摘要：Objectives. Research has indicated that there is minimal use of pharmacies among injection drug users (IDUs) in specific neighborhoods and among Black and Hispanic IDUs. We developed a community-based participatory research partnership to determine whether a multilevel intervention would increase sterile syringe access through a new policy allowing nonprescription syringe sales in pharmacies. Methods. We targeted Harlem, NY (using the South Bronx for comparison), and disseminated informational material at community forums, pharmacist training programs, and counseling or outreach programs for IDUs. We compared cross-sectional samples in 3 target populations (pre- and postintervention): community members (attitudes and opinions), pharmacists (opinions and practices), and IDUs (risk behaviors). Results. Among community members (N = 1496) and pharmacists (N = 131), negative opinions of IDU syringe sales decreased in Harlem whereas there was either no change or an increase in negative opinions in the comparison community. Although pharmacy use by IDUs (N=728) increased in both communities, pharmacy use increased significantly among Black IDUs in Harlem, but not in the comparison community; syringe reuse significantly decreased in Harlem, but not in the comparison community. Conclusions. Targeting the individual and the social environment through a multilevel community-based intervention reduced high-risk behavior, particularly among Black IDUs. The many strategies for preventing HIV/AIDS among injection drug users (IDUs) who cannot cease drug use have included syringe exchange programs and the removal of barriers to purchase (primarily through pharmacies) and possess syringes. 1 Syringe exchange programs, which couple syringe exchange with counseling, education, and referrals to care, have been shown to reduce HIV infection. However, obstacles such as fear of being identified as an IDU and police harassment have prevented some IDUs from using these programs. 2 – 7 Furthermore, inadequate syringe supplies, limited operation hours, and long travel distances have also been identified as barriers to syringe exchange program use. 8 , 9 As a result, numerous researchers urge the use of pharmacies as safe syringe sources to supplement syringe exchange programs. 1 , 10 Recognizing this need, New York State enacted the Expanded Syringe Access Demonstration Program (ESAP), which permits pharmacy syringe sales without a prescription. Since January 1, 2001, individuals aged 18 years or older have been permitted to purchase and legally possess up to 10 syringes without a prescription from pharmacies registered with the New York State Department of Health. Early data revealed that IDUs in East and Central Harlem (referred to as “Harlem” hereafter) and South Bronx minimally participated in ESAP. 11 – 14 In addition, studies indicated that Black and Hispanic drug users were less likely to use pharmacies as safe and legal syringe sources compared with their White counterparts, irrespective of geographic location. 11 , 12 , 14 , 15 In the summer of 2001, the Harlem Community and Academic Partnership recognized the disparities in both the use of ESAP and the burden of HIV disease in their community, and organized an intervention work group to address this issue. The partnership had been formed 2 years earlier, as described elsewhere, 16 and currently includes 30 community-based organizations in Harlem, 4 academic institutions, and the local health department. Because of the complex social factors (e.g., police harassment, various types of discrimination) that contribute to injection risk, and previous work that shows how contextual factors (e.g., public policy, cultural norms, illegality of drug use) may influence individual behaviors, a multilevel design was chosen. 17 – 19 Using a community-based participatory research approach, 20 we targeted 3 populations: community residents, pharmacists, and IDUs. The specific goals for the intervention were (1) to sensitize community residents to drug users and dispel negative myths by providing education on the positive affect that ESAP could have in their community (e.g., reducing the risk and burden of HIV disease), (2) to provide education to pharmacists about what was and was not required by the law and provide information to help dispel negative perceptions of drug users, and (3) to increase awareness of ESAP among IDUs and provide the location and hours of ESAP-participating pharmacies and information about safe injection and syringe disposal practices. All activities were to be performed in a culturally appropriate manner to specifically reach Black and Hispanic IDUs. We report the final results of our non-randomized, multilevel intervention, including pre- and postintervention evaluations in both intervention (Harlem) and comparison (South Bronx) communities. Using a community-based participatory research approach, we obtained data on 3 target populations: community residents, pharmacists, and IDUs.
