Needle Exchange Programs

“The study was conducted with non-governmental organizations (NGOs) in three locations with high concentrations of IDU [intravenous drug users]: Kiev, Odessa and Makeevka/ Donetsk [in the Ukraine]…Using a previously used syringe was not associated with HIV infection”

“The HIV incidence among drug users in the ACS has declined since 1985. Accompanied by a reduction in injecting drug use and needle sharing, this decline occurred despite continued sexual risk behaviour.”

“Of 1,315 participants…11.0% reported NEP attendance but did not attend, and 2.2% reported not attending NEP but did attend…persons who overreported NEP [Needle Exchange Program] attendance were more likely to have injected frequently (adjusted odds ratio (AOR) = 1.29), denied needle sharing (AOR = 0.69), and been an HIV seroconverter (AOR = 1.83).”

“In this study, sharing syringes in the past 6 months was negatively [!] associated with HIV prevalence among both sexes…After adjustment for other factors, male injection drug users who had shared syringes in the previous 6 months were at lower risk of being HIV positive [61% of the risk of those who had not shared]”

“Needle exchange is one of the few interventions available, and a context-specific approach to its use seems to be the responsible way to proceed [translation: Often the programs don’t reduce the rate of HIV transmission, or even increase it, but doing nothing would be a worse sin than doing something counterproductive!]”

“Syringes supplied by SEPs [syringe exchange programs] account for fewer than 2% of those needed to meet the standard of 1 syringe per injection.…syringes with either 2 or 20 microliters of blood [containing HIV-negative blood mixed with the supernatant of an HIV culture to simulate 0.1 to 5 infectious units per microliter] stored at 4C yielded viable HIV-1 even at 42 days of storage, the longest duration tested. At the other extreme, at 37C, syringes with either 2 or 20 microliters of blood failed to yield viable HIV-1 if stored for 7 days or longer. At 22C [room temperature], viable HIV-1 was recovered from some syringes with approximately 2 and 20 microliters of blood for up to 21 and 42 days, respectively. At both 27C and 32C, viable HIV-1 was receovered from some syringes with approximately 2 and 20 microliters of blood for 1 and 7 days, respectively.”

“Injection drug users (IDU) constitute the major risk group for HIV infection in many countries world- wide. IDU are at risk of HIV infection through unsafe injecting practices and risky sexual behaviour [no reference given]...[but]...As previously found in this cohort, the study results demonstrated an increased risk of HIV infection associated with NEP use: inconsistent NEP users had a higher risk than consistent users when compared with non-users. However, we chose to exclude this variable”

“Of 694 subjects [IV drug users in Vancouver], the 15-month cumulative HIV incidence [number of people changing from HIV-negative to HIV-positive] was significantly elevated in frequent NEP attendees (11.8 ± 1.7 versus 6.2 ± 1.5%).”

“The authors utilized a cohort study among Seattle injection drug users (IDUs) to assess whether participation in a syringe exchange program was associated with incidence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infection…There was no apparent protective effect of syringe exchange against HBV (former exchange users, relative risk (RR) = 0.68, 95% confidence interval (CI) 0.2-2.5; sporadic exchange users, RR = 2.4, 95% CI 0.9-6.5; regular users, RR = 1.81, 95% CI 0.7-4.8; vs. RR = 1.0 for nonusers of the exchange; adjusted for daily drug injection). Neither did the exchange protect against HCV infection (sporadic users, RR = 2.6, 95% CI 0.8-8.5; regular users, RR = 1.3, 95% CI 0.8-2.2; vs. RR = 1.0 for nonusers; adjusted for recent onset of injection and syringe sharing prior to enrollment). [In other words regular needle exchange users were 1.8 times more likely to be Hepatitis B positive than non-users, and 1.3 times more likely to be Hepatitis C positive]”

“[Table 5 shows that the risk of an IV drug user becoming HIV-positive is 10.2 to 22.9 times greater among consistent needle exchange program users versus non-users. Frequent users were 2.2 to 3.9 times more likely and infrequent users had about the same risk as non-users.]”

“The HIV epidemic raging in the heart of Vancouver is now considered to be the most rampant in the developed world…the epidemic…has occurred despite Vancouver’s celebrated needle exchange program. More than two million needles are exchanged each year in the program, which started in 1988”

“HIV-positive IDU were significantly more likely to be established IDU [>2 yrs]…HIV-positive IDU were more likely to have ever attended NEP, and to attend NEP on a more regular basis, compared with HIV-negative IDU”

“Current intravenous cocaine use (HR 2.5) and (marginally) crack [cocaine] use (HR=3.2) were associated with risk of seroconversion, but intravenous heroin and amphetamine use were not…Sharing needles and bleach use were not associated with seroconversion”