who can distribute injection equipment, the maximum number of needles and syringes an individual can purchase or possess, and many other issues.
The experiences of other industrialized countries (Porter and Gostin, 1991) that have no paraphernalia or prescription laws (e.g., Netherlands, Italy) point out that merely amending these statutes to alleviate the scarcity of sterile injection equipment should not be expected to eliminate syringes and needles as a important route of HIV transmission. In that regard, it seems important to distinguish between two levels of syringe and needle availability (T. Stephen Jones, Centers for Disease Control and Prevention, February 1994, personal communication): the first, community availability, is a necessary condition for the second level, time of injection availability, to be met. However, it is not a sufficient condition for ensuring that the second level will be attained. That is, amending paraphernalia and prescription laws would increase the availability of syringes and needles within a community but would not necessarily ensure that injection drug users have a sufficient supply of sterile equipment for each injection. Availability at the time of injection is more difficult to achieve (Bruneau, 1994).
Countries in which community availability is no longer a problem (e.g., Netherlands, Australia, Canada, France) still observe the sharing of syringes and needles at the time of injection. This is in part due to the fact that time of injection availability is a function of multiple factors, including drug purchasing, preparing, and distributing norms and practices among injectors and environmental factors (e.g., police harassment and community availability). It is important to realize that increasing community availability will not completely eliminate sharing behavior.
In the United States, nine states have prescription laws. These nine states are located in a region with high concentrations of injection drug users (the Northeast). In these states, injection drug users (who typically have limited contact with medical services) have to visit a physician to obtain a prescription. Elimination of this barrier would increase the availability of sterile injection equipment to injection drug users whose access is currently quite limited. Finally, repeal of the prescription laws in the nine states that have them would increase availability.
Although needle exchange programs tend to reduce the discarding of used syringes (for they are assets, when exchangeable), augmenting the pharmacy sales of needles will tend to increase the number of needles that reach users and pose a potential increase in the total number of discarded needles. Alternatives for dealing with these issues have already been put forth in the United States and other countries. For example, in an attempt to minimize the improper disposal of used needles, some countries (e.g.,