Syringe exchanges expand despite government ban
Syringe exchanges expand despite government ban
Growth seen in numbers and activity
Despite a recent congressional ban on using federal funds for syringe-exchange programs (SEPs), new evidence indicates that SEPs continue to grow in number, geographic coverage, and activity. (For more information on the federal ban, see AIDS Alert, August 1998, pp. 92-93.)
The Centers for Disease Control and Prevention in Atlanta recently summarized a survey of U.S. SEPs during 1997 and compared those findings with two previous surveys (1994-1995 and 1996) of SEPs, which indicated that SEPs have increased dramatically in number and scope in recent years.1
From questionnaires and telephone interviews of 100 U.S. SEPs, investigators found out the following information:
· Fifty-two (52%) of the SEPs were located in four states - California (19), New York (14), Washington (11), and Connecticut (eight).
· Nine cities had at least two SEPs.
· In 1997, a median of 57,343 syringes per SEP were exchanged, with a total of 17.5 million syringes exchanged compared to 14 million syringes (median 36,017) in 1996.
· Most of the SEPs offer public health and social services, with 99% providing instructions in safe sex, 96% providing information on safer injection techniques, and 94% referring clients for substance abuse programs.
· Health care services offered on-site include HIV counseling and testing (64%), tuberculosis skin testing (20%), STD screening (20%), and primary health care (19%).
· A total of 52 SEPs were "legal," or operating in a state with no law requiring a prescription to purchase a syringe, or were in a state with a formal vote of support or approval from a local elected body. Sixteen SEPs were illegal but tolerated, and 32 were illegal but underground.
· The most common settings for operation were home visits (37%), storefront locations (35%), and vans (35%).
Denise Paone, PhD, director of research at the Chemical Dependency Institute at Beth Israel Medical Center in New York City, who led the survey, says enough members of Congress object to SEPs to keep them from becoming federally funded.
"There is an opposition to syringe-exchange programs," she says. "The people who oppose it will say they don't work or they send the wrong message or they increase drug use. But there is no science to support that position. The science shows that in fact [SEPs] reduce HIV transmission and don't increase drug use. But even without federal funding, each year we see new programs opening up."
Paone adds that SEPs help increase the proportion of drug injections in which a syringe is used only once, which prevents reuse of contaminated syringes. Injection drug users (IDUs) who use syringes from SEPs have lower rates of HIV compared to IDUs who use syringes obtained illicitly.
Seek advice from other programs
She recommends that communities that would like to start SEPs in their areas first contact other SEPs for advice. "They can learn a lot from people who started these," Paone advises. "They have to learn to set these programs up, and also how to work with the community to get support. You have to get the community boards, the leaders in the community, and the AIDS groups to work together."
Paone also recommends that communities trying to start SEPs contact the North American Syringe Exchange Network (NASEN) in Tacoma, WA, a service organization for SEPs that provides technical assistance, a buyer's club for supplies, grants, and other support.
Dave Purchase, founder of NASEN, which helped conduct the recent survey, says his organization has contracted with the local health department to provide HIV prevention and advocacy for IDUs.
"So we essentially try to provide them with any service they ask for," he says. "What that first means is syringes, [then] condoms, AIDS prevention information, and helpful information around better injecting," he explains. "We provide referrals for medical and drug treatment and a certain amount of advocacy with the welfare system, and in some cases, bilingual translation."
Wendy Royalty, MSW, director of legislative affairs at the Baltimore City Needle Exchange Program, which is part of the Baltimore City Health Department, says the four-year old program is exempt from state prescription laws by a special ruling from the state legislature. Funding and drug treatment is provided by the city of Baltimore.
The program, which started with one mobile van, recently added a second. Seven drug treatment staffers go to eight sites throughout the city over the course of each week.
"We're at set locations at set times, so our clients know exactly when we're going to be there," she says. "We provide one-for-one needle exchange, HIV counseling and testing, and referrals for TB and STDs at our health department clinics."
'If they have to wait, you lose them'
Clients can get "drug treatment on demand," says Royalty, which means that if a van goes out and finds an IDU who requests drug treatment, the client can usually get services right away.
"If they have to wait, you lose them," she says. "If they're ready, we want to give them the opportunity."
Drug treatment consists of outpatient metha done maintenance, which includes regular metha done treatment, urine testing for the presence of drugs, and counseling. It is provided under contract through the University of Maryland and Johns Hopkins University.
Royalty says the program is successful without publicity. "We don't do any advertising," she says. "We let the treatment programs know where we are at what time, but most of it is word-of-mouth on the street."
The vans go to allotted locations and provide one-for-one exchange for syringes. Royalty says about 8,000 IDUs are enrolled. "Some of them come in often, but some of them only come in once a month or once every six months," she says.
The total number of syringes exchanged in the last four years is more than 1.5 million, which is more than 1.5 million contaminated syringes that weren't used to inject drugs. "The whole idea is to get the dirty needles out of circulation," Royalty says. exchanging is a control that we have."
In addition, retrieving used needles allows the program to determine how many of its own needles are coming back. Program needles are marked with a special bar code that can be scanned. Some needles are randomly selected for DNA testing to determine if there is multiple DNA in the syringe (indicating more than one person had used the needle). No results are available on that testing, but another study of clients in the program who were compared to other IDUs not in the needle exchange program indicates that HIV seroconversion rates were 40% lower in program participants than in nonparticipants, says Royalty.
"Some people are against [SEPs] because they say they don't care about drug addicts," says Royalty. "But if you want to help people, you get them into treatment, and you make sure they don't get diseases, and try to help them get back on their feet. You can't turn your back on people. Those are our values here, and our clients are treated with the utmost respect with no judgement. There aren't many places they can go where people aren't looking down on them. That doesn't help the situation - it only makes it worse."
[Editor's note: To find out more about NASEN, contact the organization at 535 Dock St., No. 112, Tacoma, WA 98402. Telephone: (253) 272-4857.]
Reference
1. Centers for Disease Control and Prevention. Update: Syringe exchange programs - United States, 1997. MMWR 1998; 47:652-655.
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