Spatial access to sterile syringes through the Expanded Syringe Access Demonstration Program (ESAP) in NYC: Description and relationship to need and local characteristics

Background: Until 2001, New York State prohibited injection drug users from acquiring syringes through pharmacies without a prescription. To reduce HIV transmission, NYS initiated a pilot project (ESAP) to permit select pharmacies to sell <11 syringes to customers without a prescription. Here, we describe patterns of spatial access to ESAP pharmacies across NYC neighborhoods, and determine whether neighborhood-level need and sociodemographic characteristics predict ESAP access.

Methods: Units of analysis are NYC's United Hospital Fund (UHF) districts (N=42). Street addresses of each of the 914 ESAP pharmacies active in 2003 were geocoded to a digital map containing NYC streets and UHF boundaries. We calculated the mean density of ESAP pharmacies per square mile for each district. District socioeconomic characteristics (e.g., poverty rate) were measured using 2000 US Census data. “Need” was operationalized using 2000 NYC Department of Health UHF-level data on mortality from drug-related causes and HIV/AIDS. The UHF-level spatial access variable was regressed on measures of need and socioeconomic characteristics.

Results: Analyses will answer these questions: (1) What was the nature of district-level spatial access to ESAP pharmacies two years after ESAP started?; (2) does access vary according to local need?; and (3) controlling for need, are ESAP pharmacies distributed equitably across districts?

Conclusions: ESAP enrollment is voluntary. We will discuss the need for targeted recruitment of pharmacies into ESAP to stem HIV epidemics among injectors in NYC, and to promote equitable access to this intervention. Where few pharmacies exist, expansion of syringe exchange programs may be necessary.