My Paper on Needle Exchange Programs

November 22, 1994  (Note that this paper is over 3 yrs old)

     AIDS, or acquired immunodeficiency syndrome, is considered to be at epidemic proportions throughout the world.  According to John Watters, in June 1993 there were 310,780 reported AIDS cases in the United States alone (115).  HIV, the human immunodeficiency virus, causes AIDS and is a blood borne infectious disease.

          "Among drug users, the virus [HIV] can be passed by sharing items used in drug injection, including the syringe, the water used to mix the drug and rinse the syringe, the filter used to remove impurities from the drug solution, and the container the drug is mixed in."  (Van Vught 38)

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Needle exchange programs usually hand out clean needles and kits.  A good kit will include condoms, a couple of vials of sterile water and bleach for cleaning the syringes, cotton pellets to use as filters and info on safe sex and AIDS transmisson and prevention.


Drug users often share injection equipment due to a limited availability of sterile equipment and a fear of being arrested for carrying drug paraphernalia.  About 24 percent or 74,582 of the AIDS cases in America are intravenous drug users who shared needles (Watters 115).  Obviously something needs to be done to protect America's population of injecting drug users from continuing to be victims of this epidemic.  America needs to change its policies regarding legal access to injection equipment to help the user protect himself from contracting HIV.

     There are two policies that the United States can pursue too provide legal access to sterile injecting equipment, purchase without a prescription and needle exchange programs.  Purchase without a prescription, usually referred to as legal access, would allow anyone to buy sterile syringes over the counter, which is already an option in thirty-eight states.  Needle exchange programs exist in several cities and will allow drug users to exchange a number of used syringes for sterile equipment.  Both policies exist in other nations around the world and both are considered successful in cutting the spread of HIV among injecting drug users.

     The United Kingdom and foreign cities like Paris, Amsterdam and Sydney have all made changes in their public policies to increase the availability of sterile injection equipment.  The United Kingdom has a widespread needle exchange program and no law requiring a prescription for the purchase of syringes.  Needle exchange programs vary from town to town, but some will allow clients to exchange up to one hundred needles at a time.  The government is also considering a syringe vending machine to provide twenty-four hour access to sterile injecting equipment (Des Jarlais 52-54).  In Paris a law requiring a prescription to purchase syringes was struck down and pharmacists were trained to provide some HIV education to injecting drug users (Des Jarlais 56).

     Amsterdam has no prescription law and its needle exchange program was established in 1985, before AIDS was considered an epidemic.  Although, these programs did not prevent HIV from appearing within the injecting drug user population, they have kept the disease rate stable (Des Jarlais 51).  In Sydney, Australia, government supported organizations of intravenous drug users developed a mobile needle exchange to reach users who may not take advantage of their legal access to sterile injecting equipment (Des Jarlais 55).  All of these programs have helped to reduce or stabilize the rate of HIV among the injecting drug user population in their country.

     Some concerns about providing legal access to sterile injecting equipment have been brought up by community leaders, local citizens and government officials.  Fears are that legal access will worsen the drug problems, encourage young people to shoot drugs and will make it appear that the government condones drug use.  Other opponents suggest that addicts deserve their fate and maybe it would be better if they all got sick and died out.  Bob Martinez, an opponent to the idea of legal access said, "'When you use drugs intravenously, that clearly shows you're not concerned about your health.'" (qtd. in Thompson 56).  However, as a civilized society we have a responsibility to provide the means for drug users to protect themselves from HIV and AIDS.

     Many of these fears are unfounded based on research being done in connection with the legal access programs through out the world.  The research demonstrates that new injecting drug use is not being encouraged by these programs.  A study done in San Francisco on the participants using the illegal needle exchange program there showed that over a five year period the mean age of its clients also increased by five years (Watters 118).  As for Bob Martinez's opinion, it is well known that injecting drug users will try to protect their health as much as possible (Fernando 1825).  So we should go out of our way to ensure that they can protect themselves and their families from these diseases.

     Although thirty-eight states in the U.S. have no laws preventing the sale of syringes without a prescription, it is often difficult for a drug user to purchase equipment over the counter.  This is due to the policies that individual pharmacies may enforce.  These policies may restrict the sale of syringes to people with prescriptions, or regular customers, and often prevent sales to suspected drug users.  A study done in St. Louis, Missouri shows that nearly half of thirty-three pharmacies refused to sell syringes to the researchers or would only sell them in large quantities due to their in store policy (Compton 595-596).

     There are many advantages to a nationwide legal access program to syringes.  Pharmacies are located everywhere, which would ensure some measure of availability to all intravenous drug users.  Also it would be an inexpensive program to create since no special locations are needed and they already stock the necessary supplies.  It could also help prevent labeling the purchaser as an addict, something that is hard to avoid at needle exchange sites (Des Jarlais 44).  However, since these are all state laws, putting a nationally organized program into effect would be extremely difficult if not impossible.  Also it would be difficult to ensure that all the pharmacies were cooperating with the program.

     Needle exchange programs are another means of providing clean syringes to injecting drug users.  These programs can reach users everywhere, can provide other on site services and ensure the proper disposal of used injecting equipment.  Although several cities in the U.S. operate independent or locally funded needle exchange programs, a national policy does not exist.  In fact, until 1992 the government had placed a ban on federal funding for a national plan (Friedman 24).  In July of 1992 Congress set aside five million dollars to fund research on needle exchange programs.  This was due to the success of such programs in other countries as well as the programs in the U.S. (Fernando 1825).

