Street Syringe Sellers: Pros and Cons by HC120621005011

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									   Syringe Access, Use & Discard:
     Context in AIDS Risk Study
     (NIDA Grant # RO1 DA12569, PI: Merrill Singer, PhD)


– Hispanic Health Council, Htfd., CT: Tom Stopka, MHS,
 Merrill Singer, PhD, Claudia Santelices, ABD, Wei Teng, PhD,
 Glenn Scott, Susan Shaw, PhD, Anna Marie Nicolaysen, MA,
 Julie Eiserman, M.A.
– Yale Univ. Dept. of EPH: Robert Heimer, PhD, Kaveh
 Khoshnood, PhD, Mark Kinzly, Anthony Givens, Kevin Irwin, BS
– UMass SPH: David Buchanan, DrPH
– New North Citizens’ Council, Spfd.: Antonio Arzola
– Spfd. SW Comm. Hlth. Ctr., MA: Sabrina Simmons
  Public Health Interventionists,
Successful Capitalists, Harbingers
    of Risk? Syringe Sellers in
 Connecticut and Massachusetts

     Tom Stopka1, Merrill Singer1, Claudia
 Santelices1, Wei Teng1, Robert Heimer2, Susan
 Shaw1, Anna Marie Nicolaysen1, Mark Kinzly2,
   Kaveh Khoshnood2, David Buchanan3, and
                  Glenn Scott1

  1) Hispanic Health Council, Hartford, CT; 2) Yale University,
 New Haven, CT; 3) University of Massachusetts, Amherst, MA
       Need for a New Intervention

10 years since any new public health
 interventions have been attempted to reduce
 HIV and Hepatitis transmission among IDUs
     SEP
     OTC sales of pharmacy syringes
     Outreach efforts
     Bridge to treatment programs

Need a new approach
  Can syringe sellers fill an important harm reduction
   niche?
                        Methods
In-depth Interviews (N=25):
  Hartford:    20 IDIs with 18 syringe sellers
   Springfield: 7 total
  Hartford:    13 Latino, 3 AA, 1 white, 1 M.E.
   Springfield: 4 PR, 2 AA, 1 white
  Hartford:   15 male, 3 female; mean age = 37
   Springfield: 3 male, 4 female; mean age = 39
    *Syringe sellers difficult to locate in New Haven*

Structured surveys with IDUs (N=878)
Ethnographic Observations
Syringe Source Used Most ) Often,
      Past 30 Days (N=878)

  70
  60
  50
  40                                        SEP
  30                                        Pharmacy
                                            Syringe Seller
  20                                        Diabetic
  10
  0
       Hartford   Springfield   New Haven
       (n=328)     (n=300)       (n=250)

Categorization of syringe sellers and diabetics is
based on perceptions of IDUs who were interviewed.
         Rationale for Selling Syringes
Easy Labor -- “I started hanging around on the corner
 right over here ..., and I saw some people selling
 syringes, and selling drugs. I had no choice. I don’t do
 no drugs. And the syringes were easy to sell. So, I
 said, ‘hell, that is what I am going to do.’” (Hartford)
 “Easy money”
“Insurance source…wouldn’t have to go steal…”
“Less worries” with police
Harm Reduction -- “So I got hepatitis C. That is why
 I am selling [sterile syringes] now…I don’t want nobody
 to catch that.” (Hartford Seller)
        Typology of Syringe Sellers in
          Hartford and Springfield
Opportunistic Sellers -- “I got a box of syringes
  from a friend for a couple of bucks and I sold them.”

