208516 Pharmacy barriers to the sale of non-prescription syringes in New York City Preliminary findings from the Pharmacies as Resources Making Links to Community Services (PHARM-Link) study

Tuesday, November 10, 2009

Rachel J. Stern, BA , Center for Urban Epidemiologic Studies, New York Academy of Medicine, New York, NY
Carolyn Hernandez, BA , Center for Urban Epidemiologic Studies, New York Academy of Medicine, New York, NY
Shannon Blaney, MPH , Center for Urban Epidemiologic Studies, New York Academy of Medicine, New York, NY
Silvia Amesty, MD, MPH, MSEd , Center for Family and Community Medicine, Columbia University, College of Physicians and Surgeons, New York, NY
Natalie Crawford, MPH , Department of Epidemiology, Columbia University, New York City, NY
Crystal M. Fuller, PhD , Center for Urban Epidemiologic Studies, New York Academy of Medicine, New York, NY
Background: The New York State Expanded Syringe Access program (ESAP) legalized pharmacy non-prescription syringe sales in 2001 to reduce HIV transmission among injection drug users (IDUs). Some pharmacies impose “additional requirements” for a syringe sale– requiring customers to sign a log book, show diabetic or other identification –potentially affecting syringe access. This analysis identifies pharmacist characteristics associated with “additional requirements.”Methods: ESAP-registered pharmacies in ethnographically-mapped high drug activity areas in Harlem, Lower Manhattan, Bronx, Brooklyn and Queens were contacted to assess eligibility for participation in a study about ESAP. Logistic regression was used to identify pharmacist characteristics significantly associated with additional requirements. Results: Of 231 pharmacists surveyed, most were male (67.5%), Asian/Pacific Islander (38.3.%) and white (23.4%). Most pharmacies were in Harlem (26.8%), Lower Manhattan, (26.0%) and Bronx (22.9%). Although half of pharmacies were contacted in a mobilization campaign encouraging ESAP compliance, additional requirements were required by 13.0% of pharmacies. These pharmacies had fewer conversations with ESAP customers (p=.0173), were more likely in Bronx, Brooklyn or Queens neighborhoods (p=.0419) and had fewer new ESAP customers/month (p=.059). Mobilization campaign participation was not associated with additional requirements (p=.1235). After adjustment, pharmacy location in a Bronx (AOR=7.126) or Brooklyn neighborhood (AOR=5.959) remained significantly associated with additional requirements. Conclusion: Given the highest burden of HIV/AIDS in NYC occur in these neighborhoods, future research should explore why pharmacies impose requirements not stipulated by NYS health department. This could be explained by individual pharmacist, pharmacy and neighborhood-level factors that could directly inform HIV prevention and intervention strategies.

Learning Objectives:
1. Explain the importance of proper implementation of the Expanded Syringe Access Program (ESAP) to HIV prevention among Intravenous Drug Users. 2. Describe how neighborhood, pharmacy, and pharmacist-level factors may influence the differential implementation of ESAP.

Keywords: Pharmacies, Injection Drug Users

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I earned a B.A. from Harvard University. Since then I have spent two years coordinating the study that the data in this abstract has been drawn from. I assisted in the design of the survey used and the management of the data used. I am an APHA member and was a co-author on a poster on a related topic at the 2008 annual meeting.
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.