title: Community attitudes towards harm reduction services and a newly established needle and syringe automatic dispensing machine in an inner-city area of Sydney, Australia.
abstract: BACKGROUND
  Automatic dispensing machines (ADMs) are an inexpensive method of increasing needle and syringe distribution to people who inject drugs but widespread implementation has been limited. The operation of ADMs in Australia has been met with apparent community opposition despite national data indicating support for harm reduction. Key community concerns include perceived increases in crime and drug use. This study aimed to examine community-level support for a newly implemented ADM in an inner-city Sydney area known for high levels of drug use.
  
  
  METHODS
  Attitudes to harm reduction and ADMs were assessed via a brief face-to-face survey of local residents (n=118) and businesses (n=35) located within the vicinity of needle and syringe program (NSP) services including the ADM. Participation was voluntary and no reimbursement was provided. Univariate analysis assessed statistically significant differences between residents' and businesses' knowledge of, and support for, a range of harm reduction initiatives, both generally and in the local area. Univariate logistic regression models were used to determine factors associated with indicating support for an ADM locally.
  
  
  RESULTS
  The response rate was higher among businesses (60%) compared to residents living in street-accessible dwellings (42%). Participants indicated support for fixed-site NSPs in general (83%) and locally (77%). Support for ADMs was slightly lower - 67% indicated support for ADMs generally and 60% locally. Negative opinions regarding ADMs (believing that they encourage drug use, attract drug users to the area and increase drug-related crime) were found to be significantly associated with a lower likelihood of indicating support for ADMs locally.
  
  
  CONCLUSIONS
  Despite media reports suggesting widespread community concern, there was general community support for harm reduction, including ADMs. While it is important that harm reduction services are aware of community concerns and respond appropriately, such responses should be considered and interpreted against a broader backdrop of support.
authors.affiliation: Discipline of Addiction Medicine, Central Clinical School, The University of Sydney, NSW 2006, Australia. Electronic address: bethany.white@sydney.edu.au.
authors.forename: Bethany
authors.initials: B
authors.lastname: White
authors.affiliation: Discipline of Addiction Medicine, Central Clinical School, The University of Sydney, NSW 2006, Australia.
authors.forename: Paul S
authors.initials: PS
authors.lastname: Haber
authors.affiliation: Discipline of Addiction Medicine, Central Clinical School, The University of Sydney, NSW 2006, Australia.
authors.forename: Carolyn A
authors.initials: CA
authors.lastname: Day
mesh_terms: D000328:Adult; D001294:Attitude to Health; D001315:Australia; D005260:Female; D040261:Harm Reduction; D006801:Humans; D016015:Logistic Models; D008297:Male; D018671:Needle-Exchange Programs / Q000458:organization & administration*; D015819:Substance Abuse, Intravenous / Q000150:complications* / Q000453:epidemiology; D011795:Surveys and Questionnaires
keywords: Automatic dispensing machines; Community opinion; Harm reduction; Household survey; Needle and syringe programs