Syringe HIV seroprevalence and behavioural and demographic characteristics of intravenous drug users in Sydney, Australia, 1987

The contents of needles and syringes returned by intravenous drug users to two Sydney needle and syringe exchange centres were analysed for HIV antibodies by the enzyme-linked immunosorbent assay (ELISA). Reactive and borderline samples were further tested by the Western blot method. Basic demographic and needle sharing data were also collected from the clients of the exchanges. Of a sample of 1544 returned syringes, 48 (3%) were confirmed as containing HIV-infected blood. The proportion of infected syringes at exchange 2 was 6% (33 out of 545), which was significantly greater (P less than 0.05) than the proportion of exchange 1 at 1.5% (15 out of 999). The difference in seroprevalence between the two centres may be related to the behavioural characteristics of the client populations that attended each of the exchanges. The maintenance of a low syringe HIV seroprevalence (1-1.5%) over a 7-month period at one exchange may indicate that the availability of sterile needles and syringes prevented transmission of HIV among the clients of that exchange. HIV antibody testing of the contents of used syringes is a potentially valuable method of monitoring HIV infection among intravenous drug users. In this study, syringe exchange schemes have proved to be suitable venues for investigating the demographic characteristics and risk-taking behaviours of this population.     

The role of pharmacies in the care of drug users: what has changed in ten years. The case of a Swiss region

This article assesses changes over 10 years in the role of pharmacies in the care of drug misusers--needle/syringe provision and methadone treatment supervision--in the Swiss French-speaking Canton of Vaud (636,000 inhabitants, 238 pharmacies). A review of data collected in four surveys (1991, 1994, 1996, 2003) on the provision of sterile material (and methadone treatment supervision in 2003) including all the pharmacists of the Canton of Vaud was conducted, as well as a review of data of the monitoring of needle exchange programmes introduced since 1996 in this canton, and of methadone treatment statistics. In 2003, interviews with pharmacists complemented the survey. Pharmacies play an important role in the 'frontline' services to drug misusers: the provision of needles/syringes to drug users by pharmacies remains important in spite of a decrease in the provision of sterile material by them since the advent of needle exchange programmes, and they are included in the supervision of two thirds of the methadone treatments. However, they do not feel integrated enough in the network of care to drug misusers and ask for more training and better recognition of their role.     

Factors associated with injecting risk behaviour among serial community-wide samples of injecting drug users in Glasgow 1990-94: implications for control and prevention of blood-borne viruses

Aims. To examine the association between recipient-sharing of needles and syringes and demographic characteristics, injecting behaviour and needle and syringe exchange utilisation . Design. Self-report data from serial cross-sectional surveys. Setting. Multiple street, needle and syringe exchange and drug treatment sites throughout Glasgow. Participants. 2576 current injecting drug users (IDUs) recruited during 1990–94. Findings. In the multiple logistic regression analysis, a significantly lower level of recipientsharing was associated with respondents who resided within 1 mile of a needle and syringe exchange compared to those who lived further away (adjusted OR 1.3; 95% CI 1.0–1.6), and by IDUs who reported obtaining either 6–15, 16–30, or > 30 sterile needles and syringes in an average week from a needle exchange and/or pharmacist (adjusted ORs 0.55, 0.34, 0.25; 95% CIs 0.3–0.9, 0.2–0.6 and 0.2–0.4, respectively) compared to those who obtained no sterile equipment from these sources. Recipient-sharing of needles and syringes in the previous 6 months reduced significantly between 1990 (43%) and 1991–94 (27–33%) (p < 0.0001); this decline was not explained by needle and syringe exchange utilization, suggesting that additional factors were influencing behavioural change at that time. Conclusion. Our data indicate that improving injectors' convenience of access to exchange facilities and increasing the numbers of sterile needles and syringes available to them is likely to result in further reductions in recipient-sharing, and thus the potential for blood-borne virus transmission, among IDUs.     

High street prices of syringes correlate with strict syringe possession laws

The current epidemic of injection drug use in the United States and abroad has precipitated an increase in transmission of infectious diseases, including human immunodeficiency virus (HIV), hepatitis B, hepatitis C, and human T-lymphotrophic virus II (HTLV-II) in injection drug users (IDUs) who share syringes and other injection equipment. Sharing is often due to a lack of available sterile syringes, which is, in part, a result of laws and regulations controlling the purchase and possession of syringes. These laws, in turn, raise the price of questionably sterile black market syringes, inadvertently encouraging the reuse and sharing of syringes. To date, very little information has been gathered on the street price of syringes in different communities. We surveyed 42 needle exchange programs (NEPs) in the United States in July and August 1998 to determine the street prices of syringes. The relationship among local laws regulating syringe possession, the enforcement of those laws, and street syringe prices was examined. There was a strong correlation between the presence of syringe possession laws and higher street syringe price ($2.87 vs. $1.14, p< .01). In areas with syringe possession laws, cost was significantly higher when laws were perceived to be enforced strictly ($3.66 vs. $2.08, p<.01). Street prices for syringes are an easily quantifiable indirect measure of availability of sterile syringes and may reflect syringe sharing and reuse.     

