Rollins School of Public Health at Emory University, Atlanta, GA, USA.
J Urban Health. 2012 Aug;89(4):678-96. doi: 10.1007/s11524-012-9673-y.
Despite the 2010 repeal of the ban on spending federal monies to fund syringe exchange programs (SEPs) in the U.S.A., these interventions--and specifically SEP site locations--remain controversial. To further inform discussions about the location of SEP sites, this longitudinal multilevel study investigates the relationship between spatial access to sterile syringes distributed by SEPs in New York City (NYC) United Hospital Fund (UHF) districts and injecting with an unsterile syringe among injectors over time (1995-2006). Annual measures of spatial access to syringes in each UHF district (N = 42) were created using data on SEP site locations and site-specific syringe distribution data. Individual-level data on unsterile injecting among injectors (N = 4,067) living in these districts, and on individual-level covariates, were drawn from the Risk Factors study, an ongoing cross-sectional study of NYC drug users. We used multilevel models to explore the relationship of district-level access to syringes to the odds of injecting with an unsterile syringe in >75% of injection events in the past 6 months, and to test whether this relationship varied by district-level arrest rates (per 1,000 residents) for drug and drug paraphernalia possession. The relationship between district-level access to syringes and the odds of injecting with an unsterile syringe depended on district-level arrest rates. In districts with low baseline arrest rates, better syringe access was associated with a decline in the odds of frequently injecting with an unsterile syringe (AOR, 0.95). In districts with no baseline syringe access, higher arrest rates were associated with increased odds of frequently injecting with an unsterile syringe (AOR, 1.02) When both interventions were present, arrest rates eroded the protective effects of spatial access to syringes. Spatial access to syringes in small geographic areas appears to reduce the odds of injecting with an unsterile syringe among local injectors, and arrest rates elevate these odds. Policies and practices that curtail syringe flow in geographic areas (e.g., restrictions on SEP locations or syringe distribution) or that make it difficult for injectors to use the sterile syringes they have acquired may damage local injectors' efforts to reduce HIV transmission and other injection-related harms.
尽管美国在 2010 年废除了禁止使用联邦资金为注射器交换项目（SEP）提供资金的禁令，但这些干预措施——特别是 SEP 地点——仍然存在争议。为了进一步为关于 SEP 地点位置的讨论提供信息，本纵向多层次研究调查了纽约市（NYC）联合医院基金（UHF）区无菌注射器分布的 SEP 获得的空间与时间（1995-2006 年）之间的关系。使用有关 SEP 地点位置和特定地点注射器分配数据的每年每个 UHF 区的空间访问量的年度措施（N = 42）。从风险因素研究中获取了居住在这些区的注射者中未使用无菌注射器进行注射的个体水平数据（N = 4,067），以及个体水平协变量，该研究是对纽约市吸毒者的一项正在进行的横断面研究。我们使用多层次模型来探索地区一级获得注射器与过去 6 个月内超过 75％的注射事件中使用未使用无菌注射器的可能性之间的关系，并测试该关系是否因地区一级因毒品和药物用具占有而被捕的人数（每 1000 人）而异。地区一级获得注射器与使用未使用无菌注射器进行注射的可能性之间的关系取决于地区一级的逮捕率。在基线逮捕率较低的地区，更好的注射器获取与频繁使用未使用无菌注射器的可能性降低有关（AOR，0.95）。在没有基线注射器获取的地区，较高的逮捕率与频繁使用未使用无菌注射器的可能性增加有关（AOR，1.02）。当这两种干预措施都存在时，逮捕率会削弱对注射器获取的空间保护作用。在小地理区域内获得注射器的机会似乎会降低当地注射者使用未使用无菌注射器进行注射的可能性，而逮捕率则会增加这些可能性。在地理区域限制注射器流动（例如，限制 SEP 地点或注射器分配）或使注射者难以使用他们获得的无菌注射器的政策和做法，可能会损害当地注射者减少 HIV 传播和其他与注射相关的伤害的努力。
