title: Effect of legal status of pharmacy syringe sales on syringe purchases by persons who inject drugs in San Francisco and San Diego, CA.
abstract: BACKGROUND
  Sharing blood-contaminated syringes is the main risk factor for acquiring and transmitting blood-borne infections among persons who inject drugs (PWID). To reduce this risk, in 2005, California enacted legislation allowing local health jurisdictions to legalize non-prescription syringe sales after approving a disease prevention demonstration project (DPDP). With San Francisco approving a DPDP immediately and San Diego never approving one, we compared PWID across cities for their use of pharmacies PWID to obtain syringes.
  
  
  METHODS
  PWID age 18-30 years old were recruited into separate studies in San Francisco (n=243) and San Diego (n=338) between 2008 and 2011. We used multivariable logistic regression to compare the proportions of PWID who obtained syringes from pharmacies by city while controlling for sociodemographics, injection practices and other risk behaviors.
  
  
  RESULTS
  Overall, most PWID were White (71%), male (63%), and between the ages of 18-25 years (55%). Compared to San Francisco, a smaller proportion of PWID in San Diego had bought syringes from pharmacies in the prior three months (16.9% vs. 49.8%; p<0.001), which remained statistically significant after adjusting for sociodemographic and behavioral factors (adjusted odds ratio=4.45, 95% confidence interval: 2.98, 6.65).
  
  
  CONCLUSIONS
  Use of pharmacies to obtain syringes was greater where it was legal to do so. Public health policy can influence HIV and hepatitis C associated risk among PWID; however, implementation of these policies is crucial for the benefits to be realized.
authors.affiliation: Graduate School of Public Health, San Diego State University, San Diego, CA, USA.
authors.forename: Saira S
authors.initials: SS
authors.lastname: Siddiqui
authors.affiliation: Division of Global Public Health, School of Medicine, University of California San Diego, San Diego, CA, USA.
authors.forename: Richard F
authors.initials: RF
authors.lastname: Armenta
authors.affiliation: Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Evans
authors.affiliation: Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Michelle
authors.initials: M
authors.lastname: Yu
authors.affiliation: Division of Global Public Health, School of Medicine, University of California San Diego, San Diego, CA, USA.
authors.forename: Jazmine
authors.initials: J
authors.lastname: Cuevas-Mota
authors.affiliation: Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Page
authors.affiliation: Division of Global Public Health, School of Medicine, University of California San Diego, San Diego, CA, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Davidson
authors.affiliation: Division of Global Public Health, School of Medicine, University of California San Diego, San Diego, CA, USA. Electronic address: rgarfein@ucsd.edu.
authors.forename: Richard S
authors.initials: RS
authors.lastname: Garfein
mesh_terms: D000293:Adolescent; D000328:Adult; D001519:Behavior; D002140:California; D005260:Female; D015658:HIV Infections / Q000209:etiology / Q000517:prevention & control; D006526:Hepatitis C / Q000209:etiology / Q000517:prevention & control; D006798:Housing; D006801:Humans; D007885:Legislation, Pharmacy / Q000639:trends*; D008297:Male; D016485:Needle Sharing; D018671:Needle-Exchange Programs; D010594:Pharmacies; D012495:San Francisco; D012959:Socioeconomic Factors; D015819:Substance Abuse, Intravenous / Q000150:complications; D013594:Syringes / Q000191:economics*; D055815:Young Adult
keywords: Health policy; Hepatitis C; Human immunodeficiency virus; Injection drug use; Persons who inject drugs; Pharmacies; Syringe access