Transmission of HIV and other bloodborne viruses among injection drug users (IDUs) has been linked to restricting syringe access through pharmacies. Conversely, strategies that have expanded syringe access through pharmacies have been shown to reduce injection-related HIV risk. The best of these work with pharmacists to increase their willingness to serve as agents of public health, encouraging them to provide not just more syringes but expanded services to the IDUs who patronize their pharmacies. But to date no comprehensive studies have been undertaken to understand what elements of pharmacist training and which services are most critical in reducing the risks for disease transmission. Ideally, a multi-site intervention trial to fill this gap could have a significant impact in locations in which injection-related HIV transmission poses significant burdens. Before such a trial can begin, however, appropriate sites need to be identified. This application is one of five linked R21 applications - two in the U. S. and one each from India, Russia, and Vietnam -- that have begun to explore the possibility of participating in such a trial. The following scientists with appropriate background and experience will serve as PIs for each of the five international sites: Dr. Alla V. Shaboltas The Biomedical Center St. Petersburg, Russia Dr. Carl Latkin Johns Hopkins Bloomberg Scholl of Public Health Chennai, India Dr. Ted Hammet ABT Associates Ha Giang, Vietnam Dr. Patricia Case Fenway Community Health Boston, MA &Providence, RI, USA Dr. Alexander Kral RTI International San Francisco, CA, USA Each site has information about the local injection-related HIV epidemic and the extent to which IDUs already use pharmacies to obtain syringes. At this point, more information is needed to understand the local culture of pharmacies and pharmacists, their willingness to participate in such a trial, and the local barriers to developing and implementing an intervention. Additionally, determining the receptiveness of IDU syringe customers to participating in such a trial and the influences of the social and political contexts are also needed to help determine feasibility of a multi-site trial. This application from St. Petersburg, Russia proposes to a two-year scope of work that adopts the methodology of Rapid Policy Assessment and Response (RPAR) projects to learn from pharmacists, the IDUs they serve, local public health and law enforcement officials enough to develop an intervention that will work in the local context. In addition, additional data will be collected from a sample of IDUs to better determine the outcome measures to be addressed in the intervention trial. This exploratory study has three major aims: (1) to assess current pharmacy services and how these services can be expanded to include HIV related services for IDUs who purchase syringes in pharmacies;(2) to assess barriers to IDU and pharmacy staff participation in HIV prevention and access to care intervention targeted to IDU syringe customers, including pharmacists'attitudes, and possible interference from law enforcement and policy makers;and (3) to identify potential sites from among the 21 city districts for a randomized community controlled trial. This application can stand alone or be combined with data from the other linked application to develop a culturally appropriate, politically acceptable intervention trial in St. Petersburg, Russia. PUBLIC HEALTH RELEVANCE: The purpose of this study is to assess the feasibility of using pharmacies as public health venues to provide HIV-prevention to injection drug users (IDUs) in St. Petersburg, Russia. This application is one of the linked R21 proposals developed by India, Vietnam, Russia and USA in preparation for a large-scale, multi-site randomized controlled intervention trial. The expected results of these studies will help to develop the training for the pharmacists to provide HIV- related services to IDUs as highly effective intervention that could be implemented in a wide variety of cultural settings.