Racial disparities in use of syringe service programs in King County, WA: a comparison of two cross-sectional surveys

Background Syringe service programs (SSPs) provide tools to people who inject drugs (PWID) to prevent overdose, reduce the risk of HIV and HCV infection, and reduce injection frequency. While effective, previous research suggests that SSPs may not adequately reach some marginalized or particularly vulnerable subpopulations of PWID. Methods To identify disparities in SSP use, data from two cross-sectional surveys conducted in King County, Washington were compared: a survey of SSP clients and a community survey of PWID in King County. It was hypothesized that Black PWID, women, and gender minorities would be underrepresented in the SSP survey relative to the general population of PWID. Results SSP clients identified as White at a significantly higher rate than the community sample of PWID ( p = 0.030). Black ( p < 0.001), American Indian/Alaska Native ( p < 0.001), Latinx/Hispanic ( p = 0.009), and Native Hawaiian/ Pacific Islander PWID ( p = 0.034) were underrepresented in the SSP client survey. The gender of SSP clients was similar to the distribution seen in the community sample of PWID ( p = 0.483). Conclusions Black PWID are underrepresented in Seattle-area SSPs, consistent with studies in other large US cities. Both nationally and in Seattle, overdose deaths have been increasing among Black PWID, and harm reduction strategies are vital to reversing this trend. SSPs should explore and test ways to be more accessible to minority populations.