IDEAS-CANADA.CA 24 Jun 2017

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NEEDLE EXCHANGE INCREASES H.I.V.

"...Needle-exchange appears to be nothing more than a facilitator for drug abuse..." (ONDCP:1998)

In a blow to critics of syringe-exchange programs, a new UC Davis study shows that the controversial programs do reduce injection drug users' HIV risk. The study* appears in the July 27 issue of AIDS.

"Our review of the literature should blunt the claims of opponents of syringe exchange, but I'm not optimistic that it will," said lead author David R. Gibson, associate professor of infectious diseases at UC Davis and a senior scientist at UC San Francisco's Center for AIDS Prevention Studies. "Opponents of syringe-exchange programs can be quite data-resistant."

UC Davis Study Shows Syringe-Exchange Programs Effective In Reducing The Spread Of Aids - July 2000
*The research was funded with grants from the National Institute on Drug Abuse, the National Institute of Mental Health, and the United States Public Health Service.


One example of a programmatic vulnerability mentioned is the ban on US federal government dollars going toward needle exchange programs, in the face of clear evidence that they reduce the spread of HIV and do not lead to increased drug use. From a human rights perspective this could be seen as a breach of that government's obligation to respect the human right to health.

Human rights and substance abuse Canadian Centre on Substence Abuse, last update 12/12/2001

Vancouver has the largest Needle Exchange Program (NEP) in North America. The Vancouver NEP distributed approx. 3 million needles last year. A 1997 study of the city's intravenous drug users, 92% of whom used the NEP, found that 40% of HIV-positive addicts had lent their used syringes, and 39% of HIV-negative addicts had borrowed a used syringe. (SOURCE: STRATHDEE et al: AIDS II, 1997 AND US OFFICE OF NATIONAL DRUG CONTROL POLICY, 1998)

There is now direct evidence that increasing the availability of clean injection equipment slows the spread of HIV, and indirect evidence that limited access to supplies of needles and syringes accelerates it. Both forms of evidence demonstrate that access to sterile injecting equipment and outreach in conjunction with development of trust between health care officials and injection drug users are critical in limiting the spread of HIV infection.

Many studies have shown that the majority of injection drug users will change their behaviour to reduce their risk of HIV infection and that they are motivated to seek help in changing their behaviour. Although some studies have shown that those who have attended exchanges are themselves a higher risk group than are non-attenders, behaviour change has been shown to occur more often among attenders of needle exchanges than amongst non-attenders. There is no evidence of increased drug use in any of the communities where syringe exchanges are now operating.

Syringe Exchange: One Approach to Preventing Drug-related HIV Infection A policy discussion paper prepared by the Canadian Centre on Substance Abuse (CCSA) National Working Group on Policy, December 1994 last update 12/12/2001

Needle Exchange Programs (NEP), however well meaning, do not work. In fact, in Vancouver, the HIV rate among NEP participants is actually higher than the HIV rate among injecting drug users who do not participate. These findings are similar throughout the world. Addicts in the Montreal NEP become HIV-infected at twice the rate of addicts not in the program. (AMERICAN JOURNAL OF EPIDEMIOLOGY)

We found no evidence that this NEP is causally associated with HIV transmission. The observed association should not be cited as evidence that NEPs may promote the spread of HIV. By attracting higher risk users, NEPs may furnish a valuable opportunity to provide additional preventive/support services to these difficult-to-reach individuals.

Do needle exchange programs increase the spread of HIV among injection drug users: An investigation of the Vancouver outbreak
Schechter M, Strathdee S, Cornelisse PGA et al. . AIDS 1999 Apr 16;13(6):F45-51.


Study after study has found that needle-exchange programmes reduce the risk of HIV infection. In 1993, a study on needle-exchange programmes by the Centers for Disease Control and Prevention and the University of California, San Francisco, concluded that "the time has arrived for federal, state, and local governments to remove the legal and administrative barriers to increased needle availability and to facilitate the expansion of needle exchange programmes in the US". In 1995, the National Academy of Science's Institute of Medicine, an independent organisation set up by Congress for advice on scientific and technical matters, concluded that needle-exchange programmes were effective and did not encourage illegal drug use. In 1997 an independent consensus panel convened by the National Institutes of Health found that "an impressive body of evidence suggests powerful effects from needle-exchange programmes . . . there is no longer doubt that these programs work".

Needle-exchange programmes in the USA: time to act now Editorial, The Lancet - Volume 351, Number 9096 10 Jan 1998

Nowhere has tolerance toward injecting drug addicts helped them. It only encourages the spread of more needles for more kinds of drugs, stimulants and hallucinogens. In fact, the #1 injected drug is not heroin but cocaine because injecting brings a quicker high and retards withdrawal. (NATIONAL HOUSEHOLD SURVEY ON DRUG ABUSE) The Cost of Drug Abuse to Society is Enormous

The data indicate that the presence of a syringe exchange program does not increase the use of illegal drugs among participants in syringe exchange programs, and in many cases, a decrease in injection frequency has been observed among those attending these programs.

Evidence-based findings on the efficacy of syringe exchange programs: an analysis of the scientific research completed since April 1998 David Satcher, MD., Assistant Secretary for Health and Surgeon General, U.S. Department of Health and Human Services Washington, DC , March 17, 2000

Highest rates of property crime in Vancouver are within 2 blocks of the NEP and a 24-hour drug market and open injection site operate immediately adjacent to the Needle-Exchange.

The Real Issue...

Why must Canadians pay millions of dollars in taxes to fund NEP's that have been proven to increase crime, disease and addiction?

They estimated that between 4,000 and 10,000 injection drug users in the US would not now be infected with HIV had they had access to sterile needles. Using the conservative estimate of US$119,000 for the lifetime cost of treating an HIV infection, the authors concluded that these infections have cost the US health care system US$250 to US$500 million.

An opportunity lost: Estimating the number of HIV infections associated with the US government opposition to needle exchange programs. P. Lurie, E Drucker. Paper presented at the XI International Conference on AIDS, Vancouver, Canada, July 1996.





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