A variety of studies have concluded that a primary reason injection drug users (IDUs), their sexual partners, and children continue to be infected with HIV is the lack of access to sterile syringes. The present study employed ethnographic interviews and observations to examine access to sterile syringes by IDUs in Puerto Rico between July 1995 and June 1997, a time characterized by the absence of legal restrictions on the sale and possession of syringes and the presence of a government-sponsored needle exchange program. Sources of sterile syringes identified by severely addicted drug injectors in two metropolitan San Juan communities are described and compared, and the reasons IDUs access one source rather than another are explored. Detailed descriptions of sources of syringes and syringe acquisition provide a basis for discussing: 1) challenges that confront the needle exchange program; and 2) the potential use of private syringe sellers and pharmacies to increase IDUs' access to sterile syringes, referrals to social and medical services, and information about blood-borne pathogens (including HIV) and hygienic injection practices.

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