Preventing HIV Transmission The Role of Sterile Needles and Bleach (1995) / Chapter Skim
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3 NEEDLE EXCHANGE AND BLEACH DISTRIBUTION PROGRAMS IN THE UNITED STATES
3 NEEDLE EXCHANGE AND BLEACH DISTRIBUTION PROGRAMS IN THE UNITED STATES
Pages 74-102
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From page 74... ...
A survey conducted in October 1994 reported 76 needle exchange programs in 55 U.S. cities (North American Syringe Exchange Network, 1994~.
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From page 75... ...
The primary sources for the information that follows are a report prepared by the School of Public Health, University of California, Berkeley, and the Institute for Health Policy Studies, University of California, San Francisco (Lurie et al., 1 993a, 1 993b) , and reports on the Washington, D.C., and Baltimore needle exchange programs, which opened subsequent to the University of California report.
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From page 77... ...
The ordinances impede injection drug users from obtaining sterile injection equipment from needle exchange programs operating in these areas and limit the operating capabilities of the programs (see Chapter 5 for an in-depth discussion of legal issues)
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From page 78... ...
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From page 79... ...
Storefront sites can also house telephones, facsimile machines, computers, desks, and chairs, which can make it easier for needle exchange program staff to provide services to injection drug users and facilitate referrals to other services. Storefront needle exchange programs may involve significant rental costs.
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From page 80... ...
An argument sometimes offered in favor of an exchange maximum is that it brings participants back to the needle exchange program more frequently, thus increasing staff-participant contact and providing more opportunities to refer injection drug users to drug treatment and other public health services. However, an exchange maximum might lead to an increase in the reuse of
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From page 81... ...
in order to use the needle exchange program is intended to limit clientele to active users. This rule is, in part, a response to the concern that needle exchange programs may encourage noninjection drug users to start injecting drugs, but it can also be used to prevent noninjection drug users from selling syringes for a profit.
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From page 82... ...
The need for and value of targeted education and behavior modification efforts directed at injection drug users at risk of HIV transmission have been clearly demonstrated in programs that do not include needle exchange (Wiebel et al., 1993~. Additional services include HIV testing and counseling, tuberculosis screening, screening and treatment of sexually transmitted diseases, primary medical care and case management, drug treatment, assertiveness training focused on negotiation skills, and other health and social services.
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From page 83... ...
The sex profile of needle exchange programs is similar to that of drug abuse treatment programs and other populations used to sample injection drug users. Needle exchange programs vary considerably in their racial/ethnic distributions.
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From page 85... ...
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From page 86... ...
The largest proportion of the budget was for personnel, ranging from 27 percent in Berkeley's NEED exchange to 79 to 80 percent in the Boulder, New Haven, and Portland exchange programs (median = 66 percent)
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From page 87... ...
The behavior change model estimates averted infections among all injection drug users in the community as well as their sexual partners and offspring over a 5-year time interval, attributable to transmissions from both sharing and sexual behavior. The combined circulation and behavior change model incorporates characteristics of both models.
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From page 88... ...
in a recent paper provides various models for estimating the cost and benefits of HIV prevention programs and uses data from the New Haven needle exchange to illustrate how such models can assist policy makers in making resource allocation decisions. In particular, the proposed models do provide some guidance for addressing pragmatic issues, such as how a given needle exchange program, in a specific epidemiologic environment, can optimize its cost-effectiveness ratio (i.e., cost per infection averted)
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From page 89... ...
New York City The first legally authorized needle exchange program in New York City opened in 1988 as a single-site operation, although it had originally been designed and proposed as a pilot study that aimed to compare injection risk behavior and the rates of entry into treatment among injection drug users seen at four different sites (Anderson, 1991; Joseph and
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From page 90... ...
was under the control of the City Health Department was in the Health Department's own Lower Manhattan headquarters, which happened to be in an area that was not only inconvenient for injection drug users, but also conspicuously near police headquarters and the Manhattan criminal courts. Moreover, the registration procedures themselves lasted several hours and included tuberculosis screening, administration of a detailed questionnaire on risk behavior, and issuance of a photo ID card.
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From page 91... ...
Manchester In 1988, Klee conducted an interview study of HIV/AIDS risk behavior among injection drug users in Manchester, United Kingdom, and published results somewhat later (Klee et al., 1991~. She found that some of the local injection drug users who had participated in the local needle exchange program had become known among the drug user community as sources of injection equipment.
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From page 92... ...
The newly authorized exchange programs had to operate within regulations issued by the New York State Department of Health. The original intention of the Health Department's regulations was to require continued tagging of syringes issued through the now legally authorized exchanges, and this stipulation was included in the first versions of the regulations.
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From page 93... ...
Although they did not conduct formal quantitative analyses, they were able to show that user-friendliness was associated with both attracting and retaining injection drug users in needle exchange programs. (It should be noted that the participation of injection drug users in the U.K.
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From page 94... ...
(1993a) Legal status Administrative body Funding source Sites Staff On-site services On-site items provided Nonjudgmental staff attitude Convenient location Convenient hours of operation Willingness to exchange large numbers of syringes at one time Legal Illegal tolerated Illegal underground Activist run Community-based organization run Community-based organization with government support Government run Private donations Foundation grants Community-based organization City, county, and/or state government Fixed sites Stationary van Streetfront Street Health facility Mobile sites Walk route Deliveries Roving van Paid Volunteers Both paid and volunteers Educational material HIV testing and counseling Primary medical care Tuberculosis screening Sexually transmitted diseases screening Drug treatment Referrals to above services Referrals to social services Needles/syringes Bleach Alcohol wipes Cotton Cookers Water Condoms Lubricant
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From page 95... ...
program, which was initiated in 1987 by NIDA. The purpose of NADR was to assess the efficacy of different strategies of AIDS prevention with out-of-treatment injection drug users and their sexual partners.
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From page 96... ...
NADR came to involve a total of 41 projects in nearly 50 cities nationwide. Over the life of the program, data were collected on more than 43,000 injection drug users and nearly 10,000 sexual partners, although many more tens of thousands of participants received outreach and intervention services (AIDS prevention services)
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From page 97... ...
Although the NADR program provides information to describe and evaluate bleach distribution programs in the United States, it does not describe all existing bleach distribution programs. Also, the NADR programs used outreach workers to establish trust and rapport with injection drug users outside treatment for drug abuse; bleach distribution is thus intertwined with the intervention of community health outreach workers.
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From page 99... ...
It also helps to ensure that existing injection drug users, not new users, are the ones using the program. Conducting the programs as an exchange also increases the possibilities for evaluating program effectiveness through tracking exchanged syringes and conducting surveys of exchange participants to ensure safe practices (Lurie et al., 1993a)
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From page 100... ...
Hsiehs 1993 Trends in self-reported HIV risk behavior: Injection drug users in Los Angeles. Journal of Acquired Immune Deficiency Syndromes 6:82-90.
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From page 101... ...
Des Jarlais 1990 Effects of outreach intervention on AIDS risk reduction among injection drug users. AIDS Education and Prevention 2:253-271.
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From page 102... ...
Fergusson 1990 AIDS prevention for injection drug users in the community: Street-based education and risk behavior. American Journal of Community Psychology 18:587-596.
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