Health Un/Care: Missed Opportunities in Pharmacy Interactions with PWID Seeking Sterile Syringes

Author: Danielle Russell

Theme: Social Science & Policy Research Year: 2023

In 2020, 7% of new HIV infections within the US were attributed to people who inject drugs (PWID), most occurring in highly population-concentrated areas, Maricopa County, Arizona is one of these areas. Pharmacies are one of few accessible healthcare systems that PWID encounter, and with lack of coverage by syringe service programs, assuring pharmacy syringe sales is critical to reducing infection-related diseases among PWID. 
A ‘secret shopper’ syringe purchase study was conducted with 38 pharmacies, geomapped to within 2-miles from drug copping areas in two AZ counties, 3 different field researchers with lived/living experience visited each pharmacy 3 times during the study period and responded to a 24-item instrument documenting sales outcome and subjective experience of the pharmacy staff interaction.  If pharmacy staff inquired why they needed syringes, they were to reply, “I need to protect myself from HIV and Hepatitis C”. 

Arizona state law does not directly regulate retail syringe sales to adults, yet 44.7% of pharmacies consistently refused to sell syringes, and only 21.1% consistently sold syringes. Two distinct pharmacy staff interactions emerged irrespective of sales outcome: negative and positive. Negative pharmacies tended to stigmatize secret shoppers, while Positive pharmacies tended to treat them as customers regardless of sales outcome.

Pharmacies gatekeep important tools that help prevent the transmission of infectious diseases.  Stigmatizing behavior by pharmacy staff impacts future behavior by PWID, who may become less likely to seek out sterile syringes to protect their body from harm after negative pharmacy experiences.  Legislation and policy change that removes staff discretion in the sale of syringes is advisable.

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