0
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
Abby E. Rudolph, MPH, MD; Natalie D. Crawford, MPH; Danielle C. Ompad, PhD; Ebele O. Benjamin, MPH; Rachel J. Stern; Crystal M. Fuller, PhD
J Am Pharm Assoc (2003) 2010;50:140-147. doi:10.1331/JAPhA.2010.09193

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.

Sign In
APhA Members 
Welcome to JAPhA.org! Please log in below using your APhA username and password. Update your APhA profile.
Not a Subscriber
New to JAPhA? Become an APhA member to receive a full subscription to both the print and online editions.

OR

Register for a FREE limited account to benefit from personalization features such as alerts.

References

 Centers for Disease Control and Prevention. HIV prevalence estimates–United States, 2006 MMWR Morb Mortal Wkly Rep. 2008;57:1073–6.[PubMed]
 
 New York State Department of Health. AIDS surveillance quarterly update for cases reported through March 2000. Albany, NY:  New York State Department of Health;  2000.
 
 New York City Department of Health and Mental Hygiene. HIV Surveillance and Epidemiology Program quarterly report. New York:  New York City Department of Health and Mental Hygiene;  2003.
 
Mitty JA, Bazerman L, Selwyn K, et al. Decrease in the proportion of injection drug use–related HIV/AIDS in Massachusetts, New York, Connecticut, and Rhode Island AIDS Read. 2008;18(12):596–600.[PubMed]
 
Normand J, Vlahov D, Moses L. Preventing HIV transmission: the role of sterile needles and bleach. Washington, DC:  National Academies Press;  1995.
 
 U.S. Public Health Service. HIV prevention bulletin: medical advice to persons who inject illicit drugs. Washington, DC:  U.S. Public Health Service;  1997.
 
Brady JE, Friedman SR, Cooper HL, et al. Estimating the prevalence of injection drug users in the U.S. and in large U.S. metropolitan areas from 1992 to 2002 J Urban Health. 2008;85:323–51.[PubMed][CrossRef]
 
Lurie P, Jones TS, Foley J. A sterile syringe for every drug user injection: How many injections take place annually, and how might pharmacists contribute to syringe distribution? J Acquir Immune Defic Syndr Hum Retrovirol. 1998;18(suppl 1):S45–51.[PubMed]
 
Bruneau J, Lamothe F, Franco E, et al. High rates of HIV infection among injection drug users participating in needle exchange programs in Montreal: Results of a cohort study Am J Epidemiol. 1997;146:994–1002.[PubMed]
 
Heimer R, Clair S, Teng W, et al. Effects of increasing syringe availability on syringe-exchange use and HIV risk: Connecticut, 1990-2001 J Urban Health. 2002;79:556–70.[PubMed]
 
Des Jarlais DC, Friedman SR, Sotheran JL, et al. Continuity and change within an HIV epidemic: Injecting drug users in New York City, 1984 through 1992 JAMA. 1994;271:121–7.[PubMed]
 
Marx MA, Crape B, Brookmeyer RS, et al. Trends in crime and the introduction of a needle exchange program Am J Public Health. 2000;90:1933–6.[PubMed]
 
Strathdee SA, Celentano DD, Shah N, et al. Needle-exchange attendance and health care utilization promote entry into detoxification J Urban Health. 1999;76:448–60.[PubMed]
 
Doherty MC, Junge B, Rathouz P, et al. The effect of a needle exchange program on numbers of discarded needles: A 2-year follow-up Am J Public Health. 2000;90:936–9.[PubMed]
 
Des Jarlais C, Perlis T, Friedman SR, et al. Behavioral risk reduction in a declining HIV epidemic: Injection drug users in New York City, 1990-1997 Am J Public Health. 2000;90:1112–6.[PubMed]
 
 Centers for Disease Control and Prevention. Syringe exchange programs: United States, 2005. Accessed at www.cdc.gov/mmwr/preview/mmwrhtml/mm5644a4.htm, February 1,  2010.
 
 Australian Department of Health and Ageing. Return on investment on needle and syringe programs in Australia 11/05/06. Canberra, Australia:  Department of Health and Ageing;  2002.
 
Feldman HW, Biernacki P. The ethnography of needle sharing among intravenous drug users and implications for public policies and intervention strategies NIDA Res Monogr. 1988;80:28–39.[PubMed]
 
Zule WA. Risk and reciprocity: HIV and the injection drug user J Psychoactive Drugs. 1992;24:243–9.[PubMed]
 
Booth RE, Watters JK, Chitwood DD. HIV risk-related sex behaviors among injection drug users, crack smokers, and injection drug users who smoke crack Am J Public Health. 1993;83:1144–8.[PubMed]
 
Koester SK. The context of risk: Ethnographic contributions to the study of drug use and HIV NIDA Res Monogr. 1994;143:202–17.[PubMed]
 
Bluthenthal RN, Watters JK. Multimethod research from targeted sampling to HIV risk environments NIDA Res Monogr. 1995;157:212–30.[PubMed]
 
Gostin LO, Lazzarini Z, Jones TS, Flaherty K. Prevention of HIV/AIDS and other blood-borne diseases among injection drug users: A national survey on the regulation of syringes and needles JAMA. 1997;277:53–62.[PubMed]
 
Deren S, Fuller C, Pouget ER, et al. Impact of expanding syringe access in New York on sources of syringes for injection drug users in Harlem and the Bronx, NYC, USA Int J Drug Policy. 2003;14:373–9.
 
