Adverse childhood experiences, resilience, and syringe services program attendance among persons who inject drugs in Northeast Georgia, USA: A mediation analysis

Background: Syringe services programs (SSP) are evidence-based venues offering harm reduction services to persons who inject drugs (PWID), such as sterile syringes, STI/HIV testing, and linkage to care to decrease drug use-related morbidities and mortalities. Adverse childhood experiences (ACEs) have been linked with reduced resilience, while increased resilience can help PWID attend SSPs. This study examined the potential mediating role of resilience between ACEs and SSP attendance among PWID.

Methods: Data were collected from adult HIV-negative PWID in northeast Georgia, between February-December 2023 (N = 173). Data were collected on SSP attendance (Yes vs. No), resilience, and ACEs. Covariates included age, gender, sexual orientation, race/ethnicity, education, homelessness, HIV risk behavior, syringe sharing, syringe use frequency, and primary drug. Path analysis was performed using Stata 18.0.

Results: The majority of PWID were cisgender men (68.8 %), heterosexual (92.5 %), homeless (93.6 %), had HIV risk behavior (65.9 %), had high resilience (54.3 %), and had never attended SSP (64.2 %). The mean number of ACEs was 4.1 (SD=3.2). After adjusting for covariates, high resilience was positively associated with SSP attendance (β= 0.204; p = 0.005). ACEs were negatively associated with high resilience (β= -0.035 p = 0.005) and SSP attendance (β= -0.026; p = 0.034). ACEs had a significant indirect effect on SSP attendance through high resilience (β= -0.007; p = 0.044).

Conclusions: Results indicate that resilience may mediate the relationship between ACEs and SSP attendance among PWID. It is important to develop and implement trauma-informed and resilience-based interventions to address the mental and sexual health challenges of PWID with a history of ACEs.