Original Paper

AIDS and Behavior

, Volume 14, Issue 3, pp 679-687

First online:

Open Access This content is freely available online to anyone, anywhere at any time.

Barriers to Pharmacy-Based Syringe Purchase Among Injection Drug Users in Tijuana, Mexico: A Mixed Methods Study

  • Robin A. PolliniAffiliated withDivision of Global Public Health, Department of Medicine, School of Medicine, University of California San Diego Email author 
  • , Remedios LozadaAffiliated withPatronado Pro-COMUSIDA
  • , Manuel GallardoAffiliated withPatronado Pro-COMUSIDA
  • , Perth RosenAffiliated withDivision of Global Public Health, Department of Medicine, School of Medicine, University of California San Diego
  • , Alicia VeraAffiliated withDivision of Global Public Health, Department of Medicine, School of Medicine, University of California San Diego
  • , Armando MaciasAffiliated withPatronado Pro-COMUSIDA
  • , Lawrence A. PalinkasAffiliated withDivision of Global Public Health, Department of Medicine, School of Medicine, University of California San DiegoDepartment of Social Policy and Health, School of Social Work, University of Southern California
  • , Steffanie A. StrathdeeAffiliated withDivision of Global Public Health, Department of Medicine, School of Medicine, University of California San Diego

Abstract

Injection drug users (IDUs) may be denied purchase of sterile syringes even where purchase without a prescription is legal. This study examined barriers to over-the-counter (OTC) syringe purchase among IDUs in Tijuana, Mexico. A quantitative survey and subsequent focus groups were used to quantify barriers to purchase, identify their correlates and provide in-depth exploration of syringe purchase experiences. Of 627 IDUs, 81% purchased a syringe in the past 6 months and 16% were refused or overcharged. Factors independently associated with refusal/overcharging were homelessness, receptive syringe sharing, >5 uses per syringe, and number of lifetime abscesses. Few pharmacies sold syringes to IDUs, who adapted by limiting purchase attempts to pharmacies known to sell syringes consistently. Failed purchases occurred when drug withdrawal required purchase at unusual times or locations, often following release from jail. IDUs reported syringe sharing, syringe reuse, and searching through unsecured medical waste for syringes in response to failed purchase attempts. Interventions to expand OTC syringe sales to IDUs, particularly near detention facilities, will facilitate safer injection practices.

Keywords

Injection drug use Pharmacies Syringe access Syringe sharing Mexico