HIV This Week

Des Jarlais DC, McKnight C, Goldblatt C, Purchase D. Doing harm reduction better: syringe exchange in the United States. Addiction. 2009 Feb 10. [Epub ahead of print]

To trace the growth of syringe exchange programs in the United States since 1994-95 and assess the current state of syringe exchange programs, annual surveys of US syringe exchange programs known to the North American Syringe Exchange Network (NASEN) were mailed to executive directors with follow-up interviews by telephone and/or e-mail. Response rates have varied between 70% and 88% since surveys were initiated in 1996. The numbers of programs known to NASEN have increased from 68 in 1994-95 to 186 in 2007. Among programs participating in the survey, numbers of syringes exchanged have increased from 8.0 million per year to 29.5 million per year, total annual budgets have increased from $6.3 to $19.6 million and public funding (from state and local governments) has increased from $3.9 to $14.4 million. In 2007, 89% of programs permitted secondary exchange and 76% encouraged it. Condoms, referrals to substance abuse treatment; human immunodeficiency virus (HIV), hepatitis C virus (HCV), hepatitis B virus (HBV) counselling and testing and naloxone for overdose were among the most commonly provided services in addition to basic syringe exchange. Each of these services was provided by 40% or more of syringe exchange programs in 2007. While syringe exchange has remained controversial in the United States, there has been very substantial growth in numbers of programs, syringes exchange and program budgets. Utilizing secondary exchange to reach large numbers of injecting drug users and utilizing syringe exchange programs as a new platform for providing health and social services beyond basic syringe exchange have been the two major organizational strategies in the growth of syringe exchange programs in the United States.

Editors’ note: Two-thirds of these US programmes do not adhere to a restrictive ‘one-for-one’ needle exchange policy and 89% permit secondary exchange, allowing an individual participant to exchange for peers who do not necessarily attend the exchange. These policies have served to increase the numbers of sterile syringes available to injecting drug users with the result that HIV incidence in the USA has declined to under 1 per 100 person years and the majority of new infections among injecting drug users appear to be sexually transmitted. The recent Congress bill lifting the 20-year ban on federal funding for needle exchange http://www.speaker.gov/blog/?p=1885 may encourage more equitable service coverage across the US, reduce stigmatisation of drug users, and facilitate a move toward integration of services for drug users into the regular health system.