Preventing HIV Transmission The Role of Sterile Needles and Bleach (1995) / Chapter Skim
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EXECUTIVE SUMMARY
EXECUTIVE SUMMARY
Pages 1-8
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The focus of this study lies at the interface of these two critical threats to public health. The epidemiologic data indicate that the HIV epidemic in this country is now clearly driven by infections occurring in the population of injection drug users, their sexual partners, and their offspring.
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as part of a more comprehensive public health effort to reduce the spread of HIV and other bloodborne infections among drug users, their sexual partners, and the general population. In the United States, approximately 75 needle exchange programs have been initiated in 55 cities, although many are small and the programs have not been endorsed by the federal government as a viable intervention for the prevention of AIDS.
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SCIENTIFIC ASSESSMENT OF PROGRAM EFFECTIVENESS To examine the context that frames needle exchange and bleach distribution programs, the panel assessed a wide range of studies concerning the magnitude and severity of injection drug use; HIV infection among injection drug users and their partners; and the effects of needle exchange and bleach distribution programs on drug use, HIV risk behaviors, and the spread of HIV/AIDS. The studies that examine needle exchange and bleach distribution programs have various limitations, including inadequate samples, sample attrition, improper controls, problematic measures, and incomplete analyses.
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There is no credible evidence to date that drug use is increased among participants as a result of programs that provide legal access to sterile equipment. · The available scientific literature provides evidence based on selfreports that needle exchange programs do not increase the frequency of injection among program participants and do not increase the number of new initiates to injection drug use.
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should support research directed toward identifying the simplest to use and most effective disinfection strategies, employing agents that are readily available to injection drug users. COMMUNITY AND LEGAL FACTORS In policy decisions about needle exchange and bleach distribution programs, the scientific evidence on whether the behaviors of injection drug users change and the rates at which new infections are reduced are but one dimension of an immensely complex issue.
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The legal environment is another, very different factor impinging on needle exchange and bleach distribution programs. On the basis of its review of the legal circumstances in which these programs operate, the panel concludes: ' · Any marked increase in the supply of sterile needles to injection drug users above current levels through pharmacy sales is likely to call for new measures to ensure the safe disposal of used needles.
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by drugs of choice, routes of administration for each, and the flow of injection drug users into and out of drug treatment programs. · Given the serious public health threat associated with HIV infection among injection drug users, their sexual partners, and offspring, the Assistant Secretary for Health should ensure that AIDS prevention efforts targeted to injection drug users are expanded specifically to include behavioral interventions in order to limit the further spread of HIV infection.
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Moreover, needle exchange and bleach distribution programs should make special efforts to reach and retain hard-to-reach subgroups of injection drug users, such as young injection drug users and women. Incremental funds for needle exchange programs and other AIDS prevention strategies should be appropriated but should not be taken from resources now supporting drug treatment programs.
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