Bulk Sellers -- “I sell about 40-50 syringes a day.”
Subcontractors (Hartford) -- “I give you 30
  syringes, and what you do is you work this end of the
  street and I work this end of the street…The more you
  sell, the more money you make. I give you 30, you give
  me $20 and you keep ten…”
                   Clientele
IDUs who...
  Don’t want to be seen at SEP or pharmacy (Hartford)
  Want to maintain a low profile
  Find seller’s schedule and location more convenient

Male (74%) and female (26%) IDUs
Regulars vs. “weekend junkies” (Hartford)
Buyers of Underground Syringes,
   by Race/Ethnicity (n=121)

  80
  70
  60
  50
                                            African American
  40
                                            White
  30                                        Latino
  20
  10
   0
       Hartford   Springfield   New Haven
  IDU Perceptions of Syringe Sellers
Hierarchy of Risk
  Diabetics (non-IDUs) most trusted sellers.
    “… I know that she is not a drug user. The other sources are
     drug users and you know, when you are a drug user, you say,
     no I never touched them and I’m clean. But you know, they
     ain’t gonna tell you, yeah I’ve got HIV, wanna buy these?”
     (Hartford IDU)

    “...it’s just medicine, it’s not like they shooting drugs or
      anything...” (Springfield IDU)

  “Alcoholics” next most trusted
  Fellow IDUs least trusted as syringe sellers
               Risky Sales

“One time a dude asked me, and I had no
syringes, and he said he had to get off, I
said ‘I got a couple of used ones in the
draw’r, but I got Hepatitis,’ so whatever, I
said ‘if I give it to you, I am telling you now,
you got to clean it.’” (Hartford Seller)
           Economy of Syringes I
 Variations in price:
  Sliding scale = $1.00 to $5.00; new and used pricing
   variation in Springfield
  Good days vs. bad days -- “Sundays are my good
   days. I sell syringes for $2.00. During the week I
   sell for $1.00.” (Hartford Seller)
    “Beginning of the month is good for sales.”
  Availability determines price
  Syringes sold on credit at higher prices
         Economy of Syringes II

Street sales vs. house sales
Syringes as currency
Syringe Prices, by Source and City

  $4.00
                              3.67
  $3.50
  $3.00
                                  2.68
  $2.50
                                                        Pharmacy
  $2.00                                                 Syringe Seller
                                             1.72
  $1.50   $1.501.471.42                                 Diabetic
                                                 1.22
  $1.00                                  $0.87
  $0.50
  $0.00
           Hartford       Springfield    New Haven
Syringe Sources for Syringe Sellers

•   Diabetics: self, relative
•   Syringe Exchange Program (SEP)
•   Pharmacy: OTC (Hartford), Rx (Spfd.)
•   Injection locales
•   Hospital (stealing)
•   Underground bulk source?
        Street Selling Strategies
New Sellers: “Tengo ganchos”
Experienced sellers: word of mouth
“Sales”: 2 for 1, “…five for two dollars.”
“Referral system” with drug dealers
“One stop deal”
Shelter business
           Sales Challenges
Police:
  “That (possession of syringes) will get you a year
    in Jail” (Springfield)
New faces
Syringe inventory depleted quickly
  (especially around 1st of month in Springfield)
Gangs (Hartford)
Competition
Sterility of Syringes Purchased from
            Syringe Sellers
Hartford: 0 of 59 syringes tested positive for
 human DNA (new syringes)
  37.9% originally from SEP
  8.4% individually wrapped

Springfield: 9 of 76 syringes (11.8%) tested
 positive for DNA positive (9 used syringes).
New Haven: 0 of 2 syringes positive (outlier-
 syringe selling seems very rare)
                New Haven
Most participants were reluctant to talk about
 street sellers.
IDUs shocked by the thought of repackaged
 syringes.
10 years of increased syringe availability
 through SEP and pharmacies.
Conscious effort by police to shut down
 syringe sellers.
No “Street Peddler” tradition.
  Conclusions: Syringe Sellers...
can improve harm reduction efforts by
 increasing access to sterile syringes, filling
 a gap in supply
may decrease the possibility of IDUs
 experiencing crisis events with syringes
sell more sterile syringes in Hartford than in
 New Haven and Springfield
can play an integral part in future HIV and
 hepatitis interventions
   •Operationalizing Syringe Sellers as
        Public Health Advocates
Conduct further research about public health
 risks and benefits of street sellers.
Educate sellers on safe sales practices.
Advise IDUs on purchase precautions.
Encourage street sellers to sell/hand out harm
 reduction materials (e.g., water, cookers, etc.).
Consider creating a formal relationship between
 DPH and street syringe sellers.

								
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