Access to syringes for HIV prevention for injection drug users in St. Petersburg, Russia: syringe purchase test study

BMC Public Health

Alla V Shaboltas⁵  Andrey P Kozlov⁵  Lauretta E Grau¹  Leo Beletsky⁴  Patricia Case³  Robert Heimer¹  Roman V Skochilov⁵  Ekaterina V Fedorova² 

[1] Center for Interdisciplinary Research on AIDS, School of Public Health, Yale University, 60 College Street, PO Box 208034, New Haven CT 06520-8034, USA;The Biomedical Center, 8, Viborgskaya Street, St. Petersburg 194044, Russia;The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA 02215, USA;Northeastern University School of Law & Bouvé College of Health Sciences, 400 Huntington Ave, Boston, MA 02115, USA;Saint Petersburg State University, 7-9, Universitetskaya nab, St. Petersburg 199034, Russia

关键词: Pharmacy;    Syringe access;    HIV prevention;    Injection drug use;   

Others  :  1162496
DOI  :  10.1186/1471-2458-13-183

 received in 2012-07-07, accepted in 2013-02-19,  发布年份 2013

【 摘 要 】

Background

The HIV epidemic in Russia is concentrated among injection drug users (IDUs). This is especially true for St. Petersburg where high HIV incidence persists among the city’s estimated 80,000 IDUs. Although sterile syringes are legally available, access for IDUs may be hampered. To explore the feasibility of using pharmacies to expand syringe access and provide other prevention services to IDUs, we investigated the current access to sterile syringes at the pharmacies and the correlation between pharmacy density and HIV prevalence in St. Petersburg.

Methods

965 pharmacies citywide were mapped, classified by ownership type, and the association between pharmacy density and HIV prevalence at the district level was tested. We selected two districts among the 18 districts – one central and one peripheral – that represented two major types of city districts and contacted all operating pharmacies by phone to inquire if they stocked syringes and obtained details about their stock. Qualitative interviews with 26 IDUs provided data regarding syringe access in pharmacies and were used to formulate hypotheses for the pharmacy syringe purchase test wherein research staff attempted to purchase syringes in all pharmacies in the two districts.

Results

No correlation was found between the density of pharmacies and HIV prevalence at the district level. Of 108 operating pharmacies, 38 (35%) did not sell syringes of the types used by IDUs; of these, half stocked but refused to sell syringes to research staff, and the other half did not stock syringes at all. Overall 70 (65%) of the pharmacies did sell syringes; of these, 49 pharmacies sold single syringes without any restrictions and 21 offered packages of ten.

Conclusions

Trainings for pharmacists need to be conducted to reduce negative attitudes towards IDUs and increase pharmacists’ willingness to sell syringes. At a structural level, access to safe injection supplies for IDUs could be increased by including syringes in the federal list of mandatory medical products sold by pharmacies.

