Journal of Acquired Immune Deficiency Syndromes Vol. 39; No.
Syringe exchange programs (SEP) have been effective in
reducing syringe sharing and reuse. To prevent the
transmission of blood-borne infections, CDC and other
government agencies recommend that injection drug users (IDUs)
use a new, sterile syringe for each injection. In order for
this recommendation to be implemented fully, drug injectors'
access to syringes must be expanded.
On January 1, 2001, the New York state Expanded Syringe Access
Demonstration Program (ESAP) took effect. The law allows
pharmacies to sell up to 10 syringes at a time without a
prescription; it also allows syringe distribution through
private doctors, hospitals, and clinics to persons age 18 or
older; and it permits the possession of those syringes for the
purpose of injecting drugs. The law requires that providers
register with the New York State Department of Health; it
mandates an independent evaluation of the program; and it
stipulates that the syringes be accompanied by information on
safe use and disposal.
Researchers in the current study sought to assess changes in
receptive syringe sharing since the inception of the ESAP. To
accomplish this, they combined data on sociodemographic
characteristics and syringe use regarding the last injection
episode from three ongoing studies in Harlem and the Bronx
from January 2001 through June 2003. These data were analyzed
as serial cross sections by 10 calendar quarters.
"The ESAP has increased access to sterile syringes for IDUs in
New York State," the researchers wrote. Their investigation
found that receptive syringe sharing decreased significantly,
from 13.4 percent of participants to 3.6 percent in the final
quarter. The percentage of IDUs who obtained their most recent
injection syringe from an ESAP source (chiefly pharmacies)
increased from 7.5 percent in the first quarter to 25 percent
in the last quarter. Multiple logistic regression analysis
found that variables associated with less receptive sharing
were syringe exchange and ESAP syringe source as well as time
since ESAP inception. Female gender and white race/ethnicity
were significantly associated with more receptive sharing.
"The increase in the use of pharmacies and other ESAP syringe
sources in this sample has been accompanied by a decline in
receptive sharing," the researchers concluded. "SEPs remained
the most frequent syringe source. This highlights the
importance of SEP accessibility for IDUs in Harlem and the
Bronx. Further research regarding the potential serious
barrier that the cost of syringes may represent for many IDUs
is suggested. Increasing SEP access and lowering the cost of
syringes at pharmacies may lead to greater reductions in
unsafe injecting practices, especially for IDUs with low