182309 Spatial access to sterile syringes through the Expanded Syringe Access Demonstration Program (ESAP) in NYC: Description and relationship to need and local characteristics

Wednesday, October 29, 2008: 11:00 AM

Hannah LF Cooper, ScD, SM , Department of Behavioral Sciences and Health Education, Rollins School of Public Health at Emory University, Atlanta, GA
Brian Bossak, PhD, MPH , Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA
Barbara Tempalski, MPH, PhD , National Development and Research Institutes, Inc, New York, NY
Samuel R. Friedman, PhD , Iar, National Develpment & Research Institutes, New York, NY
Don C. Des Jarlais, PhD , Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center, New York, NY
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.

Learning Objectives:
At the close of the session, the participant will be able to: (1) Describe a method of calculating spatial access to sterile syringes. (2) Assess the extent to which spatial access to sterile syringes in NYC is responsive to local need. (3) Evaluate whether spatial access to sterile syringes in NYC varies by local sociodemographic characteristics, controlling for local need.

Keywords: HIV/AIDS, Injection Drug Users

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the principal investigator on the study that gave rise to this analysis.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.