The effectiveness of NEP's

Needle Exchange Programs

In The News

These articles are linked to their sources whenever possible.

Ignoring the solution. Jury's in: Needle exchanges slow the spread of AIDS

AIDS was once the scourge of the gay community. Soon, it will be largely a drug addict's disease. Scientists believe that 50 percent of all new HIV infections occur among intravenous drug users, with an additional 20 percent or so occurring among junkies' sex partners. The syringe is the Typhoid Mary of the 1990s.

Yet what worked best in curtailing the spread of HIV among homosexuals--mass-education campaigns promoting safe sex--has been ineffective with drug addicts lurking in society's shadows. What does seem to work is giving drug users clean needles. Since 1986, some 100 small

needle-exchange programs have sprouted up around the country, through which used syringes are traded for new, sterile ones--no questions asked. Often run by private groups with limited funds, these experiments have been the object of intense scrutiny by major universities and federal health agencies. The conclusion? The programs work. Studies have shown up to a sevenfold reduction in all blood-borne diseases, a 33 percent projected drop in HIV infections and 25 percent fewer cases of dangerous behavior, such as needle sharing.

Besides saving lives, these needle exchanges deliver a huge financial payoff. Consider the case of an HIV-positive addict who infects eight others in a one-year period (a very modest estimate). If each turns to Medicaid to pay his or her lifetime medical costs (at an average $119,000 plus), that's about a $1 million burden for taxpayers--money that could have been saved if the one addict had been in a needle-exchange program.

Evidence for the effectiveness of needle exchanges is not airtight. Drug users who participate in needle exchanges may be more safety conscious and thus at less risk of contracting HIV in the first place. But studies also show that those who participate improve their own behavior over time. So evidence that needle exchanges have at least some positive effects is strong.

High-level conflict. On balance, the studies are persuasive enough that physician Scott Hitt, chairman of President Clinton's Advisory Council on HIV/AIDS, rebuked his own president for banning the use of federal AIDS funds for needle exchanges. Hitt is joined in the endorsement of needle exchanges--and the call for more federal involvement--by the National Academy of Sciences, the Centers for Disease Control and Prevention and the General Accounting Office.

The administration worries that needle exchanges might increase drug use. It's a reasonable fear but one not borne out by research, according to the CDC. Only a handful of needle-exchange studies have tracked drug use, but their conclusions jibe with anecdotal evidence and common sense: While addicts prefer clean needles, they will eagerly opt for the abundant supply of dirty ones in the face of a monstrous drug craving.

Some worry that needle exchanges are the classic "Band-Aid"--dealing with HIV infection but not the underlying drug addiction. But needle exchanges have actually worked as a bridge into real treatment. One program in Tacoma, Wash., made nearly 1,000 referrals to drug treatment programs in two years. Others worry that needle exchanges, cheap as they are, will siphon funds from zero-tolerance treatment efforts. But the real problem is that all anti-addiction programs are woefully underfunded.

It's hard to avoid the suspicion that these concerns have less to do with science or public health than with politics: specifically, a reluctance to muddy the "just say no" message.

But there's another message leaders should heed--that no one has to die needlessly. Peter Lurie, a leading University of California researcher, estimates that nearly 10,000 lives could have been saved over the past few years by an aggressive expansion of needle-exchange programs. Wasn't the war on drugs supposed to be about saving lives?

BY JOSHUA WOLF SHENK

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"The Benefits of Needle Exchange"

Boston Globe (05/22/95) P. 12

Abstract:

In its second year, Massachusett's pilot needle exchange program has provided more than 1,300 drug users with sterile hypodermic needles without an increase in drug abuse, write the editors of the Boston Globe. Because addicts can only participate if they undergo an interview and counseling, the program has been credited with getting hundreds of injection drug users into treatment. Boston was the nation's 20th city to implement a needle exchange program in an effort to reduce the spread of AIDS. But in addition to reducing the risk of HIV infection through dirty needles, participants can also receive free AIDS tests and counseling. The Legislature's Health Care Committee has proposed a measure that would modestly expand the needle exchange program. Gov. Weld has said he will sign it if it reaches him. Substance abuse is one of

America's greatest problems, and every means to get people into treatment must be pursued, the editors conclude.

DISTRIBUTED BY GENA/aegis (714.248.2836 * 8N1/Full Duplex): Copyright © 1995 - Information, Inc., Bethesda, MD. This information is provided by the Centers for Disease Control & Prevention (CDC), National AIDS Clearinghouse as a public service. Noncommercial reproduction encouraged.

