Finding 3-1: The Committee finds that almost all published studies of multi-component HIV prevention programs that include needle and syringe exchange originate in North America, Western Europe, and Australia.

ALTERNATIVE ACCESS TO STERILE NEEDLES AND SYRINGES

Pharmacy Access

Pharmacists can play a key role in preventing HIV infection among IDUs. They can provide advice, including information on safe needle use and substance abuse treatment, and also sell condoms and sterile needles and syringes (Jones and Coffin, 2002). In the United States, many states have “deregulated” or removed laws to allow increased access to sterile needles and syringes through pharmacy sales or physician prescription (Burris et al., 2003). As noted in Chapter 1, syringe prescription laws prohibit the sale of needles and syringes without a prescription and pharmacy regulations may limit the number of syringes a person can purchase at one time (Burris et al., 2003). Relaxation of such laws and regulations governing pharmacy sales of syringes has improved attitudes toward selling to injecting drug users, and increased the number of IDUs who turn to pharmacies for clean injecting equipment (Coffin et al., 2002; Deren et al., 2006).

A well-studied example of the effects of deregulating the availability of syringes through pharmacies is the New York Expanded Syringe Access Demonstration Program (ESAP). This program began in 2001 by allowing pharmacies, health care facilities and practitioners to register and provide up to 10 syringes without a prescription to persons at least 18 years old (Klein et al., 2002). Studies show that IDUs began using pharmacies as a result of this legislation (Deren et al., 2003; Des Jarlais et al., 2002; Fuller et al., 2004).

A serial cross-sectional study by Pouget et al. (2005) found that self-reports of receptive sharing fell significantly—from 13.4 percent in 2001 to 3.6 percent in June 2003 following the legislative change. The number of IDUs obtaining syringes from an ESAP source, mostly pharmacies, rose from 7.5 percent to 25 percent. Deren et al. (2006) examined syringe sources pre- and post-ESAP (n=130). Most drug users who reported obtaining syringes at an NSE before ESAP began continued using that source, although 10 percent reported some use of ESAP. Of drug users who originally relied on unsafe sources, 19 percent reported some ESAP use. Overall, 14 percent of the sample reported some ESAP use.

Other regions of the United States have also experimented with this form of alternative access. Groseclose et al. (1995) examined syringe-



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