Neighborhood Variations in Syringe Access, Use, and Discard

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Neighborhood Variations in Syringe Access, Use,
and Discard

• Robert Heimer, Kaveh Khoshnood, Wei Teng, David
  Buchanan, Tom Stopka, Merrill
  SingerAcknowledgement The research described
  in this paper is supported by the National
  Institute on Drug Abuse, grant R01 DA12569,
  Merrill Singer, Principal Investigator.

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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.

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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).

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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.

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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.

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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.

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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.

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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.

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Syringe Use Risks I Shared Syringes
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Syringe Use Risks II Reused Syringes
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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.

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Arrests for Syringe Possession
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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.

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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.

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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.