Qualitative analysis of reasons for insufficient levels of individual needle and syringe coverage.

Australia has an estimated 3000+ needle and syringe distribution outlets, servicing an estimated population of 90,000 people who inject drugs (PWID), or approximately one outlet per 30 PWID. Furthermore, Australia operates under an unlimited dispensation policy, whereby PWID can acquire as many needles/syringes as needed, without the requirement of exchanging unsterile syringes; a policy adopted in other countries. Despite this comprehensive level of service delivery, previous research has shown that between 16-37% of Australian PWID do not acquire sufficient needles and syringes to cover all of their injecting episodes. This insufficiency leads to known and documented risk behaviours, such as syringe re-use and receptive syringe sharing which in turn increase the risk of disease transmission, bacterial infection and vein damage. The reasons that an individual may fail to acquire sufficient syringes are many and varied. Past research has shown that levels of service access (eg. pening times), geographical proximity to services, policing practices, and cohesiveness of PWID networks effect syringe acquisition/distribution. Other work has identified a number of person-level associations with insufficient coverage, such as risky drinking levels and hepatitis C disease status. However, the personal reasons why a person may fail to acquire sufficient syringes is poorly understood. To have greater knowledge of these reasons, the ability of services to better target at-risk groups, to enhance service provision and ultimately, to facilitate PWID to acquire enough syringes will be increased.