title: Access to syringes for HIV prevention for injection drug users in St. Petersburg, Russia: syringe purchase test study.
abstract: 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.
authors: The Biomedical Center, 8, Viborgskaya Street, St. Petersburg 194044, Russia. ekaterina_fedorova@yahoo.com
authors: Ekaterina V
authors: EV
authors: Fedorova
authors: Roman V
authors: RV
authors: Skochilov
authors: Robert
authors: R
authors: Heimer
authors: Patricia
authors: P
authors: Case
authors: Leo
authors: L
authors: Beletsky
authors: Lauretta E
authors: LE
authors: Grau
authors: Andrey P
authors: AP
authors: Kozlov
authors: Alla V
authors: AV
authors: Shaboltas
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003132:Commerce / Q000379:methods*; D005260:Female; D015658:HIV Infections / Q000209:etiology / Q000517:prevention & control*; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D010594:Pharmacies / Q000145:classification / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D010595:Pharmacists / Q000523:psychology / Q000706:statistics & numerical data; D011365:Professional Practice Location / Q000706:statistics & numerical data; D036301:Qualitative Research; D012426:Russia; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D013594:Syringes / Q000191:economics* / Q000600:supply & distribution