may be able to provide some of the unmet health-related and basic needs services of WWID. Our findings showed that WWID desire additional services at SEP sites. These services include hygiene products and help accessing local and financial resources.

Given our findings, polysubstance use and pregnancy history are important client characteristics. As a result, they should be considered to inform the types of services offered at SEP sites. Further, these client characteristics should be considered when referring clients to community organizations. These considerations will help ensure that needed services are tailored and accessible to SEP clients. Our results suggest a need for state and local policymakers to provide adequate funding to SEPs. This will enable SEPs to offer additional health-related and basic needs services to WWID.

Franz, D. J. & Cioffi, C. C. (2021). Client characteristics associated with desire for additional services at syringe exchange programs. Journal of Substance Use. DOI: 10.1080/14659891.2021.1967486

Franz, D. J. & Cioffi, C. C. (2021). Client characteristics associated with desire for additional services at syringe exchange programs. CPO Research Brief. DOI: 10.1080/14659891.2021.1967486

Daschel Franz
, M.Ed., is a doctoral student in the Counseling Psychology program at the University of Oregon;
Camille Cioffi, Ph.D., is a research associate at the University of Oregon Prevention Science Institute.

The authors express gratitude to the community-based SEP for their early collaboration and contributions to this work. We would also like to thank Dr. John R. Seeley for providing funding for participant incentives.  The writing of this brief and the manuscript was supported by the National Institute on Drug Abuse of the National Institutes of Health [P50DA048756].