Needle exchange programs and HIV transmission prevention among injection drug users

¶ … Exchange is a program designed to educate and promote health among drug-users. Needle Exchange, and similar programs that provide needles and syringes to drug-users are a harm-reducing motive whose aim is to enable access to sterile needles and syringes for individuals injecting drugs. This kind of action is recommended by The World Health Organization (WHO), whose experts suggest that each drug-user injecting drugs needs to be given access to two hundred clean needles and syringes on an annual basis as a way of tackling and preventing the transmitting of HIV and other blood-borne viruses through this method.

Overall, most programs similar to Needle Exchange are facilitated by pharmacies. Some of these programs work from fixed locations, while others are mobile, and some even employ strategically placed sites. The aim of most Needle Exchange programs is to alleviate and prevent the transmission of HIV, as well as other blood-borne viruses, through sharing of the instruments of drug injection ("Needle and Syringe Programs (NSPs) for HIV Prevention," Para 1-3). The method of tackling the problem is provision of needles to injecting drug-users at a low or no cost at all.

On the one hand, there has been widespread support of such programs. Those in favor of Needle Exchange suggest that such programs are an effective method of addressing the issue of sharing drug-injecting equipment, and that the distribution of needles reduces the extent of this practice. Consequently, the lower rate of transmission of blood-borne diseases such as HIV and Hepatitis C Various studies underline that, in the United States, about a third of HIV-diagnosed patients has a history of sharing the drug-injection equipment and potential use of contaminated needles. On the other hand, there has been wide opposition to Needle Exchange programs, as criticizers underline the weakening effect it may have on 'The War on Drugs' (Harris, Bernard and Nancy, 83-4). The aim of this research paper is to discuss the two opposing schools of thought when it comes to Needle Exchange Programs.

2 Needle Exchange Supporters

There is a tri-fold effect of Needle Exchange programs that helps alleviate the issue of HIV transmission: when drug-users are provided with clean needles, contaminated needles are stopped from circulating, and drug-users are educated about the hazards of needle sharing. These programs have had an effect on the falling rates of injection equipment sharing (Strike et al., 16). The World Health Organization, substantiating its claims with an elaborate literature review, suggests that the introduction of NEPs is an efficient method of drastically reducing the transmission of blood-borne viruses, such as HIV / AIDS.

A New York City-based study concludes that there is a direct correlation between the amount of shared injection equipment and the number of cases of HIV-transmission; the study encompasses NYC's drug-injecting population (also known as IDU) of 3,651 during the period of 1990-2002 (Strike et al., 17). Furthermore, the link between the two is underlined by the figures from cities with effective NEPs in place, whose HIV prevalence levels are below 5%, such as Toronto, Washington, Sydney, Glasgow and Lund. All of these cities have efficiently implemented Needle Exchange Programs, and consequently have much lower rates of HIV diagnoses. In addition, there has been internationally spanning data that stands in favor of NEP introduction. When comparing cities with and without an NEP set in place, the former reported average yearly drops of HIV seroprevalence of up to 18.6%, while the latter had average yearly growth of 8.1% (Strike et al., 17).

When it comes to cost-efficiency, international data cannot be made into a coherent whole. However, figures from the U.S., Australia and Canada demonstrate that Needle Exchange Programs are significantly more cost-efficient than the lifelong costs of HIV infection treatment (Strike et al., 19).

The Needle Exchange type of programs have given rise to plenty of controversy, but are nevertheless one of the most effective ways of reducing harm that comes from needle-sharing among IDUs. Needle Exchange programs provide access to sterile needles and other injection instruments (e.g. alcohol swabs, clean water) at a low or no cost. With some NEPs, bringing a used needle is mandatory for getting one, or a couple of new ones. The background idea of NEPs is to minimize the potential harm of injection drug use. Instead of ignoring the problem, these programs acknowledge the existence of injecting drug users, and attempt to alleviate the issues that arise in connection to injected drug use. The rationale is that ignoring, or publicly shaming the drug-user will not bring any positive result. The importance of NEPs is highlighted by studies suggesting that injected-drug users are willing to use clean equipment if they can get hold of it (Strike et al., 197).

Needle Exchange Programs are far from being a global policy or trend. In the United States, or Singapore, for instance, there is a widely spread belief that they should not be supported. The main point of criticism is that such programs in fact promote illegal drug abuse, as well as that they may be a motivator for switching from one mode of drug use (e.g. inhaling) to another (injecting) because of the availability of injecting equipment. However, NEPs are not only there to provide needles; the aim of such programs is also take contaminated needles out of distribution, which greatly lowers the potential for injuries from the needle. A great number of NEPs takes place in medical centers or larger pharmacies that offer other drug-related service, like methadone treatment and drug treatment referrals, as well as health education. A number of NEPs provides drug-users with a three-needle pack that also features a flyer with some basic information about drug usage, and health services telephone numbers ("Needle Exchange Program -- Alcohol Rehab" Para 1-3).

Finally, these programs have demonstrated their potential in linking unavailable injected drug users with a range of public health options, such as TB and STD testing and therapy. Needle Exchange Programs also have the possibility of directing drug-users towards substance abuse treatments. Evidence indicates that NEPs neither encourage injected drug use, nor stimulate the arrival of first-time drug users.

3 My opinion

As the discourse on the Needle Exchange Programs and its benefits continues, my belief is that there is a strong necessity of better, scientifically supported methods of aiding drug-ingesting individuals. Although NEPs have been established in different places, there are no universally set criteria or benchmarks that will ensure a uniform enforcement of Needle Exchange Programs. Currently, these programs have become more of a needle-distribution and recuperation method, and are often a starting point for additional health services. The only document somewhat standardizing the implementation of such programs is the Mandatory Guidelines Legislation; there are no additional documents, guidelines or criteria that have to be taken into account during the planning or operative phase of the programs. A number of similar programs cannot find adequate funding sources and stabilize their source of founding, and lack the basic acknowledgment of their role in the public health sector. These programs mostly remain unacknowledged in the fields of health-education, health-promotion, and disease prevention, as well. Regardless of the obviously positive effects of NEP implementation, the programs still struggle daily and fight to continue working in minimal conditions.

While there are evident advancements and improvements in the sphere of Needle Exchange Programs, the road ahead is much longer. For example, the supporters of the program initiative frequently argue that distributing needles, which are cheap, is a small price to pay when the alternative is the very expensive, lifelong disease that will otherwise be transmitted, especially if there will be a trust-building relationship between the IDU and the medical worker, and if the NEPs will be supported by the public and large health organizations. Regardless of the evidently positive effects of NEP efficiency, however, there has been plenty of resistance to implementing such programs. The opposition is largely concerned, in fact, with the symbolism of 'lifesaving medication,' as the resistance to drug-abusers and the equating of lifesaving medication with drug-injecting equipment, motivates many to be against NEPs (Brownstein, Para. 4). In my opinion, and without undermining the importance and effectiveness of NEP, providing needles cannot be equated with providing lifesaving medication, regardless of the fact that the provision of the equipment may be implicitly saving the lives of IDUs.