Monday, June 25, 2012

Does Needle Exchange Reduce HIV? Needle Exchange Programs

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Needle Exchange Programs
Do They Help Prevent HIV Infection?

Why Do We Need Needle Exchange?
More than a million people in the United States inject drugs, at a cost to society (in health care, lost productivity, accidents, and crime) of more than $50 billion a year. Obviously, people who inject drugs imperil their health. But if they become infected with HIV or Hepatitis C they also imperil their needle sharing partners, sexual partners and offspring as well.

One-third of all AIDS cases are linked to injection drug use. For women, 64 percent of all AIDS cases are due to injection drug use or sex with partners who inject drugs. Injection drug use is the source of infection for more than half of all children born with HIV.

Around the world and in more than sixty locations in the United States, needle exchange programs have sprung up to address drug injection risks. These programs:

• distribute clean needles
• safely dispose of used needles
• offer referrals to drug treatment
• offer HIV counseling and testing

Why Do Drug Users Share Needles?
The answer is as simple as supply and demand. Needle sharing is common in part because there are not enough needles and syringes to go around. The overwhelming majority of intravenous drug users (IVDUs) are aware of the HIV risk associated with sharing contaminated equipment. However, sterile needles are not always available or affordable and their physical and emotional need for injectable drugs clouds their better judgement.

Most US states have paraphernalia (items used to inject or use drugs) laws that make it a crime to possess or distribute drug paraphernalia not for a "legitimate medical purpose". If caught those that break these laws are subject to prosecution. In addition, ten states and the District of Columbia have laws that require a prescription to buy a needle and syringe. Even where over-the-counter sales of syringes are permitted by law, pharmacists are often unwilling to sell to IVDUs.

In July of 1992, the state of Connecticut passed a law permitting the purchase and possession of up to ten syringes without a prescription. After the new law went into effect, the sharing of needles among IVDUs decreased, indicating a shift from street needle and syringe purchasing to pharmacy purchasing. It's believed that such a shift could decrease HIV infection due to needle sharing.

How Can Injection Risks Be Reduced?
Getting drug injectors into treatment and off drugs is the best answer. Unfortunately, not all drug injectors are ready to quit. Even those who are highly motivated may find few drug treatment services available. Drug treatment centers frequently have long waiting lists and fewer than 15 percent of IVDUs are in treatment at any given time.

For those who cannot or will not stop injecting drugs, the best way to avoid spreading HIV is to use a sterile needle for each injection, or at the very least not to share needles. Users who share should disinfect their injection equipment thoroughly with bleach, although this is not as safe as always using a sterile needle and syringe.

Does Needle Exchange Encourage Drug Use?
There is no evidence that needle exchange programs increase the amount of drug use by needle exchange clients in the community in general. A study of a San Francisco needle exchange program that opened in 1988 found that from 1987 to 1992, frequency of injecting drugs among street-recruited IVDUs declined from 1.9 to 0.7 injections per day. The mean age of IVDUs increased from 36 to 42 years, and the percentage of new initiates into injection drug use dropped from three percent to one percent. Drug abuse and the recruitment of new or younger users did not increase in the presence of the exchange; in fact, the exchange may have helped decrease the amount of drug abuse in the area.

Does Needle Exchange Reduce the Spread of HIV?
Simply put, the answer is yes, almost certainly. Needle exchange programs are based on a sound public health principle; the principle of eliminating the item that helps transmit infection from one person to another, just as, for example, reducing the number of mosquitoes helps prevent malaria.

Needle exchange programs have also achieved reductions in the rate of hepatitis infection, which can also be spread through sharing needles. In Tacoma, WA, clients of a needle exchange program were up to eight times less likely to contract Hepatitis B or C than non-client IVDUs.

Finally, needle exchange programs can act as a bridge to:

• drug treatment
• HIV testing and counseling
• primary medical care
• tuberculosis and sexually transmitted disease screening

Source: Lurie, P. and DeCarlo, P., The Center for AIDS Prevention Studies at the University of California San Franciso, 2005.

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