Neighborhood Variations in Syringe

Access, Use, and Discard

Robert Heimer, Kaveh Khoshnood, Wei Teng, David Buchanan, Tom Stopka, & Merrill Singer

Acknowledgement: The research described in this paper is supported by the National Institute on Drug Abuse, grant #R01 DA12569, Merrill

Singer, Principal Investigator.

I-91 Study: HIV Risk in Syringe Access, Use and Discard

Neighborhood based analysis of IDUs in New Haven, Hartford, and Springfield.

New Haven and Hartford have SEPs and legal pharmacy access, Springfield does not.

Recruitment of 320 IDUs in each city.

Quantitative data collection instrument focused on HIV transmission risk behaviors in the past 30 days.

Neighborhood Level Analysis of Quantitative Data from I-91 Study

Three main categories for syringe access considered: pharmacies, syringe exchange programs (SEPs), all other sources.

Formative research identified neighbor-hoods with high concentrations of IDUs.

Research focused on those that had SEPs only (4), pharmacies that sell to IDUs (7), both SEPs and pharmacies (2), and neither (11).

Sociodemographic Analysis of I-91 Neighborhoods

To date, 875 IDUs recruited into this study.

The four categories of neighborhood do not differ in terms of participants’ sex, age, schooling, self-reported HIV or hepatitis serostatus, and phsyical diability.

Salient significant differences are worth considering in detail.

Sociodemiographic Differences I

Race Ethnicity Latinos most populous, white least populous in

neighborhoods without either pharmacy or SEP.

Blacks evenly distributed across all four categories of neighborhoods.

Income Poorest neighborhoods are those without

pharmacies that sell syringes to IDUs.

Sociodemiographic Differences II

Housing and Homelessness Neighborhoods with highest percentage of IDUs

having their own residences are those with pharmacies but no SEP van sites.

Neighborhoods with lowest percentage of IDUs having their own residences are those with pharmacies and SEP van sites.

Homelessness is highest in neighborhoods with pharmacies and SEP van sites.

Syringe Acquisition I

SEPs were the major source of syringe in neighborhoods with SEP stops, regardless of presence of pharmacies.

Pharmacies were the major source in neighborhoods with pharmacies, but without SEP stops.

Unsafe sources predominated in those neighborhoods without SEPs or pharmacy.

Syringe Acquisition II

Few IDUs in neighborhoods with neither acquired syringes from a pharmacy (13.7%) or from an SEP (15.6%).

Half the IDUs in neighborhoods with an SEP stop but no pharmacy acquired syringes from a pharmacy.

Syringe Use Risks I: Shared Syringes

Syringe Use Risks II: Reused Syringes

Syringe Discard

IDUs in neighborhoods without either SEPs or pharmacies are 2.5 times as likely to stash syringes for later use (26.1% vs. 10.3%).

IDUs in neighborhoods without either SEPs or pharmacies are twice a likely to publicly discard their syringes.

Arrests for Syringe Possession

Conclusions IDUs who reside in neighborhoods where

they are denied local access to clean syringes through SEPs or over-the-counter pharmacy sales are more likely to be Latino and poor.

These IDUs are more likely to get their syringes from an unreliable source, share and reuse syringes, improperly discard syringes, and be arrested or detained for syringe possession.

Caveats

These data were obtained in three cities. Springfield, MA differs from its Connecticut cousins in that neither SEPs nor pharmacy sales are legal there.

Springfield IDUs may unduly influence the findings of higher risk in those neighborhoods lacking SEPs and pharmacies that sell syringes over the counter.

Recommendations

Increasing access to clean syringes is likely to be associated with decreases in the transmission of syringe-borne viruses.

More pharmacies should be encouraged to sell syringes without a prescription.

Hispanic neighborhoods, especially, need such pharmacies.

Springfield should adopt a public health approach to its IDUs.