How accessible are needle exchange programs in Manhattan to injecting drug user populations? A closer look at geographic access to needle exchange programs using a Geographic Information System (GIS)

Methods

1 Data Collection
Statistics for the total cases of HIV/AIDS among injecting drug users were collected from the New York City Department of Health. Under Dr. Susan Forlenza, the director of the Office of HIV/AIDS in New York City, the Department of Health published a report entitled, “AIDS in Boroughs and Neighborhoods of New York City”. ¹⁸The data in the report reflects data collected in New York City between 1994 and 1999. The data was categorized by the United Hospital Fund Neighborhoods in each borough. Physicians, infection control practitioners, AIDS coordinators and other health care professionals throughout the city provided the data through a network of hospitals, clinics and private offices. This is the most recent report published with geographic data by neighborhood on injecting drug users living with AIDS. This document and the semi-annual AIDS surveillance publication are produced in alternate years.¹⁹

Throughout New York City, there are nine legal organizations that provide needle exchange services: ADAPT, CitiWide, Comrades in ARMS, Housing Works, From Our Streets with Dignity (FROST’D), Lower East Side Harm Reduction Center (LESHRC), New York Harm Reduction Educators, Inc. (NYHRE), Positive Health Project (PHP), and St. Ann’s Corner of Harm Reduction (SACHR).2 Every organization, except for SACHR and Comrades in A.R.M.S. operates services in Manhattan. The researchers collected the needle exchange addresses and entered the needle exchange program addresses into a database file.² They marked street-based clinics within the block range of operation. And they marked door-to-door operations at their point of origin. One mobile clinic was not included due to the expansive geographic area of operation. The mobile clinic operated in the general areas of Essex, Delancy, and Pike Streets; under the Manhattan Bridge, Lower East Side.²

The geographic boundaries for neighborhoods were provided by the United Hospital Fund. The United Hospital Fund is a health services research and philanthropic organization that creates policies and supports programs that promote accessible healthcare for everyone²⁰. In 1982, The United Hospital Fund began aggregating groups of 3-10 contiguous NYC zip codes into neighborhood boundaries.²¹ These neighborhood boundaries are used universally throughout the city for public health and statistical analyses. They identify smaller areas than boroughs, but larger areas than zip codes. They are the smallest geographic unit for which data is available.¹⁸ The United Hospital Fund updated the UHF neighborhood system as of October 1998.¹⁸

There are 455 schools in Manhattan. The school addresses were obtained from the Basic Educational Data System (BEDS) Unit which is a subdivision of the Elementary, Middle, Secondary and Continuing Education (EMSC) Division of the New York State Education Department²². This list was updated as of 2002 and used to geocode all of the school locations in Manhattan. The zip codes, borough boundaries, streets, and base map comprised the spatial data. Most of these features are provided by geographically referenced databases, or geodatabases. Geodatabases are physical stores of spatial information.²³ The zip codes and borough boundaries are from the Environmental Systems Research Institute (ESRI) CD-ROM of domestic data.²⁴ ESRI provides this CD of domestic and limited international spatial data with the purchase of one of their software packages. The CD was most recently updated in 2002.²⁵ The streets were from the U.S. Department of Commerce, Bureau of the Census, Geography Division. The street information was last updated in 2000. The background map was from mapciti.²⁶ This project and all of its components use the coordinate system of state-plane 1983 Long Island, New York.