SERINGE EXCHANGE PROGRAMS

In order to properly tackle the problem of transmission through IDU, there must be programs to decrease sharing needles and other paraphernalia, such as cookers and cotton. Certain behaviors are associated with sharing needles, as well as certain locations. Shooting galleries, places that rent out syringes and equipment in exchange for money or drugs and provide a location to shoot up, are associated with increased risk for HIV infection (Des Jarlais & Friedman, 1994). Shooting galleries provide a way out of carrying equipment, reducing the risk of police encounters and being caught by a family member (Des Jarlais & Friedman, 1994; Mandell et al., 1994; Bluthenthal et al., 2004). The problem with shooting galleries is proper cleaning habits are rarely practiced, and users do not know the HIV status of the previous users (Des Jarlais & Friedman, 1994). New York State has tried to resolve the use of shooting galleries and needle sharing by implementing laws in 2000 that changed their syringe carrying policy. Through their Expanded Access Syringe Demonstration Program (ESAP) individuals 18 and over are legally allowed to purchase, from pharmacies, without a prescription and possess up to 10 syringes (Bluthenthal et al., 2004). While making syringes legal and available to IDUs, capping the number available at each exchange is less effective than programs that are more flexible. IDUs who participate in syringe exchange programs (SEP) are less likely to re-use syringes in programs that do not have a cap on exchanges per visit. Cities where the SEP laws are more restricting demonstrate higher levels of run-ins with the police for drug paraphernalia possession than cities with fewer. The high levels of police encounters could help continue their attendance to shooting galleries. Perhaps to most effectively put their ESAP into use New York should remove the 10 syringes per visit cap. In New Haven, Connecticut, syringes from SEP were tracked and upon their return to an SEP location the HIV prevalence in the syringes was measured. Before the SEP the HIV prevalence rate in syringes was 62.8%, 4 months into the SEP the rate dropped to 44% (Heimer et al., 2002). 96.1% of SEP users get HIV tests compared to non-customers, showing that SEPs have a positive effect on the behavior of users (Heimer et al., 2007).

KNOWLEDGE OF SEP

Currently there are 5 pharmacies in 10035 and 15 in 10029 that are registered distributors in the ESAP (New York State Department of Health, 2006). However, ESAP registered pharmacies are not allowed to advertise the sale of syringes without a prescription, and syringes must be kept where they are only available to pharmacists (New York State Department of Health). Measures were taken by the Harlem ESAP Intervention Program to make the presence of ESAPs well known, and dispel false beliefs of the negative effects ESAPs can potentially have on a community. They tried to reach people by attending community organizations geared toward IDUs and health fairs (Fuller et al., 2007). However, the attendees of such events are feasibly more aware of the health risks involved with IDU. Efforts to inform less involved IDUs may increase their use of ESAPs; this was addressed through the distribution of pamphlets at local community areas such as salons and bodegas (Fuller et al., 2007). This information should also be made available at homeless shelters, in one study (Mandell et al.,1994) homelessness (sometime within the previous 10 years) was associated with injection and sharing needles 49% or injectors reported being homeless. Information on ESAP locations should also be provided at STD clinics; in Bluthenthal’s study IDUs who use SEP in Oakland, Chicago, and Hartford reported infections of Hepatitis B and C among 14-20% of the users. In one study (Fuller et al., 2007) looking at the current use of pharmacy syringe sales among Hispanic and Black IDUs, researchers determined what barriers kept them from using these programs. They found that, prior to intervention, knowledge of non-prescription pharmacy syringe sales was uncommon. However, results after intervention, which consisted of distributing poster and pamphlets about ESAP, showed that there was a decrease in the belief that ESAPs would increase hazardous disposing of syringes (down to 57% from 68%). No changes were made regarding IDUs opinions on the effect available syringes have on drug use as well as the spread of HIV. The interventions proved to be successful among Black IDUs, 22% reported using pharmacies as a source for syringes post intervention compared to the 5% who did pre intervention, supporting the need for advertisement of ESAP locations. This evidence that Blacks are not aware of SEPs suggests that the SEPs should go to them.

OTHER FORMS OF SEP

In San Francisco, the Late Night Breakfast Buffet was created in an attempt to reduce MSM in relation with IDUs (Rose et al., 2006). This program was aimed at late-night MSM in three districts, one known to be predominately gay, one related to drug use and sale, and one with a needle exchange program open during the week. The van was stocked with equipment for rapid oral HIV testing, Orasure, needle exchange, condom distribution, urine STI testing with counseling, and harm reduction information, as well as free water and snacks. The van would park in the same location in the neighborhoods for three nights a week from 1-5 am. This would provide the opportunity to get clean syringes without going to a pharmacy during business hours, Fuller et al. reported that negative attitudes are expressed towards selling syringes to IDUs, despite its legality. While in San Francisco this program is addressing MSM who use methamphetamines, it could be successful in 10029 and 10035 in nightlife areas. The program was formed to address issues stemmed from MSM, it could have an impact on IDU alone. Over 4 months, the van saw 600 people, and exchanged 2000 needles and distributed 200 packs of 3 syringes to those who could not exchange syringes. This program, for 5 months, costs $100,000 to maintain, including incentives for clients, food and water.