Academy’s Interventions in Harlem Result in Broader Acceptance of Pharmacy Syringe Sales to Prevent HIV Transmission Among Injection Drug Users

NEW YORK CITY, Jan. 25 — Community-based education and intervention programs are very effective in ensuring that injection drug users (IDUs) can purchase the sterile syringes they are entitled to under the New York State law designed to stem the re-use of dirty needles and the spread of HIV/AIDS in high-risk neighborhoods, according to a first-of-its-kind study conducted by The New York Academy of Medicine and the Harlem Community and Academic Partnership. The results appear in the January American Journal of Public Health.

Specifically, the percent of Harlem-based IDUs who used dirty syringes declined by more than a third, from 26 to 16 percent, after receiving the intervention. In comparison, a community in the South Bronx that did not receive the same intervention program actually experienced an increase of syringe re-use, from 20 to 26 percent of IDUs, during the same time period. The program also improved pharmacists’ attitudes and public opinion regarding syringe purchasing.

“While stopping use of injection drugs is the most effective way to reduce needle-borne HIV transmission, some populations are unable or not ready to stop drug use,” said lead author Crystal M. Fuller, MPH, PhD, an investigator in the Academy’s Center for Urban Epidemiologic Studies and an assistant professor of epidemiology at Columbia University’s Mailman School of Public Health. “Our documented success with a program that targets individuals at risk and their social environment, could help other communities in efforts to protect public health, to help dispel negative perceptions of IDUs among community residents and pharmacists, and to increase awareness of ways to reduce HIV transmission rates.”

Based on the study, similar interventions could have national implications, since sharing syringes and other equipment for drug injection is a well-known route of HIV transmission. Since the AIDS epidemic began, injection drug use has directly and indirectly accounted for more than one-third (36 percent) of AIDS cases in the United States, according to the U.S. Centers for Disease Control and Prevention.

The Harlem intervention study was inspired by a New York State law passed in January 2001, the Expanded Syringe Access Demonstration Program (ESAP), which permits pharmacies to sell up to 10 syringes per individual without a prescription. In response to racial disparities in the use of ESAP statewide and to Harlem’s disproportionate HIV burden, the Harlem Community and Academic Partnership organized in the summer of 2001.

About the study

In the Academy-led study, community residents, pharmacists, and IDUs in Harlem received various enhanced interventions, while a similarly comprised comparison group in the South Bronx did not. South Bronx participants received standard educational efforts from local government and community-based agencies. Fuller and her coinvestigators at the Academy surveyed each of the three groups in both communities before and after the intervention. The intervention extended from June 2002 to May 2003 with 1,091 participants completing surveys before the intervention and 1,264 participants after.

The intervention activities in Harlem included: disseminating ESAP educational materials to organizations that provide services to IDUs; training pharmacy staff about the program; holding group training sessions for safe syringe-disposal practices; and more. Pamphlets including a list and map of all pharmacies registered to sell syringes in Harlem were also distributed by Academy research outreach staff.

In addition to assessing syringe purchase and use rates, Fuller and her coninvestigators found that: