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Concerning African American IDUs in Central Harlem, there should be more syringe exchange programs in pharmacies. In the study by Cleland et al., New York State enacted the Expanded Syringe Access Demonstration Program (ESAP) on January 1, 2001. It allows syringes to be sold in pharmacies without prescription or dispensed through doctors, hospitals, and clinics to 18 years of age or older (6). There has been controversy in the effectiveness of the syringe exchange programs, concerning disposal and reuse of syringes. Possibly safe disposal increased over the study period from 18% to 64%. But the safe disposal decreased from 62.7% to 20.5% (6). There is a problem if the unsafe disposal, including bushes, ground, and toilets, is a hindrance in the HIV prevention. Another concern in the solution is IDUs enrolling in more hospital Syringe Exchange Program than community-based syringe exchange program in the study by Masson et al (7). The hospital setting is more accessible because it is easier for IDUs to travel to outpatient clinics (7). In the study by Fuller et al., the Harlem ESAP Intervention Project, from July 1, 2002 to June 30, 2003, conducted a community-based research to determine whether a multilevel intervention would increase sterile syringe access by nonprescription syringe sales in pharmacies (1). There was an increase in pharmacy use among Black IDUs, and an increase in positive opinions and attitudes toward syringe sales to IDUs among community residents and pharmacists (1). In the study by Des Jarlais et al., there are negative correlations between HIV prevalence and syringe sharing (8). “HIV prevalence among the participants in the programs ranged from 2% to 22%.” “Partner restriction” and “informed altruism”, which is the sharing of needles and syringes with sex partners, relatives, and close friends, reduced the likelihood of HIV transmission because they are more likely to know the status of the individuals, avoiding distributive sharing (8).
Central Harlem is one of best locations for syringe exchange programs because the largest number of IDUs reside there (9). My plan is to establish syringe exchange programs in the pharmacies in zip codes (10026, 10030, 10035, 10037) with the highest living with HIV/AIDS rates by IDU. There will be a total of 19 pharmacies and staff members with the new syringe exchange programs. All zip codes have rates between 2000 and 3400. The most important pharmacies are Keane Pharmacy and Malcolm X Pharmacy because they are located in the same zip code as Harlem Hospital.
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