Syringe Acquisition and Use of Syringe Exchange Programs by Puerto Rican Drug Injectors in New York and Puerto Rico: Comparisons Based on Quantitative and Qualitative Methods

Universidad Central del Caribe
AIDS and Behavior (Impact Factor: 3.49). 11/2000; 4(4):341-351. DOI: 10.1023/A:1026498321919


Quantitative and qualitative data are used to compare alternative sources of syringes, including syringe exchange programs (SEPs), accessed by 165 Puerto Rican injection drug users (IDUs) in East Harlem, New York (NY), and 115 in Bayamn, Puerto Rico (PR). IDUs in PR obtained, on average, 45.2% of their syringes from syringe sellers, 18.0% from pharmacies, and 17.6% from a SEP. By contrast, IDUs in NY obtained 55.0% of their syringes from SEPs and 22.9% from syringe sellers. Compared to their island counterparts, IDUs in NY received significantly more syringes from SEPs (NY, 104.5; PR, 9.2) in the prior 30 days, and were more likely to be referred by SEPs to drug treatment and HIV/TB-testing services. The results of this study suggest the need in Puerto Rico to eliminate restrictive syringe exchange policies, reform drug paraphernalia laws to protect SEP clients, and address police harassment related to carrying syringes.

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    • "Factors constraining the effectiveness of safer environment interventions 3.4.1. The impact of drug law enforcement While SEIs altered the risk environment to minimize drug and health harms, studies indicated that access to these interventions was constrained by drug law enforcement, and in particular the threat of detainment for the possession of drugs or harm reduction paraphernalia (Andrade et al., 2001; Bluthenthal et al., 1997; Cooper et al., 2005; Finlinson et al., 2000; Ngo et al., 2009; Rhodes et al., 2003; Sarang et al., 2008, 2010; Sherman et al., 2008). "
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    ABSTRACT: There is growing acknowledgment that social, structural, and environmental forces produce vulnerability to health harms among people who inject drugs (PWID), and safer environment interventions (SEI) have been identified as critical to mitigating the impacts of these contextual forces on drug-related harm. To date, however, SEIs have been under-theorized in the literature, and how they minimize drug-related risks across intervention types and settings has not been adequately examined. This article presents findings from a systematic review and meta-synthesis of qualitative studies reporting PWID's experiences with three types of SEIs (syringe exchange programmes, supervised injection facilities and peer-based harm reduction interventions) published between 1997 and 2012. This meta-synthesis sought to develop a comprehensive understanding of SEIs informed by the experiences of PWID. Twenty-nine papers representing twenty-one unique studies that included an aggregate of more than 800 PWID were included in this meta-synthesis. This meta-synthesis found that SEIs fostered social and physical environments that mitigated drug-related harms and increased access to social and material resources. Specifically, SEIs: (1) provided refuge from street-based drug scenes; (2) enabled safer injecting by reshaping the social and environmental contexts of injection drug use; (3) mediated access to resources and health care services; and, (4) were constrained by drug prohibition and law enforcement activities. These findings indicate that it is critical to situate SEIs in relation to the lived experiences of PWID, and in particular provide broader environmental support to PWID. Given that existing drug laws limit the effectiveness of interventions, drug policy reforms are needed to enable public health, and specifically SEIs, to occupy a more prominent role in the response to injection drug use.
    Social Science & Medicine 02/2014; 106C:151-158. DOI:10.1016/j.socscimed.2014.01.051 · 2.89 Impact Factor
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    • "The primary hypothesis of the present analysis was that young people who inject MA would be more likely to report syringe sharing as compared to young IDU who inject other substances. Drawing on a growing literature demonstrating that social and structural barriers to accessing SEPs are important drivers of HIV risk behavior among IDU populations [17–19], we also hypothesized that reporting difficulty accessing sterile syringes would mediate the association between MA injection and syringe sharing. These findings may inform the development of more effective behavioral and public health interventions aiming to reduce syringe sharing and resultant infectious disease transmission among young MA injecting populations. "
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    ABSTRACT: Injection drug users (IDU) who use methamphetamine (MA) are at an increased risk of HIV infection due to engagement in injection-related risk behavior including syringe sharing. In this cohort study of young IDU aged 18-30, we investigated the relationship between injection MA use and syringe sharing, and whether difficulty accessing sterile syringes mediated this association. Behavioral questionnaires were completed by 384 IDU in Vancouver, Canada between October 2005 and May 2008. Generalized estimating equations were used to estimate direct and indirect effects. The median age of participants was 24 (IQR: 22-27) and 214 (55.7%) were male. Injecting MA was independently associated with syringe sharing. Mediation analyses revealed that difficulty accessing sterile syringes partially mediated the association between injecting MA and syringe sharing. Interventions to reduce syringe sharing among young methamphetamine injectors must address social and structural barriers to accessing HIV prevention programs.
    AIDS and Behavior 10/2011; 15(7):1546-53. DOI:10.1007/s10461-010-9876-8 · 3.49 Impact Factor
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    • "This article follows the lead of others in combining qualitative and quantitative methods to provide a comprehensive view of blood-borne disease risk among injection drug users (Carlson et al., 1996; Coí on et al. 2001; Deren et al. 2003; Friedman et al., 1999; Finlinson et al., 2000; Page, 1999; Weeks et al., 2001). The results described are based on the analysis of baseline interviews and ethnographic research conducted as part of a socially focused intervention project for injection drug users in Denver, Colorado. "
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    ABSTRACT: Qualitative and quantitative findings from the baseline survey of a longitudinal, socially-focused blood-borne disease intervention study among 611 heroin IDU in Denver indicate that high risk injection practices-the sharing of contaminated drug solution in particular-often occur as a consequence of how heroin is obtained, the quantity obtained and the setting where it is injected. Contamination occurs if a contaminated syringe is used to liquefy and apportion the shared drug. In our cohort of 304 heroin injecting networks there was at least one member who, when asked to describe their last injection, reported dividing the drug as a liquid (82%), using a reservoir of water that syringes had been rinsed in to mix drugs (67%), using a common cooker (86%)-a proxy for drug sharing-and beating a shared cotton filter (58%). In contrast, only 22% reported syringe sharing. Variables associated with various injection practices included location of the last injection episode, quantity of drug injected, dope sickness, and years injecting. When compared to those who injected in a safe setting, those in an unsafe location had almost three times the odds (OR = 2.9; 95% CI: 1.9, 4.6) of being part of an injection episode where there was cooker sharing; and the smaller the quantity of heroin (< or =1/4 gram v. > 1/4 gram) present at the episode, the greater the odds that cooker sharing occurred (OR = 1.8; 95% CI: 1.2, 2.6). Use of a used, unbleached syringe to prepare shared drugs had twice the odds of occurring in "unsafe" v. safe settings (OR = 2.2; 95% CI: 1.3, 4.0) and in episodes in which a participant was dopesick (OR = 2.1; 95% CI: 1.2, 3.6). In summary, risky injection practices occur within an injection process that is, in part, a response to a structurally imposed risk environment. Lessening the blood-borne disease risks embedded within this process requires interventions designed to mitigate the environmental factors that influence it, including syringe accessibility, law enforcement strategies and the settings where IDU inject drugs.
    AIDS and Behavior 03/2005; 9(1):27-39. DOI:10.1007/s10461-005-1679-y · 3.49 Impact Factor
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