IDU Access to HIV/HCV Prevention

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DESCRIPTION: (provided by applicant) A recent health promotion campaign in Rhode Island (RI) to prevent HIV and Hepatitis C prompted the deregulation of syringes, allowing their sale in pharmacies without a prescription. Included in this law is that pharmacies may sell syringes: if so, pharmacists are required to provide syringe disposal information and may provide drug treatment referral information. This proposal is to investigate racial/ethnic and gender disparities in access to pharmacy-based prevention services associated with this law change. We propose to evaluate racial/ethnic and gender disparities by geographic barriers (Specific Aim 1), barriers related to drug users (the consumer of these services) (Specific Aim 2), and barriers related to pharmacists (the providers of these services) (Specific Aim 3). We limit our evaluation to the two largest non-white groups in RI, African Americans/Blacks, and Latino/ Hispanics in comparison to whites. Geocoding methods will be used for Specific Aim 1. Census 2000 data will be used to identify racially diverse block groups. Socioeconomic conditions will be quantified to adjust for class in analyses of race. Both pharmacy and drug user locations will be overlaid to determine geographic barriers to access. For drug user studies, qualitative and quantitative methods will determine both perceived and real barriers to accessing pharmacy prevention services. The qualitative study will use a targeted street recruitment of injection drug users, while the quantitative study will include participants in existing drug user cohorts. For pharmacy-related studies, all pharmacies in the state will be included. We propose a purchaser experience trial where non-drug using purchasers of different racial/ethnic groups attempt to purchase a syringe, as well as a pharmacist telephone survey, evaluating attitudes regarding the law change, their perception regarding drug users and racial/ethnic groups in general. Analyses will evaluate access (or barriers to access) and its relation to race, across and between racially and socioeconomically diverse neighborhoods. These analyses will provide important data regarding the implementation of a policy change and the need for targeted solutions in response to racial disparities.