Multiple access to sterile syringes for injection drug users: Vending machines, needle exchange programs and legal pharmacy sales in Marseille, France

Objective: In Marseille, southeastern France, HIV prevention programs for i njection drug users (IDUs) simultaneously include access to sterile syringe s through needle exchange programs (NEPs), legal pharmacy sales and, since 1996, vending machines that mechanically exchange new syringes for used one s. The purpose of this study was to compare the characteristics of IDUs acc ording to the site where they last obtained new syringes. Methods: During 3 days in September 1997, all IDUs who obtained syringes from 32 pharmacies, four NEPs and three vending machines were offered the opportunity to compl ete a self-administered questionnaire on demographics, drug use characteris tics and program utilization. Results: Of 485 individuals approached, the n umber who completed the questionnaire was 141 in pharmacies, 114 in NEPs an d 88 at vending machines (response rate = 70.7%). Compared to NEP users, ve nding machine users were younger and less likely to be enrolled in a methad one program or to report being HIV infected, but more likely to misuse bupr enorphine. They also had lower financial resources and were less likely to be heroin injectors than both pharmacy and NEP users, Conclusions: Our resu lts suggest that vending machines attract a very different group of IDUs th an NEPs, and that both programs are useful adjuncts to legal pharmacy sales for covering the needs of IDUs for sterile syringes in a single city. Asse ssment of the effectiveness and cost-effectiveness of combining such progra ms for the prevention of HIV and other infectious diseases among IDUs requi res further comparative research. Copyright (C) 2001 S. Karger AG, Basel.