Harm Reduction in Needle Exchange Program
Advocates of harm reduction argue that HIV transmission through blood can be effectively averted through needle exchanges as they empower IDUs to protect themselves and others from HIV.4 Studies have found that through offering an accessible alternative to needle sharing, HIV transmission within IDU communities can be brought under control.5 6 However, this form of harm reduction can be controversial and the scale of implementation varies between countries. The Living Affected Corporation embraces the concept that such programs should be considered for their respective areas and implementation of these programs are vital in the battle to thwart continuing infections. Unfortunately Arkansas has no "official" program however LA Corp does provide printed material and navigation to access harm reduction kits.
As well as providing clean needles, a needle exchange scheme can also act as a gateway through which users learn about safe injection practices and equipment disposal, safer sex education, access to other prevention services such as substitution therapy, and referral to treatment. The World Health Organisation says that without such complementary measures, needle exchange programmes will not control HIV infection among injecting drug users.8
The UK’s medical advisory body recommends that needles are provided in different sizes, and are distributed in a quantity that meets need rather than being limited arbitrarily.9
Low numbers of NSP sites and low distribution rates can be due to a variety of reasons; for example, the lack of resources, public and/or political opposition to harm reduction, as well as laws which criminalise harm reduction.15
Overall, Western European countries and Australia are the leaders in harm reduction, and some of the highest distribution levels in the world are among these countries. In 2009, Australia distributed an average of 213 needles/syringes per IDU, per year.16 However, many countries are failing to deliver an adequate harm reduction service.
As of March 2009, only 184 needle exchange programmes existed in 36 US states, plus Washington DC and Puerto Rico.17 For over two decades, the US government forbade funding for such services, but in 2009 the federal funding ban was lifted. This should lead to needle exchange services becoming far more widespread throughout the United States. Currently, the needle/syringe rate is 22 per IDU, per year - far below the recommended rate and one of the lowest in the world.18
Throughout Eastern Europe and Central Asia, a promising scale up of harm reduction services has occurred in recent years in many countries, notably Ukraine (which increased the number of NSPs by nearly a thousand to 1,323 between 2008 and 2010).19 A study focusing on 14 European countries, including Estonia, Slovakia and Belgium, found a 33 percent increase in the number of syringes distributed by needle and syringe programmes between 2003 and 2007.20 However, distribution levels remain low across this region.
Despite an average of one in six IDUs in Asia living with HIV,21 most Asian countries have a long way to go before the needle exchange services which exist make an impact on their HIV epidemics. Whilst some countries have many NSPs, in several cases they are only reaching a very low percentage of the country’s injecting drug users, who receive very few clean needles/syringes per year.22 Despite increasing the number of NSPs from 92 in 2006 to 901 in 2010, syringe distribution in China remains very low, at an average of 32 needles/ syringes per IDU, per year.23 24
Apart from a few notable exceptions needle exchanges across Latin America and the Caribbean, Africa and the Middle East are largely non-existent or where they exist inadequate. Brazil, Mauritius and Iran are some of the countries which have the most advanced NSPs throughout these regions, although the number of syringes they distribute is low.25
According to an Australian government study, investment in needle exchange programmes from 1991 to 2000 averted 25,000 HIV infections and 21,000 hepatitis C infections.29 A later Australian study examining the impact of needle exchanges in the following decade revealed they had prevented 32,000 HIV infections and almost 100,000 hepatitis C infections. Furthermore, it is believed the needle exchanges led to healthcare cost savings of over AU$1 billon, equating to a five-fold return on investment for every dollar spent.30
The effectiveness of needle exchanges in preventing needle reuse and the potential transmission of HIV has been reflected in a Canadian report.31 The study found that between 2008 and 2009, needle sharing increased from 10 to 23 percent following the closure of Victoria's only fixed needle exchange. On the other hand needle sharing among those studied in Vancouver, which has a number of needle exchanges, remained at less than 11 percent.
The World Health Organization (WHO) released a report in 2004 that reviewed the effectiveness of needle exchange programmes in many countries, and examined whether they promoted or prolonged illicit drug use. The results produced convincing evidence that needle exchange programmes significantly reduce HIV infection, and no evidence that they encourage drug use.32
Advocates of harm reduction argue that HIV transmission through blood can be effectively averted through needle exchanges as they empower IDUs to protect themselves and others from HIV.4 Studies have found that through offering an accessible alternative to needle sharing, HIV transmission within IDU communities can be brought under control.5 6 However, this form of harm reduction can be controversial and the scale of implementation varies between countries. The Living Affected Corporation embraces the concept that such programs should be considered for their respective areas and implementation of these programs are vital in the battle to thwart continuing infections. Unfortunately Arkansas has no "official" program however LA Corp does provide printed material and navigation to access harm reduction kits.
How does a needle exchange operate?
Needle exchange schemes provide access to sterile syringes and other injecting equipment such as swabs and sterile water to reduce the risk of IDUs coming into contact with other users' blood. Needle exchange programmes that offer safe syringe access may be run by NGOs, hospitals or medical facilities, and local or national governments. Needles may be provided at drop-in centres, outreach points or from vans that service different points within a city or area. In some places, vending machines are used to distribute needles, functioning as a 24-hour service when other sites are shut.
A video about a harm reduction facility in America.
