Special Feature
Comparison of injection drug users accessing syringes from pharmacies, syringe exchange programs, and other syringe sources to inform targeted HIV prevention and intervention strategies

https://doi.org/10.1331/JAPhA.2010.09193Get rights and content

Abstract

Objective

To describe injection drug users (IDUs) who access syringes through different outlets to help inform the prevention needs of IDUs who underuse safe syringe sources in New York City (NYC), where syringe availability is high compared with other U.S. cities.

Design

Cross sectional.

Setting

NYC, 2005–2007.

Participants

285 IDUs.

Intervention

Participants were recruited using random street-intercept sampling in 36 socioeconomically disadvantaged neighborhoods.

Main outcome measures

IDUs using syringe exchange programs (SEPs), pharmacies, or other outlets as a primary syringe source were compared based on sociodemographic characteristics, injection practices, and medical service use.

Results

Chi-square tests and polytomous logistic regression were used to compare IDUs with different self-reported primary syringe sources used in the 6 months preceding study entry. Compared with IDUs using other syringe sources, those primarily using SEPs were less likely to be black (adjusted odds ratio 0.26 [95% CI 0.11–0.57]), more likely to inject daily (3.32 [1.58–6.98]), and more likely to inject with a new syringe (2.68 [1.30–5.54]). Compared with IDUs using other syringe sources, those primarily using pharmacies were less likely to be black (0.39 [0.17–0.90]).

Conclusion

These data suggest that pharmacies and SEPs may be reaching different populations of IDUs and highlight a subpopulation of highly marginalized IDUs (i.e., black race, infrequent injectors) who are underusing safe syringe sources in NYC. Targeted interventions are needed to reduce racial disparities and increase use of safe syringe outlets.

Section snippets

Objectives

Although SEPs and pharmacies have increased the availability of clean syringes for IDUs, mounting evidence suggests that neither can meet this need alone. The purpose of this analysis is to describe the characteristics of IDUs who access syringes through different outlets and to assess the prevention needs of IDUs who are still not using safe syringe sources in NYC, where safe syringe sources are more prevalent than in most other U.S. cities. Several studies across the United States and abroad

Methods

The data used for this analysis were collected as part of the IMPACT (Inner-City Mental Health Study Predicting HIV/AIDS, Club, and Other Drug Transitions) studies—a series of cross-sectional studies conducted at the New York Academy of Medicine (NYAM) to determine the association between features of the urban environment and several health outcomes. Participants were recruited using random street-intercept sampling in 36 socioeconomically disadvantaged neighborhoods as described elsewhere.32

Results

Of the 285 IDUs included in this analysis, the median age was 36 years (range 18–59), 73% were men, 16% were black, 67% were Hispanic, 53% had at least a high school degree or the equivalent, 21% were married, 37% made greater than $10,000 per year, 58% were homeless in the previous 6 months, 55% used SEPs as their primary source of syringes during the previous 6 months, 27% used pharmacies as their primary source of syringes during the previous 6 months, and 18% used sources other than

Discussion

These data suggest that both SEPs and pharmacies are reaching most IDUs in NYC and that different subpopulations of IDUs access syringes viespread use of sterile injecting equipment among IDUs. Unfortunately, these data also highlight that black IDUs are disproportionately represented among those using other syringe sources. While previous studies have noted considerable reductions in high-risk injecting practices and greater entry and retention in drug treatment programs associated with both

Limitations

The cross-sectional design of the current study did not allow a causal relationship to be assessed or the direction of a relationship to be determined. For example, whether the identified safe injection practices associated with SEP use occurred before or as a result of SEP use (i.e., use of a new syringe to inject) is unclear. However, previous research has shown evidence of lower risk associated with use of SEPs using prospective study designs.16 In addition, as with all studies involving

Conclusion

The findings of this study have important policy implications with regard to safe syringe access among IDUs in NYC. These findings provide support for (1) expanding syringe access via legalization of nonprescription syringe sales in pharmacies in other states, cities, and municipalities across the United States and (2) increased funding for SEPs to expand current services. To target subpopulations of high-risk IDUs who are harder to reach, several other countries have implemented additional

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Disclosure: The authors declare no conflicts of interest or financial interests in any product or service mentioned in this article, including grants, employment, gifts, stock holdings, or honoraria.

Funding: National Institute on Drug Abuse (grant DA018061).

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