Syringe Acquisition, Peer Exchange and HIV Risk
| Autor: | Robert Bright, Liviana Calzavara, Ted Myers, Carol Strike, Walter Cavalieri, Margaret Millson |
|---|---|
| Rok vydání: | 2005 |
| Předmět: |
Program evaluation
030505 public health Health (social science) business.industry Health Policy Public Health Environmental and Occupational Health 030508 substance abuse medicine.disease Computer security computer.software_genre Outreach 03 medical and health sciences Snowball sampling Acquired immunodeficiency syndrome (AIDS) Community health medicine Peer exchange Over-the-counter Medical emergency 0305 other medical science business Law computer Syringe |
| Zdroj: | Contemporary Drug Problems. 32:319-340 |
| ISSN: | 2163-1808 0091-4509 |
| Popis: | Injection drug users (IDUs) who have difficulty acquiring sterile syringes are 3.5 times more likely to inject with a used syringe than other IDUs (Wood et al., 2002). While syringe exchange programs (SEPs) are designed to increase access to sterile equipment, these programs often cannot meet the demand for syringes. Estimates of the number of syringes exchanged by SEPs versus those needed by IDUs reveal a large disparity (Remis et al., 1998). Hours of operation, staffing levels, availability of mobile services, maximums on the number of syringes that can be exchanged per visit or per day, and other factors limit the ability of SEPs to reach many IDUs and provide an adequate supply of sterile equipment and reduce syringe-related transmission of infectious diseases such as HIV and hepatitis C (HCV) (Strike et al., 2002a; Wood et al., 2003; Grund et al., 1992).While SEPs are one important source of sterile equipment, there are many others. In some jurisdictions, syringes may also be purchased over the counter (OTC) in pharmacies. As well, informal and/or unsanctioned sources of sterile equipment appear to play an important role in the acquisition of sterile syringes. Encouraging collective exchange of syringes (i.e., exchange of syringes for a group of users) as well as individual exchange has been shown to expand the availability of sterile equipment for a larger proportion of active IDUs (Grund et al., 1992). In Vancouver an informal and unsanctioned SEP provided exchange services to IDUs who had not used Vancouver's formal SEP programs (Wood et al., 2003). Training peers to distribute, trade or sell sterile equipment and/or bleach kits has been recommended as a way to reach IDUs (Valente et al., 1998; Stopka et al., 2003). The ability of these informal networks to reach otherwise unreachable IDUs suggests that other models of syringe distribution may help to fill the gap between demand and access to sterile equipment.Given the importance of easy access to sterile equipment to HIV prevention, we were interested to examine syringe accessibility and the role of peer syringe exchangers in an environment characterized by legal syringe exchange and OTC sales. In Toronto, Canada, syringe exchange and OTC sales have been available since 1989, and the prevalence of HIV among IDUs has remained at or below 10% (Millson et al., 2005). The SEP provides syringe exchange, distribution of other sterile injection equipment (e.g., cookers, cottons and alcohol swabs), condoms, nursing services, counseling, referrals, and support to local area injection drug users from a fixed site and a mobile service. As well, the SEP contracts out exchange services to other local area agencies in order to increase the coverage of exchange services without increasing human resource and other program costs (Strike et al., 2002a). In 2000, over 20 agencies (e.g., pharmacies, AIDS service organizations, community health centers, temporary shelters, drop-in centers, and a hospital emergency department) provided satellite exchange services to IDUs across the city (Challacombe et al., 2001). In Toronto, possession of an unused needle and syringe is not illegal. However, individuals caught in possession of a used needle may be charged with a criminal offense should there be trace amounts of an illegal substance in the needle or syringe (Canadian HIV Legal Network, 2002).Using data from a qualitative study and a program evaluation, we examined syringe accessibility issues with a particular focus on answering the following questions: From where or whom and in what quantities do IDUs obtain syringes? What programmatic, social or economic factors influence these patterns of acquisition? What is the relationship, if any, with HIV risk behaviors?MethodsData for these analyses were drawn from a qualitative study conducted between 2000 and 2001. IDUs who had injected in the 30 days prior to the interview were recruited through SEP staff members, posters in laundromats, field outreach, and snowball sampling. … |
| Databáze: | OpenAIRE |
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