1. Neighborhood Variations in Syringe Access, Use, and Discard Robert Heimer, Kaveh Khoshnood, Wei Teng, David Buchanan, Tom Stopka, & Merrill Singer Acknowledgement: The research described in this paper is supported by the National Institute on Drug Abuse, grant #R01 DA12569, Merrill Singer, Principal Investigator.

3. I-91 Study: HIV Risk in Syringe Access, Use and Discard b Neighborhood based analysis of IDUs in New Haven, Hartford, and Springfield. b New Haven and Hartford have SEPs and legal pharmacy access, Springfield does not. b Recruitment of 320 IDUs in each city. b Quantitative data collection instrument focused on HIV transmission risk behaviors in the past 30 days.

4. Neighborhood Level Analysis of Quantitative Data from I-91 Study b Three main categories for syringe access considered: pharmacies, syringe exchange programs (SEPs), all other sources. b Formative research identified neighbor- hoods with high concentrations of IDUs. b Research focused on those that had SEPs only (4), pharmacies that sell to IDUs (7), both SEPs and pharmacies (2), and neither (11).

5. Sociodemographic Analysis of I-91 Neighborhoods b To date, 875 IDUs recruited into this study. b The four categories of neighborhood do not differ in terms of participants’ sex, age, schooling, self-reported HIV or hepatitis serostatus, and phsyical diability. b Salient significant differences are worth considering in detail.

6. Sociodemiographic Differences I b Race Ethnicity â Latinos most populous, white least populous in neighborhoods without either pharmacy or SEP. â Blacks evenly distributed across all four categories of neighborhoods. bIncome â Poorest neighborhoods are those without pharmacies that sell syringes to IDUs.

7. Sociodemiographic Differences II b Housing and Homelessness â Neighborhoods with highest percentage of IDUs having their own residences are those with pharmacies but no SEP van sites. â Neighborhoods with lowest percentage of IDUs having their own residences are those with pharmacies and SEP van sites. â Homelessness is highest in neighborhoods with pharmacies and SEP van sites.

8. Syringe Acquisition I b SEPs were the major source of syringe in neighborhoods with SEP stops, regardless of presence of pharmacies. b Pharmacies were the major source in neighborhoods with pharmacies, but without SEP stops. b Unsafe sources predominated in those neighborhoods without SEPs or pharmacy.

9. Syringe Acquisition II b Few IDUs in neighborhoods with neither acquired syringes from a pharmacy (13.7%) or from an SEP (15.6%). b Half the IDUs in neighborhoods with an SEP stop but no pharmacy acquired syringes from a pharmacy.

10. Syringe Use Risks I: Shared Syringes

11. Syringe Use Risks II: Reused Syringes

12. Syringe Discard b IDUs in neighborhoods without either SEPs or pharmacies are 2.5 times as likely to stash syringes for later use (26.1% vs. 10.3%). b IDUs in neighborhoods without either SEPs or pharmacies are twice a likely to publicly discard their syringes.

13. Arrests for Syringe Possession

14. Conclusions b IDUs who reside in neighborhoods where they are denied local access to clean syringes through SEPs or over-the-counter pharmacy sales are more likely to be Latino and poor. b These IDUs are more likely to get their syringes from an unreliable source, share and reuse syringes, improperly discard syringes, and be arrested or detained for syringe possession.

15. Caveats b These data were obtained in three cities. Springfield, MA differs from its Connecticut cousins in that neither SEPs nor pharmacy sales are legal there. b Springfield IDUs may unduly influence the findings of higher risk in those neighborhoods lacking SEPs and pharmacies that sell syringes over the counter.

16. Recommendations b Increasing access to clean syringes is likely to be associated with decreases in the transmission of syringe-borne viruses. b More pharmacies should be encouraged to sell syringes without a prescription. bHispanic neighborhoods, especially, need such pharmacies. b Springfield should adopt a public health approach to its IDUs.