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evidence
for the effectiveness of syringe exchange programs phila-based outcomes | rates of infection | cost-effectiveness | behavior change | promoting drug use | service linkages
outcomes: philadelphia-based HIV infection study The HIV Prevention Research Division of the Center for Studies of Addiction at the University of Pennsylvania has been conducting HIV-related studies since 1989 to investigate the spread of HIV among injection drug users in Philadlephia. This work has explored the relationship between the introduction of PPP's Syringe Exchange Program, needle-sharing behaviors among injectors, and new infections of HIV. These studies have observed dramatic declines in both needle sharing and new infections of HIV since the establishment of the Syringe Exchange Program. Among the original 415 injection drug users recruited for the study in 1989, reported rates of needle-sharing have shown a steady and significant decline, as have new infections of HIV. During the first two years of the study—prior to the establishment of a syringe-exchange program in Philadelphia—the rate of new HIV infections among injection drug users was among the highest rates of HIV infection observed in the United States. Among injectors followed during the eight years of study, the rate of new HIV infections dropped from 6.8% per year to less than 0.05% per year. This correlation between reductions in new infections and the establishment of syringe exchange services is consistent with a large body of research that clearly establishes the public health benefits of providing sterlie injection equipment (and collecting used syringes) to active drug users.
rates of HIV infection: incidence and prevalence Hagan, et al., (1995) in Tacoma, WA found that use of a syringe exchange program was associated with an 80% reduction in the rate of new Hepatitis B and C infections. In their study of the New Haven, CT syringe exchange program, Kaplan and Heimer of Yale University (1992) found that the program reduced the rate of HIV incidence by 33%. In New York City, DesJarlais, et al. (1996) found that injection drug users who used a needle exchange program were 4 times less likely to become infected with HIV than injection drug users who did not use the program. Hurley, et al. (1997) examined HIV seroprevalence data from 81 cities. Those cities with syringe exchange programs saw a 5.8% decline per year in HIV seroprevalence while those cities without syringe exchange programs experienced a 5.9% increase per year. cost-effectiveness of syringe exchange programs A 1993 study (Lurie et al.) concluded that syringe exchange programs are a bargain: the cost per HIV infection prevented is $9,400 in syringe exchange program operating costs as compared to $119,000 to treat a person with AIDS (More recently, Holtgrave and Pinkerton (1997) estimated that the cost of treating a person with AIDS is $195,000). reductions in behaviors that can expose individuals to disease In a study funded by the CDC, Lurie, et al. (1993) reported that 10 out of 14 studies of syringe exchange programs documented significant decreases in syringe sharing among injection drug users using syringe exchange programs; four of the 14 studies documented no change (i.e., no increase or decrease) in syringe sharing. Behavioral and serological data from 5 U.S. cities indicate that out-of-treatment injection drug users who do not have access to sterile syringes are at increased risk of HIV exposure as compared to those who have such access (Friedman et al., 1995). There is no evidence that the presence of a syringe exchange program in a community results in an increase in drug use or new initiates to drug use. Watters (1994) examined the age of injection drug users and the frequency of injection drug use in San Francisco over a six year period when syringe exchange programs were in operation. From 1988 to 1992, the average age of injection drug users increased from 36 to 42 years, indicating that there was no increase in new, younger injection drug users. In fact, Watters documented a 2% decline in the number of new initiates to injection drug use over the six year period. He also documented a significant decline in the frequency of injection drug use. In Portland, OR, Oliver et al. (1994) found that over 75% of injection drug users participating in a syringe exchange program had been injecting for 5 or more years. Less than 2% had started injecting during the past year. Doherty et al. (1997) found no increase in the number of discarded syringes in a Baltimore community after the opening of a syringe exchange program. In a Brooklyn neighborhood where a syringe exchange program was operating for 8 years, only 7% of young people aged 18 to 24 years were aware that a syringe exchange program was operating in their neighborhood (Friedman et al., 1999). Syringe exchange programs link hard-to-reach drug users with drug treatment programs and other services.
In New Haven, CT, Heimer (1994) documented that syringe exchange programs facilitate drug users entry into drug treatment and access to other services. In Tacoma, WA, Hagan et al. (1993) documented that the syringe exchange program was the largest single source of referrals to county drug treatment programs. A large proportion of those seeking treatment had never before been in treatment. Brooner et al. (1998) found that 76% of Baltimore syringe exchange participants who entered drug treatment as a result of a referral by exchange program staff remained in treatment for at least three months and achieved good treatment outcome, i.e., reductions in both drug use and criminal activity for profit.The majority of those injection drug users who entered treatment were unemployed, middle-aged, African-American males who had never been in a drug treatment program. |
