Our colleagues at the Rural Center for AIDS/STD Prevention recently published the below article which synopsizes another in the growing collection of articles demonstrating the effectiveness of syringe exchanges in reducing new HIV infections. Our St. Johnsbury syringe exchange demonstrates not just an increase in safer injection behaviors, but also an increase in referrals to treatment. Thanks to the Rural Center for AIDS/STD Prevention at Indiana University for this article! http://www.indiana.edu/~aids/
Increased access to sterile syringes found related to reductions in HIV incidence
HIV epidemics are increasing among injection drug users throughout the world resulting from the sharing of contaminated needles. Many efforts, including syringe exchange programs (SEPs), have been initiated to curb the epidemics.
Despite increased SEPs, IDU-driven HIV epidemics persist in many locations. For some cities with SEPs, many local IDU have experienced difficulties in accessing sterile syringes because of restrictive program and policy factors.
This study assessed the effects of an expanded SEP policy on rates of HIV risk behavior and HIV incidence among IDUs.
Between 2000 and 2002 the health authority of Vancouver, British Columbia, Canada, modified its SEP policy by shifting focus on syringe to syringe distribution.
The new policy included (1) increasing the number of sites distributing syringes, (2) diversifying distribution methods, (3)removing the limit on number of syringes that could be obtained, (4) IDU were able to obtain sterile needles without having to exchange used syringes, and (5) and distribution and exchange programs were separated. Further, the local health clinics were required to provide sterile syringes and a peer-run SEP was established.
Outcomes of the Study
Syringe borrowing, syringe lending, and HIV incidence among a prospective cohort of 1228 injection drug users were observed.
Major findings include:
• Following the SEP policy change, declines in syringe borrowing occurred from 20.1% in 1998 to 9.2% in 2003.
• Following the SEP policy change, declines in syringe lending occurred from 19.1% in 1998 to 6.8% in 2003.
• The declines coincided with a significant increase in the proportion of participants accessing sterile syringes from nontraditional SEP sources.
• 42.3% reported syringe borrowing at least once during the study period, with 40.1% reporting lending at least once.
• The proportion of participants accessing pharmacies and the SEP vans declined over time. But, other SEP sites shown increases over time.
• Drug-user led SEP increased with about 30% to 40% of participants accessing this service every 6 months.
• The period following the SEP change was independently associated with a greater than 40% reduction in syringe borrowing and lending as well as declining HIV incidence.
Implications for Prevention
This study found that increasing access to sterile syringes was independently associated with substantial reduction in syringe borrowing, syringe lending, and HIV incidence among injection drug users in Vancouver, British Columbia, Canada.
The researchers concluded that widespread syringe distribution appears to be an effective syringe exchange program policy than one that restricts syringe access. They recommend that SEP policies and program design maximize rather hinder syringe access.
Kerr, T., et al. (2010). Syringe sharing and HIV incidence among injection drug users and increased access to sterile syringes. – American Journal of Public Health