RECEPTIVE SYRINGE SHARING AMONG INJECTION DRUG USERS IN HARLEM AND THE
BRONX DURING THE NEW YORK STATE EXPANDED SYRINGE ACCESS DEMONSTRATION PROGRAM

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 incomes."