Needle-exchange programs gain ground - Brief Article

Medical Laboratory Observer, July, 2001 by Iris Rosendadl

The number of needle-exchange programs (NEPs) is growing, according to a new study conducted by researchers from Beth Israel Medical Center in New York City and the North American Syringe Exchange Network in Tacoma, WA. These programs exchange sterile syringes for used syringes in order to reduce the transmission of HIV and other blood borne infections associated with the reuse of contaminated syringes among injection drug users.

Since there is a strong link between substance abuse and the transmission of HIV and other blood borne infections, these programs are seen by proponents as a useful tool to prevent the spread of this disease. On the other hand, critics suggest that they may encourage illegal drug use. However, organizations such as the CDC, the American Medical Association and the National Institutes of Health support NEPs.

In October 1999, staff from Beth Israel Medical Center and the NASEN mailed surveys to 131 directors of these programs in the US. Some 110 NEPs, or 84%, completed the survey. Follow-up interviews were done by telephone. The programs that participated in the survey operate in 81 cities and 31 states, the District of Columbia, and Puerto Rico.

NEPs were classified by the number of syringes exchanged during 1998. Over 100 programs (107) reported that they exchanged 19.4 million syringes in 1998, up from 8 million needles in 1994-95. States with the largest number of needle-exchange programs were California (21), New York (14), Washington (12), and New Mexico (9). The 12 largest programs were responsible for 62% of all syringe exchanges, noted the study, which appeared in the MMWR weekly (May 18, 2001/ 50(19);384-7.)

Needle exchanges were not the only services provided by the programs. Ninety-five percent, or 104, of the 110 programs referred participants to substance abuse programs; 99% (109) provided alcohol pads; 90% (99) provided bleach; 98% (108) provided male condoms; and 73% (80) provided female condoms. Some 64% (70) provided on-site voluntary counseling and testing for HIV, 24% (26) for hepatitis C, and 21% (23) for hepatitis B. In addition, some NEPs provided on-site medical care and sexually transmitted disease screening, the researchers said.

During 1998, NEPs operated at 534 sites, or an average of five sites per program. The programs operated a median of 22 hours per week per program. The combined operating budget of 105 NEPs was $86 million (median $38,000). A total of 5l NEPs in 15 states and Puerto Rico received public funding of $6 million.

The findings in the report are subject to some limitations, suggested an editorial note accompanying the report. The extent of NEP activity is likely to be underestimated because some of the known programs did not participate in the study and others may exist that are not known to the researchers. In addition, the information collected was self-reported and thus may be biased. And, finally, since 33% (36) of the programs requested that their survey data be kept confidential, some data is included only as aggregate state-level information.

Jane Silver, vice president for public policy at the American Foundation for AIDS Research in Washington, said that at a local level, these programs have garnered considerable support. A significant number of programs receive some sort of state, county, or city funding, she said. "The major stumbling block for these programs is that federal funding is prohibited. This has had a chilling effect on local communities, but eventually the science will overcome the politics of this debate."

She noted that a US Surgeon General's report last year indicated that half of new HIV infections result from sharing equipment tainted with HIV, through direct use, sexual contact with an infected user, or birth to an infected mother. The report said the NEP programs are effective public health interventions that reduce the transmission of HIV and do not encourage illegal drug use.

Injectable drug users

Estimates of the numbers of injectable drug users (IDUs) in the US range from 1.1 to 1.5 million, according to a study prepared by the School of Public Health, University of California at Berkeley, and the Institute for Health Policy Studies, University of California at San Francisco for the CDC. Injectable drug use is estimated to cost a staggering $58.3 billion per year by these researchers. These costs include drug treatment, lost productivity, motor vehicle accidents, crime, and stolen property. In addition, the lifetime cost of treating an HIV-infected person is approximately $119,000. HIV among IDUs will exact a high economic toll in the future, said the report.

According to this report, 253,148 people in the US had been diagnosed with AIDS by early 1993. Of these, some 29% or 73,311 individuals were IDUs, 3% or 8,481 were people with heterosexual contact with an IDU, and 1% or 2,420 were children born to IDUs or their sexual partners. As these figures indicate, injection drug use accounts for one-third of all AIDS cases in the US so far.