Spatial Access to Sterile Syringes and the Odds of Injecting with an Unsterile Syringe among Injectors: A Longitudinal Multilevel Study

摘要: Despite the 2010 repeal of ban on spending federal monies to fund syringe exchange programs (SEPs) in USA, these interventions—and specifically SEP site locations—remain controversial. To further inform discussions about location sites, this longitudinal multilevel study investigates relationship between spatial access sterile syringes distributed by SEPs New York City (NYC) United Hospital Fund (UHF) districts and injecting with an unsterile among injectors over time (1995–2006). Annual measures each UHF district (N = 42) were created using data locations site-specific distribution data. Individual-level (N = 4,067) living districts, individual-level covariates, drawn from Risk Factors study, ongoing cross-sectional NYC drug users. We used models explore district-level odds >75% injection events past 6 months, test whether varied arrest rates (per 1,000 residents) for paraphernalia possession. The depended rates. In low baseline rates, better was associated a decline frequently (AOR, 0.95). no access, higher increased 1.02) When both interventions present, eroded protective effects syringes. Spatial small geographic areas appears reduce local injectors, elevate odds. Policies practices that curtail flow (e.g., restrictions or distribution) make it difficult use they have acquired may damage injectors’ efforts HIV transmission other injection-related harms.