【 授权许可】

   
2013 Fedorova et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Goliusov AT, Dementyeva LA, Ladnaya NN, Briko NI, Tumanova MS, Korzhayeva NA, Semenchenko MV, Nitzsche-Bell A, Kobzeva VB: Country Progress Report of the Russian Federation on the Implementation of the Declaration of Commitment on HIV/AIDS. Moscow, RF: Federal Service for Surveillance of Consumer Rights Protection and Human Well Being, Ministry of Health and Social Development; 2008.
• [2]Rhodes T, Sarang A, Bobrik A, Bobkov A, Platt L: HIV transmission and HIV prevention associated with injecting drug use in the Russian Federation. Internatl J Drug Policy 2004, 15:1-16.
• [3]UNAIDS report on the global AIDS epidemic. http://www.unaids.org/globalreport webcite
• [4]Pokrovsky VV, Ladnaya NN, Buravtsova EV: HIV Infection: Information bulletin #34. Moscow, RF: Russian Federal AIDS Center; 2010.
• [5]Mathers BM, Degenhardt L, Phillips B, Wiessing L, Hickman M, Strathdee SA, Wodak A, Panda S, Tyndall M, Toufik A, Mattick RP: Global epidemiology of injecting drug use and HIV among people who inject drugs: a systematic review. Lancet 2008, 372:1733-1745.
• [6]Heimer R, White E: Estimation of the number of injection drug users in St. Petersburg, Russia. Drug Alcohol Depend 2010, 109:79-83.
• [7]Niccolai LM, Toussova OV, Verevochkin SV, Barbour R, Heimer R, Kozlov AP: High HIV prevalence, suboptimal HIV testing, and low knowledge of HIV-positive serostatus among injection drug users in St. Petersburg, Russia. AIDS Behav 2010, 14:932-941.
• [8]Public Health Committee of St. Petersburg: HIV infection and chronic viral hepatitis in St. Petersburg in 2009. St. Petersburg, RF: Center for Infectious Disease Control and Prevention; 2010.
• [9]Abdala N, Carney JM, Durante AJ, Klimov N, Ostrovski D, Somlai AM, Kozlov AP, Heimer R: Estimating the prevalence of syringe-borne and sexually transmitted diseases among injection drug users in St. Petersburg, Russia. Internatl J STD & AIDS 2003, 14:697-703.
• [10]Niccolai LM, Shcherbakova IS, Toussova OV, Kozlov AP, Heimer R: The potential for bridging of HIV transmission in Russian Federation: Sex risk behaviors and HIV prevalence among drug users (DUs) and their non-DU sex partners. J Urban Health 2009, 86:S131-S143.
• [11]Shaboltas AV, Toussova OV, Hoffman IF, Heimer R, Verevochkin SV, Ryder RW, Khoshnood K, Perdue T, Masse BR, Kozlov AP: HIV prevalence, socio-demographic and behavioral correlates and recruitment methods among injection drug users in St. Petersburg, Russia. J Acquir Immune Defic Syndr 2006, 41:657-663.
• [12]Kozlov AP, Shaboltas AV, Toussova OV, Verevochkin SV, Masse BR, Beauchamp G, Sheldon W, Miller WC, Hoffman IF: HIV incidence and factors associated with HIV acquisition among injection drug users in St. Petersburg, Russia. AIDS 2006, 20:901-906.
• [13]Verevochkin SV, Shaboltas AV, Gagarina SY, Skochilov RV, Toussova OV, Krasnoselskih TV, Malov SV, Kozlov AP: High HIV incidence rate in St. Petersburg IDU cohort. Rome, Italy: 6th IAS Conference on HIV Pathogenesis, Treatment and Prevention: Abstract no. TUPE346; 2011.
• [14]Molotilov V, Sofronova R, Gusseynova N, Laricheva N, Hader SL, Garfein R, Paxton L: Rapid increase in HIV rates–Orel oblast, Russian Federation, 1999–2001. MMWR 2003, 52:657-660.
• [15]Sarang A, Rhodes T, Platt L: Access to syringes in three Russian cities: implications for syringe distribution and coverage. Int J Drug Policy 2008, 19(suppl1):25-36.
• [16]Beletsky L, Macalino G, Burris S: Attitudes of police officers toward syringe access, occupational needle-sticks, and drug use: a qualitative study of one city police department in the Unites States. Int J Drug Policy 2005, 16:267-274.
• [17]Gostin LO: The legal environment impeding access to sterile syringes and needles: the conflict between law enforcement and public health. JAcquirImmuneDeficSyndrHumRetrovirol 1998, 18 Suppl 1:S60-S70.
