Access to syringes for HIV prevention for injection drug users in St. Petersburg, Russia: syringe purchase test study
- Equal contributors
1 The Biomedical Center, 8, Viborgskaya Street, St. Petersburg 194044, Russia
2 Saint Petersburg State University, 7-9, Universitetskaya nab, St. Petersburg 199034, Russia
3 Center for Interdisciplinary Research on AIDS, School of Public Health, Yale University, 60 College Street, PO Box 208034, New Haven CT 06520-8034, USA
4 The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA 02215, USA
5 Northeastern University School of Law & Bouvé College of Health Sciences, 400 Huntington Ave, Boston, MA 02115, USA
BMC Public Health 2013, 13:183 doi:10.1186/1471-2458-13-183Published: 1 March 2013
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.
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.
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.
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.