Where do all the syringes come from? Pharmacy contribution to needle and syringe distribution in Hanoi, Vietnam

Background: HIV continues to spread rapidly throughout Vietnam with injection drug use accompanied by continued high rates of syringe sharing remaining the main risk factor for HIV infection. This pilot study explored pharmacy-based harm reduction activities in Vietnam's capital, Hanoi. Since pharmacy-based syringe distribution has not previously been accurately estimated in Vietnam, unique estimates of the number of syringes pharmacies sell to IDUs were conducted and compared with the number of syringes distributed by two needle and syringe programs (NSPs). Methods: Estimates were taken from five pharmacies during a one week period selected from the same two districts in Hanoi, Dong Da and Thanh Xuan, where two peer-based NSPs operate. Interviews with pharmacists were conducted to gain an insight into their views on the practice of selling syringes, knowledge and training with respect to HIV, continued commitment to HIV prevention, and willingness to provide anti-retroviral treatment to HIV-infected individuals. Results: The data indicate that pharmacies potentially distribute more than twice as many syringes as peer educators working for the NSPs in the districts studied - 14,229 syringes per week versus 6,582 syringes per week respectively. Interviewed pharmacists showed a solid understanding HIV transmission risk factors and a strong commitment to continuing HIV prevention activities. Conclusions: Further study is required to ascertain whether the results of this study are generalisable across Hanoi and elsewhere in Vietnam, and to assess the efficacy of including pharmacies in a harm reduction program.