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BACKGROUND: There has been a significant increase in the provision of injecting paraphernalia from Scottish injecting equipment provision (IEP) services. However, there is currently a lack of evidence on whether uptake of paraphernalia has any impact on paraphernalia sharing among injecting drug users (IDU). The aim of this study was to examine the factors associated with paraphernalia sharing; in particular, whether uptake of filters, spoons and sterile water from IEPs is associated with a reduction in the sharing of these items. METHODS: A cross-sectional voluntary anonymous survey of 2037 IDUs was administered during 2008-2009. Participants were asked whether they had shared filters, spoons or water (paraphernalia) in the previous 6months, and their uptake of these items from an IEP during an average week in the previous 6months. RESULTS: Self-reported uptake of paraphernalia in an average week during the previous 6months was associated with reduced odds of sharing paraphernalia: (i) uptake of >30 filters was associated with a reduced odds of sharing filters (adjusted odds ratio (AOR) 0.50, 95% confidence interval 0.32-0.79); (ii) uptake of >30 spoons was associated with a reduced odds of sharing spoons (AOR 0.46, 95% confidence interval 0.28-0.74); and (iii) uptake of sterile water was associated with a reduced odds of sharing water (AOR 0.36, 95% confidence interval 0.22-0.61) compared to no uptake of each of these items. CONCLUSIONS: Uptake of paraphernalia appears to be associated with safer injecting practice. Further research is needed to establish the impact of paraphernalia provision on HCV transmission.