Abstract
BackgroundSterile syringe access is a critical component of HIV prevention programs. Although retail pharmacies provide convenient outlets for syringe access, injection drug users (IDUs) may encounter barriers to syringe purchase even where purchase without a prescription is legal. We sought to obtain an objective measure of syringe access in Tijuana, Mexico, where IDUs report being denied or overcharged for syringes at pharmacies.MethodsTrained "mystery shoppers" attempted to buy a 1 cc insulin syringe according to a predetermined script at all retail pharmacies in three Tijuana neighborhoods. The same pharmacies were surveyed by telephone regarding their syringe sales policies. Data on purchase attempts were analyzed using basic statistics to obtain an objective measure of syringe access and compared with data on stated sales policies to ascertain consistency.ResultsOnly 46 (28.4%) of 162 syringe purchase attempts were successful. Leading reasons for unsuccessful attempts were being told that the pharmacy didn't sell syringes (35.3%), there were no syringes in stock (31.0%), or a prescription was required (20.7%). Of 136 pharmacies also surveyed by telephone, a majority (88.2%) reported selling syringes but only one-third (32.5%) had a successful mystery shopper purchase; the majority of unsuccessful purchases were attributed to being told the pharmacy didn't sell syringes. There was similar discordance regarding prescription policies: 74 pharmacies said in the telephone survey that they did not require a prescription for syringes, yet 10 of these pharmacies asked the mystery shopper for a prescription.ConclusionsIDUs in Tijuana have limited access to syringes through retail pharmacies and policies and practices regarding syringe sales are inconsistent. Reasons for these restrictive and inconsistent practices must be identified and addressed to expand syringe access, reduce syringe sharing and prevent HIV transmission.
Highlights
Sterile syringe access is a critical component of HIV prevention programs
Injection drug users (IDUs) are at high risk of infection with HIV, hepatitis C (HCV) and other blood-borne pathogens transmitted by sharing syringes and other injection equipment
syringe exchange programs (SEPs) have proven effective in reducing syringe sharing [3], but the number of these programs - and the overall number of syringes they distribute - is not sufficient to provide injection drug users (IDUs) with a sterile syringe for each injection
Summary
Sterile syringe access is a critical component of HIV prevention programs. retail pharmacies provide convenient outlets for syringe access, injection drug users (IDUs) may encounter barriers to syringe purchase even where purchase without a prescription is legal. Almost 20% of the world’s 15.9 million IDUs are infected with HIV [1] and in some studies HCV prevalence among IDUs is >90% [2] Transmission of these pathogens can be prevented by eliminating syringe sharing among IDUs. Transmission of these pathogens can be prevented by eliminating syringe sharing among IDUs This requires that sterile syringes be available at appropriate times and in sufficient quantities to supply a sterile syringe for each injection. SEPs have proven effective in reducing syringe sharing [3], but the number of these programs - and the overall number of syringes they distribute - is not sufficient to provide IDUs with a sterile syringe for each injection. In Latin America, for example, only 5 of 20 countries are known to have implemented SEPs, which serve only approximately 2% of the region’s IDUs [4]
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