According to a new study from Australia's National Drug and Alcohol Research Center, rural intravenous drug injectors typically wait twice as long between HIV tests as city IDUs. In addition, they are much more likely to rely on other users for their injecting equipment.

Whereas the median time between HIV tests was 20 weeks for IDUs in suburban Sydney, it was 40 weeks for IDUs in rural New South Wales. The authors said lack of access to testing, "particularly anonymous and nonjudgmental testing" could help explain the disparity. "Distance to appropriate services may also be a barrier," they wrote.

In their study of 260 IDUs, the researchers found that 11 percent of rural IDUs relied on other users for the injecting equipment, compared with only 1 percent of city IDUs. Even so, reported needle sharing was nearly the same: 17 percent among rural IDUs, compared with 18 percent of those in the city.

Professor Kate Dolan, an author of the study, said improved syringe access in rural areas might cut down on needle sharing. Some rural IDUs, citing fear of stigma, said they found the location of needle vending machines to be too public. Lack of public transportation in rural areas is also a factor. "There's more opportunities in Sydney to get the equipment for free but in the country areas, usually they've got to pay and they've got to travel as well," Dolan said. She noted that while Australia has one of the world's best syringe programs, the study shows the need for better access in rural areas.

Eighty-three percent of rural IDUs reported injecting amphetamines in the previous six months, compared to 73 percent of city IDUs. Half of the 164 rural users surveyed had injected morphine in the past half-year, compared with 21 percent of the 96 Sydney IDUs surveyed.

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