The scientific evidence: STERILE NEEDLES ARE NEEDED FOR HIV PREVENTION

Access to sterile needles is essential for HIV prevention among injecting drug users.  According to the Centers for Disease Control and Prevention:

For injection drug users who cannot or will not stop injecting drugs, using sterile needles and syringes only once remains the safest, most effective approach for limiting HIV transmission.⁽¹⁾

Uninfected men and women who inject drugs need sterile needles so they can avoid becoming infected.  People with HIV/AIDS who inject drugs need sterile needles so they will not borrow the needles of others, spreading the HIV virus further.

The scientific evidence: NEEDLE EXCHANGE PROGRAMS DO NOT INCREASE DRUG USE

One effective way to get sterile needles to injecting drug users is to set up needle exchange programs that distribute sterile needles and collect used ones.  Those opposed to needle exchange programs have expressed the concern that needle exchange programs might increase drug use.   

However, extensive scientific research has been done on the relationship between access to sterile needles and drug use.  Seven major government-funded studies have concluded that needle exchange programs do not increase drug use and do not attract new people to drug use.⁽²⁾

Convinced by the strong evidence that access to clean needles is essential to controlling the HIV epidemic among injecting drug users, the American Medical Association, the American Pharmaceutical Association and other professional health associations have called on their members to support the establishment of needle exchange programs and to work to reform the state laws and pharmaceutical board regulations that limit access to sterile needles.⁽³⁾ 

The scientific evidence: NEEDLE EXCHANGE PROGRAMS CAN REDUCE DRUG USE

Surgeon General David Satcher has concluded that, under certain circumstances, needle exchange programs can actually reduce drug use.⁽⁴⁾  Upon reflection, this paradoxical finding makes sense.  Needle exchange programs work on two levels to reduce drug use: the interpersonal and the institutional. 

THE INTERPERSONAL LEVEL.  Needle exchange workers often offer information counseling and a friendly ear to drug users who in many cases have little contact with individuals outside the drug-using world.  This interaction, often focused on helping the drug user take better care of himself, can empower the drug user to decide for himself or herself to cut back on drug use or enter treatment.

THE INSTITUTIONAL LEVEL.  Needle exchange programs have helped drug treatment agencies become more receptive to poor and minority clients.  Some needle exchange programs have negotiated agreements with drug treatment agencies, so that the exchange is guaranteed a certain number of places in the treatment organization.  Other exchanges have arranged for free treatment for some injecting drug users who lack resources. 

The New Haven needle exchange experience illustrates this process.  While the main focus of the New Haven program was on exchanging needles, considerable effort also went into creating drug treatment opportunities for those who wished to take advantage of them.  One-sixth of the injecting drug users who initially joined the needle exchange subsequently entered drug treatment programs. Referrals from the New Haven needle exchange also helped redress racial/ethnic inequities in the drug treatment system.  Prior to the start of needle exchange program referrals, less than 40 percent of the injecting drug users in the area treatment programs were minorities, while over 60 percent of those placed in drug treatment by the needle exchange were minorities.⁽⁵⁾ 

Careful studies in Baltimore, Hawaii, and Seattle have all shown that needle exchange programs, given community support and the appropriate resources, can reduce drug use.⁽⁶⁾

Development of the interpersonal and institutional relationships that lead to reduced drug use occurs most effectively when the exchange has a secure legal status.  When a needle exchange is under pressure from the police, conversations between clients and volunteers are cut short, and the program's resources to encourage change in the drug treatment agencies are limited or nonexistent.⁽⁷⁾ 

Thus, ironically, those who use police power to harass or close down needle exchange programs are not only causing the spread of HIV but are also causing a continuation of drug use by hampering the needle exchange activities that would otherwise help some drug users reduce or stop their drug use.

Footnotes

(1) Centers for Disease Control and Prevention (CDC), "Drug-Associated HIV Transmission Continues in the United States," August 1999.

(2) The reports are by the (1) National Commission on AIDS,  (2) General Accounting Office, (3) University of California, (4) National Research Council and Institute of Medicine, (5) Office of Technology Assessment of the U.S. Congress, (6) National Institutes of Health Consensus, and  most recently, in March 2000, (7) Surgeon General David Satcher.  The reports are available in their entirety (5 reports) or in executive summary (2 reports) on the web. Information on any later reports is also available on the webpage.

(3) For more information on the positions of the American Medical Association and the American Pharmaceutical Association in support of greater syringe access, follow the links given here.

(4) David Satcher, "Evidence-Based Findings on the Efficacy of Syringe Exchange Programs: An Analysis of the Scientific Research Completed Since April 1998," Washington, D.C.: U.S. Department of Health and Human Services, March 17, 2000.  Report sent from Secretary Donna Shalala to Congresswoman Nancy Pelosi.

(5) Edward H. Kaplan and Elaine O'Keefe, "Let the Needles Do the Talking! Evaluating the New Haven Needle Exchange," Interfaces, January-February 1993, vol. 23, no. 1, pages 7-26. Robert Heimer, Kaveh Khoshnood, P. Clay Stepens, Bini Jariwala Freeman, and Edward H. Kaplan, "Evaluating a Needle Exchange Programme: Models for Testing HIV-1 Risk Reduction," International Journal of Drug Policy, vol. 7, no. 2, 1996, pages 123-129.

(6) Baltimore: R. Brooner, M. Kidorf, V. King, P. Bielenson, D. Svikis, and D. Vlahov, "A Drug Abuse Treatment Success Among Needle Exchange Participants," Public Health Reports, vol. 113, supplement 1, pages 130-139, June 1998. Abstract.  S. Strathdee, D. Celentano, and others, "Needle Exchange Attendance and Health Care Utilization Promote Entry into Detoxification," Journal of Urban Health, in press. Abstract. Seattle: H. Hagen, J.P. McGough, and others, "Reduced Injection Frequency and Increased Entry and Retention in Drug Treatment Associated with Needle Exchange Participation in Seattle Drug Injections, Journal of Substance Abuse Treatment, in press. Abstract. Hawaii: Don C. Des Jarlais, Mark Breda, and Suzette Smetka, Hawaii Syringe Exchange Program: 1997 Evaluation Report, available from the Chow Project, 710 North King Street, Room #5, Honolulu, Hawaii, 96817; 37 pages plus figures.

(7) Ricky N. Bluthenthal, "Impact of Law Enforcement on Syringe Exchange Programs: A Look at Oakland and San Francisco," Medical Anthropology, 1997, vol. 18, pages 61-83.

For a list of other materials used on this website, see References.