• [18]Stancliff S, Agins B, Rich JD, Burris S: Syringe access for the prevention of bloodborne infections among injection drug users. BMC Public Health 2003, 3:37. BioMed Central Full Text
• [19]Burns SM, Brettle RP, Gore SM, Peutherer JF, Robertson JR: The epidemiology of HIV infection in Edinburgh related to the injecting of drugs. J Infection 1996, 32:53-62.
• [20]Case P, Beckett GA, Jones TS: Access to sterile syringes in Maine: pharmacy practice after the 1993 repeal of the syringe prescription law. JAcquirImmuneDeficSyndrHumRetrovirol 1998, 18 Suppl 1:S94-S101.
• [21]Compton WM, Horton JC, Cottler LB, Booth R, Leukefeld CG, Singer M, Cunningham-Williams R, Reich W, Fortuin Corsi K, Staton M, Fink JL, Stopka TJ, Spitznagel EL: A multistate trial of pharmacy syringe purchase. J Urban Health 2004, 81:661-670.
• [22]Deren S, Cleland C, Fuller CM, Kang SY, Des-Jarlais DC, Vlahov D: Changes in sources of syringes for injection drug users: impact of syringe deregulation. AIDS Behav 2006, 10:717-721.
• [23]Groseclose SL, Weinstein B, Jones TS, Valleroy LA, Fehrs LJ, Kassler WJ: Impact of increased legal access to needles and syringes on practices of injecting-drug users and police officers--Connecticut, 1992–1993. JAcquirImmuneDeficSyndrHumRetrovirol 1995, 10(1):82-89.
• [24]Fuller CM, Galea S, Caceres W, Blaney S, Sisco S, Vlahov D: Multilevel community-based intervention to increase access to sterile syringes among injection drug users through pharmacy sales in New York City. Am J Public Health 2007, 97(1):117-124.
• [25]Lenton S, Kerry K, Loxley W, Tan-Quigley A, Greig R: Citizens who inject drugs: the ‘Fitpack’ study. Int J Drug Policy 2000, 11:285-297.
• [26]Sheridan J, Strang J, Barber N, Glanz A: Role of community pharmacies in relation to HIV prevention and drug misuse: findings from the 1995 national survey in England and Wales. BMJ 1996, 313:272-274.
• [27]Zaller N, Jeronimo A, Bratberg J, Case P, Rich JD: Pharmacist and pharmacy staff experiences with non-prescription (NP) sale of syringes and attitudes toward providing HIV prevention services for injection drug users (IDUs) in Providence, RI. J Urban Health 2010, 87:942-953.
• [28]Lutnick A, Cooper E, Dodson C, Bluthenthal R, Kral AH: Pharmacy syringe purchase test of non-prescription syringe sales in San Francisco and Los Angeles, 2010. J Urban Health 2012. in press
• [29]Beletsky L, Thomas R, Smelyanskaya M, Artamonova I, Shumskaya N, Dooronbekova A, Mukambetov A, Doyle H, Tolson R: Policy reform to shift the health and human rights environment for vulnerable groups: the case of Kyrgyzstan’s instruction 417. Health and Hum Rights J 2012, 14(2):e1-15.
• [30]Burris SC, Beletsky L, Burleson JA, Case P, Lazzarini Z: Do criminal laws influence HIV risk behavior? An empirical trial. Arizona St LJ 2007, 39:467-517.
• [31]Ministry of Health and Social Development of the Russian Federation: On minimal assortment of medicinal agents. Decree #351n of April 26th. Moscow, RF: Ministry of Health and Social Development of the Russian Federation; 2011.
• [32]Open Health Institute: Harm Reduction Programs in the Civilian and Prison Sectors of the Russian Federation: Assessment of Best Practices. Moscow, RF: Open Health Institute; 2006.
• [33]Quantum GIS Development Team: Quantum GIS Geographic Information System. Open Source Geospatial Foundation Project; 2010. http://qgis.osgeo.org webcite
• [34]The population of the Russian Federation by cities, towns and urban areas on January 1, 2010. http://www.gks.ru webcite
• [35]Cooper EN, Dodson C, Stopka TJ, Riley ED, Garfein RS, Bluthenthal RN: Pharmacy participation in non-prescription syringe sales in Los Angeles and San Francisco counties. J Urban Health 2010, 87:543-552.
• [36]Vorobjov S, Uusküla A, Abel-Ollo K, Talu A, Des Jarlais DD: Should pharmacists have a role in harm reduction services for IDUs? A qualitative study in Tallinn, Estonia. J Urban Health 2009, 86:918-928.