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