High Street Prices of Syringes Correlate with Strict Syringe Possession Laws

The current epidemic of injection drug use in the United States and abroad has precipitated an increase in transmission of infectious diseases, including human immunodeficiency virus (HIV), hepatitis B, hepatitis C, and human T-lymphotrophic virus II (HTLV-II) in injection drug users (IDUs) who share syringes and other injection equipment. Sharing is often due to a lack of available sterile syringes, which is, in part, a result of laws and regulations controlling the purchase and possession of syringes. These laws, in turn, raise the price of questionably sterile black market syringes, inadvertently encouraging the reuse and sharing of syringes. To date, very little information has been gathered on the street price of syringes in different communities. We surveyed 42 needle exchange programs (NEPs) in the United States in July and August 1998 to determine the street prices of syringes. The relationship among local laws regulating syringe possession, the enforcement of those laws, and street syringe prices was examined. There was a strong correlation between the presence of syringe possession laws and higher street syringe price ($2.87 vs. $1.14, p <. 01). In areas with syringe possession laws, cost was significantly higher when laws were perceived to be enforced strictly ($3.66 vs. $2.08, p <. 01). Street prices for syringes are an easily quantifiable indirect measure of availability of sterile syringes and may reflect syringe sharing and reuse.     

Drug injectors and the cleaning of needles and syringes

When people share needles and syringes they risk transmitting human immunodeficiency virus (HIV) and other infections including hepatitis B virus (HBV) and hepatitis C virus (HCV). Cleaning needles and syringes can help to reduce, although not eliminate, these risks. This article begins by engaging with some of the literature on the cleaning of needles and syringes. Drawing on qualitative research conducted with drug injectors in England, the article then goes on to explore drug injectors' perceptions and experiences of cleaning needles and syringes inside and outside prison. The article concludes by highlighting the implications for future research and policy making. Ultimately there should be a stronger policy response to reduce the risks associated with sharing needles and syringes inside prison, which should include the piloting of prison needle and syringe exchange schemes.     

A prospective study of the hazards of multiple use of disposable syringes and needles in intensified insulin therapy

The aim of the present study was to evaluate the potential hazards of multiple use of disposable syringes and needles for insulin injections over a long period of time. A special syringe container (pen-case) was developed to carry the syringe with insulin. In the microbial trial 24 patients, each injecting insulin for 1 week with one disposable needle, were studied for 201 patient-weeks with 5829 injections. Cultures of 154 needles, 155 syringe rinses, 154 pen-case rinses and the remains of insulin in 201 vials revealed no relevant contamination. In the clinical trial 100 diabetic patients were followed up for up to 7 years. Each syringe was reused for 1 to 12 weeks and each needle for 1 to 40 days (4 to 200 injections). Only sporadic redness not exceeding 4 mm2 was seen at sites of about 560,000 insulin injections. Thus, the repeated use of syringes and needles in one diabetic patient may be recommended as a convenient and safe approach in insulin administration.     

What Are the Impacts of Needle Exchange on Young Injectors?

This study was designed to describe a sample of young injectors and to investigate how needle exchange programs (NEPs) may impact this group. Young injectors who did (n = 86) and did not (n = 75) use NEPs were recruited in three California cities. Participants were asked about potential negative effects of NEPs, and about sexual and injection risk behavior. Few youth believed that availability of needles through NEPs makes drug users begin injecting earlier, inject more frequently, or be less inclined to seek drug treatment. Exchangers were less likely to have multiple sharing partners, less likely to reuse syringes, and less likely to own fewer than five syringes. NEP participation was not associated with sharing needles, sharing rinse water, inconsistent skin cleaning, or being injected by another person. Results are limited by the use of convenience sampling and by the limited number of potential negative effects examined. However, most young injectors did not believe that NEPs increase drug use or decrease treatment readiness, and some risk behaviors were lower among exchangers than among nonexchangers.Clean Needles NowSanta Cruz Needle Exchange Program     

Effects of Amsterdam needle and syringe exchange.

