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Aims To study the use of supervised injection facilities (SIFs) as a predictor of safer injecting practices. Design Cross-sectional study conducted with face-to-face interview using a structured questionnaire with computer-assisted personal interviewing. Dried blood spot samples were collected for human immunodeficiency virus (HIV) and hepatitis C virus (HCV) antibody testing. Setting All participants were street-recruited by chain referral methods in Madrid and Barcelona. Participants A total of 249 young heroin drug injectors recruited by the ITINERE cohort study in two Spanish cities with SIFs. Measurements The main outcome measures were self-reported injecting behaviours and SIFs attendance. Results SIF users were more marginalized socially than non-users. They were also more often regular injectors (weekly or more versus sporadic) [odds ratio (OR) = 4.9, 95% confidence interval (CI): 2.7–8.8], speedball users (OR = 2.5, 95% CI: 1.5–4.3) and anti-HCV-positive (OR = 3.1, 95% CI: 1.4–7.1). In the logistic regression analysis, using SIFs was associated independently with not borrowing used syringes (OR = 3.3, 95% CI: 1.4–7.7). However, no significant association was found between SIF use and not sharing injection equipment indirectly (OR = 1.1, 95% CI: 0.5–2.2).Conclusions SIFs attract highly disadvantaged drug injectors who engage none the less in less borrowing of used syringes than non-users of these facilities. The risks of indirect sharing should be emphasized when counselling SIF attendees. (Resumen extraído del artículo)