title: Access to syringes in three Russian cities: implications for syringe distribution and coverage.
abstract: BACKGROUND
  We report findings from a multi-method study investigating drug injectors' access to needles and syringes in three large Russian cities (Moscow, Volgograd, Barnaul).
  
  
  METHODS
  We undertook 209 qualitative interviews among drug injectors, and supplemented these with baseline data from a community-recruited survey of 1473 drug injectors.
  
  
  RESULTS
  Almost all (93%; 1277) injectors used pharmacies as their main source of clean injecting equipment, and only 7% (105) reported ever having had contact with city syringe exchange projects. Good access to syringes has coincided with the expansion of private pharmacies. Key factors contributing to pharmacy access included: geographic proximity; low cost; and the restrictive policies of exchange instituted at local syringe exchanges. A fear of police interference surrounded the use of pharmacies and syringe exchanges, and fed a reluctance to carry used needles and syringes, which in turn acted as a disincentive to syringe exchange attendance. The perceived benefits of syringe exchanges over pharmacies included the additional health services on offer and the social support provided, but these benefits were over-shadowed by disadvantages. Multivariable analyses of survey data in two cities show no differences on account of risk behaviour among injectors sourcing equipment from pharmacies compared to syringe exchanges.
  
  
  CONCLUSIONS
  HIV prevention coverage indicators need to include measures of pharmacy-based syringe distribution and not only measures of syringe exchange coverage. There is an urgent need to pilot pharmacy-based distribution and exchange projects in Russia as well as other forms of secondary syringe distribution. Alongside expanding the reach of dedicated syringe exchange projects, pharmacy-based syringe distribution, and exchange, may help improve coverage of cost effective HIV prevention measures targeting drug injectors.
authors.affiliation: Russian Harm Reduction Network, Ilimskaya Street, 4-1-38, 127576 Moscow, Russia. anyasarang@gmail.com
authors.forename: Anya
authors.initials: A
authors.lastname: Sarang
authors.forename: Tim
authors.initials: T
authors.lastname: Rhodes
authors.forename: Lucy
authors.initials: L
authors.lastname: Platt
mesh_terms: D000293:Adolescent; D000328:Adult; D003362:Cost-Benefit Analysis; D003625:Data Collection; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018671:Needle-Exchange Programs / Q000191:economics / Q000706:statistics & numerical data*; D010594:Pharmacies / Q000458:organization & administration; D011314:Preventive Health Services / Q000191:economics / Q000458:organization & administration; D012309:Risk-Taking; D012426:Russia; D015819:Substance Abuse, Intravenous / Q000150:complications*; D013594:Syringes / Q000600:supply & distribution; D019037:Urban Health Services / Q000600:supply & distribution