Syringe sources utilized by IDUs in California pre- and post- implementation of a pharmacy-based syringe sales initiative

BACKGROUND: Expanded syringe access has lead to decreases in injection-mediated HIV risk behaviors among injection drug users (IDUs) internationally. In 2005, California became the 46th U.S. State to permit over-the-counter (OTC) syringe sales in an effort to prevent HIV transmission. We assessed changes in self-reported syringe sources among IDUs pre- and post-implementation of the pharmacy-based syringe sale program.

METHODS: Analyses were conducted on 2004-06 data from HIV Counseling and Testing (C&T) sessions in California Counties that implemented OTC syringe sales programs early (Contra Costa, Alameda, Sonoma, San Francisco, Los Angeles). Data from 17,579 testing sessions where clients reported injection drug use in the previous two years were analyzed.

RESULTS: HIV positive test results by county ranged from 0.4-6.0%. Reported use of pharmacies for syringe acquisition increased in all counties from 2004-06; Sonoma (2.9% vs. 28.8%), Los Angeles (6.5% vs. 21.3%), Contra Costa (1.5% vs. 16.2%), San Francisco (1.9% vs. 13.5%), and Alameda (1.5% vs. 5.3%). In some counties, IDUs reported obtaining syringes from pharmacies prior to implementation of OTC syringe sales programs. Secondary syringe exchange as a source of syringes decreased from 2004-06 in San Francisco (9.4% vs. 3.9%) and Sonoma (9.4% vs. 1.3%); however, an increase was observed in Alameda (7.8% vs. 16.6%).

CONCLUSIONS: Findings indicate IDUs attending State-funded C&T services are increasingly using pharmacies as a source of sterile syringes in California while changes in acquisition patterns for other syringe sources have been less predictable. Further research on the impact of this access on HIV risk is needed.