Fuller CM, Ahern J, Vadnai L, et al. Impact of increased syringe access: Preliminary findings on injection drug user syringe source, disposal, and pharmacy sales in Harlem, New York J Am Pharm Assoc. 2002;42(6 Suppl 2):S77–82.
 
 New York Academy of Medicine. Evaluation report to the Governor and the New York State legislatures. New York:  New York Academy of Medicine;  2003.
 
Pouget ER, Deren S, Fuller CM, et al. Receptive syringe sharing among injection drug users in Harlem and the Bronx during the New York State Expanded Syringe Access Demonstration Program J Acquir Immune Defic Syndr. 2005;39:471–7.[PubMed]
 
Vlahov D. Deregulation of the sale and possession of syringes for HIV prevention among injection drug users J Acquir Immune Defic Syndr Hum Retrovirol. 1995;10:71–2.[PubMed]
 
Fuller CM, Galea S, Blaney S, et al. Explaining the relationship between race/ethnicity and pharmacy purchased syringes among injection drug users in New York City Ethn Dis. 2004;14:589–96.[PubMed]
 
Burris S, Welsh J, Ng M, et al. State syringe and drug possession laws potentially influencing safe syringe disposal by injection drug users J Am Pharm Assoc. 2002;42(6 Suppl 2):S94–8.
 
Vorobjov S, Uuskula A, Abel-Ollo K, et al. Comparison of injecting drug users who obtain syringes from pharmacies and syringe exchange programs in Tallinn, Estonia Harm Reduct J. 2009;6:3.[PubMed]
 
Ompad DC, Galea S, Marshall G, et al. Sampling and recruitment in multilevel studies among marginalized urban populations: The IMPACT studies J Urban Health. 2008;85:268–80.[PubMed]
 
 Centers for Disease Control and Prevention. Syringe exchange programs: 2005. Accessed at www.cdc.gov/IDU/facts/AED_IDU_SYR.pdf, January 20,  2010.
 
Groseclose S, Weinstein B, Jones T, et al. Impact of increased legal access to needles and syringes on practices of injecting-drug users and police officers: Connecticut, 1992-1993 J Acquir Immune Defic Syndr Hum Retrovirol. 1995;10:82–9.[PubMed]
 
Calsyn DA, Saxon AJ, Freeman G, Whittaker S. Needle-use practices among intravenous drug users in an area where needle purchase is legal AIDS. 1991;5:187–93.[PubMed]
 
Des Jarlais DC, Marmor M, Paone D, et al. HIV incidence among injecting drug users in New York City syringe-exchange programmes Lancet. 1996;348:987–91.[PubMed]
 
Strathdee SA, Ricketts EP, Huettner S, et al. Facilitating entry into drug treatment among injection drug users referred from a needle exchange program: Results from a community-based behavioral intervention trial Drug Alcohol Depend. 2006;83:225–32.[PubMed]
 
Rudolph AE, Standish K, Amesty S, et al. A community based approach to linking injection drug users with needed services through pharmacies: An evaluation of a pilot intervention in New York City AIDS Educ Prev.In press.
 
Samuels JF, Vlahov D, Anthony JC, Chaisson RE. Measurement of HIV risk behaviors among intravenous drug users Br J Addict. 1992;87:417–28.[PubMed]
 
Darke S. Self-report among injecting drug users: A review Drug Alcohol Depend. 1998;51:253–63.[PubMed]
 
Deren S, Cleland CM, Fuller C, et al. The impact of syringe deregulation on sources of syringes for injection drug users: Preliminary findings AIDS Behav. 2006;10:717–21.[PubMed]
 
Fuller CM, Galea S, Caceres W, et al. Multilevel community-based intervention to increase access to sterile syringes among injection drug users through pharmacy sales in New York City Am J Public Health. 2007;97:117–24.[PubMed]
 
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Please read the other comments before you post yours. Comments are moderated and will appear on the site at the discertion of the editorial staff.
* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe



Related Content

Customize your page view by dragging & repositioning the boxes below.

JAPhA Articles
Topic Collections
PubMed Articles
Advertisement
 
  • Print
  • PDF Download
  • Email
  • Share
  • Get Citation
  • Submit Comment
  • Article Alerts
    Please Wait... Processing your request... Please Wait.
    You must sign in to sign-up for alerts.

    Please confirm that your email address is correct, so you can successfully receive this alert.

  • Letters To Editor
  • Reprints