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Preventing HIV Transmission: The Role of Sterile Needles and Bleach
in which it is legal to purchase needles, many pharmacists require a customer to either provide a valid medical prescription or to identify oneself (e.g., sign a log book), thereby demonstrating that the intended use is for legitimate medical reasons. In some states, if a pharmacist knowingly sells needles or syringes to a customer for the purpose of injecting illicit drugs, that pharmacist can have his or her license suspended.
Moreover, in states in which there are no legal barriers to purchasing needles, study results have shown that this discretionary decision to sell or not sell has led to differential access across racial groups. For example, Compton and colleagues (1992) reported the results of a study in which two male research assistants (one white, one African American) attempted to purchase needles in 33 pharmacies in St. Louis. Of the surveyed pharmacies:
12 percent refused to sell to both purchasers,
12 percent refused to sell to the African American only,
18 percent informed study purchasers that they did not sell needles/syringes in small quantities, and
58 percent sold to both study participants.
The authors reported that the predominant reason given for refusal to sell was store policy.
A final critical point was raised by a workshop participant regarding the willingness of pharmacists to sell needles. We should not expect all pharmacists to be willing to sell needles to injection drug users. However, in communities in which there is a substantial drug abuse and AIDS problem, pharmacists may be more amenable to selling them.
Treatment Service Providers
For most practitioners in the field of substance abuse treatment, needle exchange and bleach distribution programs present a dilemma. Support for such programs is often perceived as a diversion of already unstable funding away from treatment programs. Their efficacy in lowering the risk of HIV infection and contributing to the treatment of addiction has been questioned. Practitioners are concerned that needle exchange and bleach distribution programs run counter to federal regulations. Many also feel that these programs may provide a means to continue behavior that is destructive to the individual, the family, and the community (Primm, 1990).
Drug abuse treatment programs in the United States operate in a constant state of fiscal uncertainty; it is therefore not surprising that support for needle exchange programs is often perceived as diverting scarce financial resources away from treatment. Furthermore, many programs are under