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"Prevalence of HIV-Infected Syringes During a Syringe-Exchange Program"

New England Journal of Medicine (12/24/92) Vol. 327, No. 26, P. 1883 by Heimer, Robert et al.

Abstract:

A needle-exchange program can significantly reduce the rate of HIV-1 infection among IV-drug users, write Robert Heimer et al. of the Yale University School of Medicine in New Haven, Conn. The researchers evaluated a needle-exchange program in New Haven operated by the city's health department. The program allows IV-drug users four opportunities a week to exchange their used syringes on a one-for-one basis for clean, attached syringe-needle combinations. The syringes returned were tested with the polymerase chain reaction for HIV-1 proviral DNA as proof of use by an HIV-positive IV-drug user. Before the start of the program, the rate of infected needles was determined for two sources. A total of 160 syringes not distributed through the program that were returned as the program began were randomly selected and tested. The rate of HIV-1 in these needles was 68 percent. Another 180 syringes returned through an illegal exchange that operated once a week were tested and had a prevalence of infection of 63 percent. Between Nov. 14, 1990, and December 31, 1991, the researchers tested 1860 randomly selected needles distributed through the needle-exchange program. At first, the rate of HIV-1 proviral DNA was not different from that in the 160 needles tested before the program began. But by the third month of program operation, the rate had fallen to 57 percent. In subsequent months, the rate stabilized, approaching a steady-state level of 43 percent. The researchers found no changes in the demographic characteristics or drug-use habits of newly enrolled clients that could account for the reduction in the rate of HIV-1 proviral DNA in the needles.

Copyright © 1993 - Information, Inc., Bethesda, MD. This information is provided by the Centers for Disease Control (CDC) National AIDS Clearinghouse as a public service. Non-profit reproduction is encouraged.

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"Needles and AIDS"

Washington Post (04/15/93), P. A28 by Spain, Tom

Abstract:

A Baltimore-based needle exchange program designed to thwart the spread of HIV among IV-drug users should be implemented, write the editors of the Washington Post. Baltimore Mayor Kurt Schmoke wants to begin a 30-month needle exchange program to control the spread of HIV. But Schmoke needs state approval to do so, if participants are to be protected from prosecution under Maryland's drug paraphernalia law. However, the legislature adjourned this week without approving the program. Since Schmoke believes this measure is critical to curbing the epidemic in the city, he is consulting legal experts about other options. About one-third of all AIDS cases now stem from drugs used by injection. In Baltimore, that statistic is 42 percent. But some legislators expressed opposition to the program, claiming the act of giving needles to drug addicts is immoral, impractical, and even "frightening." Nevertheless, the same type of program has been successfully executed in other cities and countries. In New Haven, Conn., new HIV infections among IV-drug users were reduced by a third after a needle exchange program was implemented. Also, there was no evidence of increased drug use after the program was initiated, and drug treatment enrollments increased. Although this approach to AIDS fosters an impression that government is condoning illegal behavior, the end result could be a reduction in HIV infection and drug use if initiated under controlled conditions, the editors conclude.

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Needle Exchange Success

International study reveals success of needle exchange programs

In the June 21st issue of Lancet (vol. 349, no. 9068), Dr. Susan Hurley and colleagues at the University of Melbourne report on an extensive international study of the role of needle exchange programs (NEP) in HIV prevention. In total, data were collected from 214 studies in 81 cities in North America, Europe, Asia and the South Pacific. Results reported were based on studies conducted between 1984 and 1994 each involving at least 50 intravenous drug users. Further data on HIV infection in American cities without NEPs were provided by the CDC.

Overall, in 52 cities without NEPs, the rate of HIV infection increased by 5.9% per year, compared to a yearly decrease of 5.8% in 29 cities with NEPs. This accounts for a total average difference of 11% in the annual rate of HIV infection in these cities.

Clearly, this study provides considerable evidence to support the effectiveness of needle exchange programs for preventing HIV infection in IV drug users. As infection rates within this population continue to rise, the significance of this data seems irrefutable. Also, given the troubling threat of re-infection, and its potential for limiting treatment options in people already infected, the adage seems as true as ever: an ounce of prevention...

From Community AIDS Treatment Information Exchange (CATIE). For more information visit CATIE's Information Network at http://www.catie.ca/

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The Gov Information on what the U.S. government is doing (or not doing) on the needle exchange issues.

Guide to cleaning needles Information and a diagram on how to keep your syringes cleaner.

My Paper A little old, but still relevant.

Hepatitis C An article with info about another virus that drug users can get

Needle Exchange Back to the main page

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