Needle/Syringe Exchange Programs

• Pages: 94-94

Contenidos

• The Issue.
• Legal and Policy Considerations.
• Practice Examples.
• References.

Page 92

The Issue

Needle exchange programs (also known as NEPs, or syringe exchange programs, SEPs) allow injecting drug users to receive a clean needle and syringe in exchange for turning in a used set. These programs are often controversial, as they may be illegal under a country's drug laws. In addition, communities may worry that exchange programs give citizens the idea that drug use is permissible, increase drug use, or devote resources to unpopular sectors of society. Needle exchange programs have been extraordinarily successful in minimizing the transmission of HIV. In a review of more than 200 studies, the WHO found that the "HIV infection rate had declined by an average of 18.6% annually in 36 cities with needle and syringe programmes, whereas it had increased by an average of 8.1% annually in 67 cities lacking such programmes." Needle exchange programs have also proven to be extremely cost effective, especially when the long-term consequences of transmission of HIV and other blood-borne diseases are considered. Importantly, studies have found no evidence that exchange programs increase illicit drug use, increase injecting frequency among users, or recruit new users. Consequently, NEPs have been successful at slowing the transmission of HIV among injecting drug users and the rest of the population.

Legal and Policy Considerations

Exchange programs have proved to be an important strategy for limiting the transmission of HIV among injecting drug users and the nondrug using population. Several countries, including Australia, the United States, Canada, Brazil, Nepal, and the Russian Federation, have implemented exchange programs (although sometimes on a small scale). These programs have been authorized under law, in some cases as exceptions to existing drug laws.

Needle exchange programs can require users to turn in old needles, thereby reducing the quantity of contaminated equipment in the community. However, many programs do not require users to turn in needles to receive replacements. Especially where law proscribes the possession of drug paraphernalia, injecting drug users may be reluctant to travel with used needles. Programs may also give needle vouchers, which can be used at pharmacies to obtain clean needles, or permit secondary distribution of needles by the injecting drug users served. In some exchange programs, condoms and...