Needle exchange and difficulty with needle access during an ongoing HIV epidemic

During the mid to late 1990s, Vancouver, Canada experienced a rapid injection drug use-related HIV epidemic, despite the presence of a well-established, high-volume, needle exchange program (NEP). The NEP presently exchanges needles through several fixed sites, the largest of which operates in the city''s Downtown Eastside where injection drug users (IDU) are concentrated, and through mobile exchange vans which exchange needles throughout neighboring areas. The program''s inability to prevent the epidemic has led to persistent questions about the efficacy of needle exchange as a public health intervention. We recently sought possible explanations for persistent needle sharing through an evaluation of the Vancouver Injection Drug Users Study (VIDUS), an ongoing cohort study of IDU that began in 1996. In these analyses, the strongest predictor of needle sharing was difficulty accessing needles; those who reported difficulty accessing needles were 3.5 times more likely to report sharing than those who did not have difficulty with access. In the present study, we sought to identify reasons why IDU continued to have difficulty accessing needles despite the efforts of the NEP. Overall, 761 active injectors were interviewed during the period June 2000–May 2001. Of these 172 (22.6%) reported having difficulty accessing sterile needles. In a multivariate analysis, frequent cocaine injection and bingeing were associated with difficulty accessing needles, whereas residing in the Downtown Eastside was negatively associated with difficulty. When we evaluated IDU''s reasons for difficulty with access, the most common reasons given were the operating hours of the NEP, difficulty meeting the needle exchange van, being away from the area where needles are exchanged, and being refused sterile needles at pharmacies. These findings suggest that programmatic deficiencies related to the operation of the needle exchange and refusal of pharmacists to sell needles may be primary factors related to difficulty accessing needles. [Copyright &y& Elsevier]