Sometimes a needle exchange may only distribute the same number of syringes that they receive from a user, whereas others may require a lower return rate or not require any return at all. Some needle exchange programmes may provide a high number of sterile syringes to a single user so they in turn can distribute them among IDU populations not accessing such programmes.7As well as providing clean needles, a needle exchange scheme can also act as a gateway through which users learn about safe injection practices and equipment disposal, safer sex education, access to other prevention services such as substitution therapy, and referral to treatment. The World Health Organisation says that without such complementary measures, needle exchange programmes will not control HIV infection among injecting drug users.8
The UK’s medical advisory body recommends that needles are provided in different sizes, and are distributed in a quantity that meets need rather than being limited arbitrarily.9
Where do needle exchanges exist?
Many countries that report injecting drug use and HIV among their injecting populations do not have needle/syringe exchanges.10 Globally, only 82 countries have needle exchange programmes.11 Moreover, it is evident that although countries report having NSP sites, injecting drug users are still not accessing enough needles/syringes. For example, in Germany there are 250 needle/syringe exchanges, yet injecting drug users only receive an average of 2 needles/syringes each, per year. It is recommended that in order for needle exchanges to prevent HIV transmission and to make an impact on the HIV epidemic a distribution rate of 200 needle/syringes per IDU, per year is needed.12 13 So far this target has only been met by three low- and middle-income countries - Bangladesh, India and Slovakia.14Low numbers of NSP sites and low distribution rates can be due to a variety of reasons; for example, the lack of resources, public and/or political opposition to harm reduction, as well as laws which criminalise harm reduction.15
Overall, Western European countries and Australia are the leaders in harm reduction, and some of the highest distribution levels in the world are among these countries. In 2009, Australia distributed an average of 213 needles/syringes per IDU, per year.16 However, many countries are failing to deliver an adequate harm reduction service.
As of March 2009, only 184 needle exchange programmes existed in 36 US states, plus Washington DC and Puerto Rico.17 For over two decades, the US government forbade funding for such services, but in 2009 the federal funding ban was lifted. This should lead to needle exchange services becoming far more widespread throughout the United States. Currently, the needle/syringe rate is 22 per IDU, per year - far below the recommended rate and one of the lowest in the world.18
Throughout Eastern Europe and Central Asia, a promising scale up of harm reduction services has occurred in recent years in many countries, notably Ukraine (which increased the number of NSPs by nearly a thousand to 1,323 between 2008 and 2010).19 A study focusing on 14 European countries, including Estonia, Slovakia and Belgium, found a 33 percent increase in the number of syringes distributed by needle and syringe programmes between 2003 and 2007.20 However, distribution levels remain low across this region.
Despite an average of one in six IDUs in Asia living with HIV,21 most Asian countries have a long way to go before the needle exchange services which exist make an impact on their HIV epidemics. Whilst some countries have many NSPs, in several cases they are only reaching a very low percentage of the country’s injecting drug users, who receive very few clean needles/syringes per year.22 Despite increasing the number of NSPs from 92 in 2006 to 901 in 2010, syringe distribution in China remains very low, at an average of 32 needles/ syringes per IDU, per year.23 24
Apart from a few notable exceptions needle exchanges across Latin America and the Caribbean, Africa and the Middle East are largely non-existent or where they exist inadequate. Brazil, Mauritius and Iran are some of the countries which have the most advanced NSPs throughout these regions, although the number of syringes they distribute is low.25
Evidence of the effectiveness of needle exchanges
There is clear evidence that needle exchange programmes have reduced HIV transmission rates among injecting drug users in areas where they have been established. One of the most definitive studies of needle exchange programmes was carried out in 1997, focusing on 81 cities worldwide. It found that HIV infection rates increased by 5.9 percent per year in the 52 cities without needle exchange programmes, and decreased by 5.8 percent per year in the 29 cities that did provide them.26A study of HIV among IDUs in New York between 1990 and 2001, found that HIV prevalence fell from 54 percent to 13 percent following the introduction of needle exchange programmes.28“While NSPs (needle and syringe programmes) can help reduce the harm caused to people who inject drugs, the consequent reduction in the prevalence of blood-borne viruses benefits wider society.”27England and Wales National Institute for Health and Clinical Excellence
According to an Australian government study, investment in needle exchange programmes from 1991 to 2000 averted 25,000 HIV infections and 21,000 hepatitis C infections.29 A later Australian study examining the impact of needle exchanges in the following decade revealed they had prevented 32,000 HIV infections and almost 100,000 hepatitis C infections. Furthermore, it is believed the needle exchanges led to healthcare cost savings of over AU$1 billon, equating to a five-fold return on investment for every dollar spent.30
The effectiveness of needle exchanges in preventing needle reuse and the potential transmission of HIV has been reflected in a Canadian report.31 The study found that between 2008 and 2009, needle sharing increased from 10 to 23 percent following the closure of Victoria's only fixed needle exchange. On the other hand needle sharing among those studied in Vancouver, which has a number of needle exchanges, remained at less than 11 percent.
The World Health Organization (WHO) released a report in 2004 that reviewed the effectiveness of needle exchange programmes in many countries, and examined whether they promoted or prolonged illicit drug use. The results produced convincing evidence that needle exchange programmes significantly reduce HIV infection, and no evidence that they encourage drug use.32
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