Multilevel community-based intervention to increase access to sterile syringes among injection drug users through pharmacy sales in New York City (2007)

ENGLISH :
OBJECTIVES: Research has indicated that there is minimal use of pharmacies among injection drug users (IDUs) in specific neighborhoods and among Black and Hispanic IDUs. We developed a community-based participatory research partnership to determine whether a multilevel intervention would increase sterile syringe access through a new policy allowing nonprescription syringe sales in pharmacies. METHODS: We targeted Harlem, NY (using the South Bronx for comparison), and disseminated informational material at community forums, pharmacist training programs, and counseling or outreach programs for IDUs. We compared cross-sectional samples in 3 target populations (pre- and postintervention): community members (attitudes and opinions), pharmacists (opinions and practices), and IDUs (risk behaviors). RESULTS: Among community members (N = 1496) and pharmacists (N = 131), negative opinions of IDU syringe sales decreased in Harlem whereas there was either no change or an increase in negative opinions in the comparison community. Although pharmacy use by IDUs (N=728) increased in both communities, pharmacy use increased significantly among Black IDUs in Harlem, but not in the comparison community; syringe reuse significantly decreased in Harlem, but not in the comparison community. CONCLUSIONS: Targeting the individual and the social environment through a multilevel community-based intervention reduced high-risk behavior, particularly among Black IDUsOBJECTIVES: We sought to determine the extent of HIV testing among urban injection drug users (IDUs) to assess whether an expansion of targeted testing programs would be consistent with national goals to identify previously undetected infections. METHODS: IDUs in 5 US cities (Oakland, Calif; Chicago, Ill; Hartford and New Haven, Conn; and Springfield, Mass) were recruited either by chain referral or time-location sampling. The IDUs were questioned about HIV testing, and factors associated with HIV testing were analyzed. RESULTS: Ninety-three percent of 1543 IDUs had been tested. Among those tested but who did not report having been told that they were HIV seropositive, 90% had been tested within the past 3 years. Women and syringe-exchange customers were more likely to have been tested ever and in the recent past. We estimated the number of undetected infections among urban IDUs in the United States to be less than 40000. CONCLUSIONS: Testing for HIV has reached the vast majority of IDUs through the current options. Expending scarce prevention money to expand testing of IDUs is unlikely to be productive. Instead, resources should be used for proven HIV-prevention strategies including syringe exchange, drug treatment, and secondary prevention for those who are HIV positive. (Author' s abstract)