     One very successful needle exchange program in the U.S. is in New Haven, Connecticut.  In 1990 health officials in New Haven established a needle exchange program to prevent the unchecked spread of HIV among its injecting drug user population.  The program provides users with a clean syringe for every one they return, along with a kit to clean the syringe after use, condoms and HIV education.  The staff of the program can also provide drug treatment referrals upon request (Thompson 55-56).  This program is extremely important because a group of Yale researchers has been tracking the program's exchanged syringes and collecting data since it was started (Heimer 214).

     As part of the program all participants must register, which  allows the exchanged syringes to be tracked through the person's code name.  Each syringe is numbered and when it is exchanged a record is kept which identifies who received it, when and where.  When a numbered program syringe is returned the staff members record who returned it, when and where, providing the researchers with some idea of where the needle has been (Heimer 216).  The returned needles are randomly tested for HIV and the collected data is used to provide a picture of the disease's spread in New Haven.  Every month the data is compiled into groups of; the total number of sterile syringes handed out, the numbers of program and nonprogram syringes returned, the average amount of time a program syringe was on the street and the number of used syringes that tested HIV positive (Heimer 216).

     A total of 26,789 sterile syringes were handed out to 1,091   program participants from November 1990 to December 1991 (Heimer 215).  About 57 percent of the program syringes were returned, which is considered normal based on the rates of returned syringes of other programs.  During this time the percentage of HIV positive syringes dropped from nearly 64 percent to about 48 percent (Heimer 216).  A report of the change in HIV positive percentages appears in Table 1.


Table 1
             Month             No Tested     No. HIV+       %HIV+
Nov-Dec 1991        274            517           63.9
Jan 1991                  160             91           56.9
Feb-Apr 91             347            141           40.6
May-July 91            343            139           40.5
Aug-Oct 91             398            166           41.7
Nov-Dec 91            338            164           48.5
Source: Adapted from Heimer et al.  216.
 

Based on the stability of the HIV positive occurrence rate from February 1991 to October 1991, I would say that the New Haven program is effective in slowing the spread of HIV among it's injecting drug user population.  Also the Yale research group has calculated that the program has led to "a drop of at least 33 percent in the rate of new HIV infections" (Friedman 24).

     There are many other needle exchange programs in America, most of which are also successful although, some are illegal.  The exchange program operated by Prevention Point in San Francisco is considered illegal but has been in operation since 1988.  This program and a strong bleach distribution program have been credited with stabilizing the HIV rate among injecting drug users in the area (Des Jarlais 61).

     A needle exchange program in New York City is being called very successful based on a study by Dr. Don Des Jarlais.  The Courier Journal quoted Dr. Des Jarlais as saying: "The best estimate of the effect of the program...is that it probably reduces the new infection rate by about half" ("Needle Exchange..." A4).

     Developing a national needle exchange program would be an effective measure to cut the spread of HIV among injecting drug users.  The program will need to track the syringes like the New Haven program does.  Also, by having both a stationary site and mobile exchange sites, the program can attempt to reach as many injecting drug users as possible.  This will assist in removing as many HIV infected syringes from circulation among drug users as possible (Des Jarlais 62-65).  In addition the national program can provide on site medical services such as tuberculosis screenings and HIV education and counseling.  A national program can also provide needed drug counseling and referrals to treatment programs.  In this way an exchange program can help the drug user and lay to rest some of the community's fears at the same time.

     Despite their effectiveness legal access and needle exchange programs are only able to help injecting drug users within their own regions.  A national program is desperately needed to provide access to all the intravenous drug users in America.  This will stabilize the HIV and AIDS rates among this risk group and perhaps reduce it over time.  Education is not enough to beat AIDS, action is required.
 

Compton III, Wilson M., et al.  "Legal Needle Buying in St. Louis."  American Journal of Public Health 82.4 (1992): 595-596.

Des Jarlais, Don C. and Samuel R. Friedman.  "AIDS and Legal Access to Sterile Drug Injection Equipment."  The Annals 521       (May 1992): 42-65.

Fernando, Ph.D., Daniel.  "Syringe and Needle Exchange to Prevent HIV Infection." Letter.  Journal of the American Medical Association. 271.23 (15 June 1994): 1825.

Friedman, Dorian.  "How Clean Needles are Saving Lives." U.S.News& World Report 29 Mar. 1993: 24.

Heimer, Ph.D., Robert, et al.  "Needle Exchange Decreases the Prevalence of HIV-1 Proviral DNA in Returned Syringes in New Haven, Connecticut." American Journal of Medicine 95.2 (Aug.1993): 214-220.

"Needle Exchange Cuts AIDS Rate." Courier Journal 1 Nov. 1994:A4.

Thompson, Dick. "Getting the Point in New Haven." Time 25 May 1992: 55-56.

Van Vught, Johannes P., ed. AIDS Prevention and Services: Community Based Research. Westport: Bergin & Garvey, 1994.

Watters, Ph.D., John K., et al.  "Syringe and Needle Exchange as HIV/AIDS Prevention for Injection Drug Users." Journal ofthe American Medical Association. 271.2 (12 Jan. 1994): 115-120.
 

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