The needle and syringe exchange in Amsterdam was initiated in 1984 by the Junky Union. To date, ample data are available to support the role of the needle exchange in facilitating drug injectors to use drugs in a safer way: no increase in drug use could be validated, participants of the exchange schemes were less involved in needle sharing, the supply of large quantities of needles to drug users did not lead to an increase in needle stick accidents by the general public, and, finally, the HIV prevalence among drug injectors has remained stable since 1986, while the incidence of acute hepatitis B has gone down.     

Evaluation of a cognitive-behavioural intervention for pregnant injecting drug users at risk of HIV infection

Pregnant injecting drug users were randomly assigned to: (i) individually receive a six-session cognitivebehavioural intervention in addition to their usual methadone maintenance treatment (intervention condition (I) ( n = 40)); or (ii) their usual methadone maintenance treatment only (control condition (C) ( n = 40)). There was no change in drug use per se in either group after the intervention. However, at 9-month follow-up the I group had significantly reduced some HIV risk-taking behaviours (in particular injecting risk behaviours). The I group reduced the needle risk associated both with "typical" use (drug use in the month before interview) and "binge" use (drug use in the month nominated as the heaviest month of drug use in the previous 6 months). The intervention had no effect on sexual risk behaviours. The finding of reduced injecting risk behaviour following the six-session intervention suggests that such an intervention may be of benefit for individuals persisting with injecting risk behaviours despite methadone maintenance treatment and the availability of sterile injection equipment.     

Unsafe injecting practices among attendees of syringe exchange programmes in France

Aims. To describe syringe exchange programme attendees and their injection practices. Design. Crosssectional study (one week in 1998). Data were collected through a standardized questionnaire. Setting. 60/74 syringe exchange programmes (SEPs) in France. Participants. Clients requesting syringes in 60 SEPs. Measurements. Self-reports of drug use, injecting behaviour, sexual behaviour, serological status (HIV, HBV, HCV). Prevalence of unsafe injecting practices in the previous month such as: syringe sharing; and sharing other injection paraphernalia. Findings. 1004 questionnaires were collected (response rate: 50%). The mean age of respondents was 30 years, and 70% were males. Among individuals tested, HIV reported prevalence was 19.2%, HCV 58.4% and HBV 20.8%. The mean duration of drug use was 11 years. Eighty-five percent were polydrug users and buprenorphine high-dosage was the substance most used (73%). In the previous month, 45% of the participants had re-used a syringe, 93% injected at least daily (mean 3.6 injections per day), 18% shared a syringe and 71% shared injection paraphernalia. In multivariate analyses, unsafe injecting practices were associated with heroin and cocaine use and with living in a couple. The cluster analysis identified five categories of IDUs: users of buprenorphine-HD (45% of the responders), morphine-sulphate (17%), benzodiazepines and other legal drugs (13%), methadone associated with other legal drugs (13%) and crack-cocaine (13%). The buprenorphine–HD group had better social status and safer injection practices. Conclusions. In France, despite an increase in the accessibility to syringes and substitution treatments, unsafe injecting practices persist among SEP attenders. Interventions should stress the importance of using sterile material for each injection, even with a steady sex partner.     

Sterile syringe access conditions and variations in HIV risk among drug injectors in three cities

Aim Better sterile syringe access should be associated with a lower likelihood of syringe re‐use and receptive syringe sharing, although few empirical studies have examined gradients in syringe access using both individual and ecological data. In this study, we compare syringe re‐use and receptive syringe sharing among injection drug users (IDUs) with syringe exchange program (SEP) and legal over‐the‐counter pharmacy access with limits on syringes that can be purchased, exchanged or possessed to IDUs with no pharmacy sales but unlimited syringe access through SEPs. We address three questions: ( 1 ) Does residing in an area with no legal syringe possession increase the likelihood of police contact related to possessing drug paraphernalia? ( 2 ) Among direct SEP users, is use of more permissive SEPs associated with less likelihood of syringe re‐use and receptive syringe sharing? ( 3 ) Among non‐SEP users, is residing in an area with pharmacy access associated with lower likelihood of syringe re‐use and receptive syringe sharing? Design Quantitative survey of IDUs recruited from SEPs, subject nomination and outreach methods. Multivariate analyses compared police contact, syringe re‐use and receptive syringe sharing among IDUs recruited in three cities. Findings In multivariate analyses, we found that police contact was associated independently with residing in the area with no legal possession of syringes; among SEP users, those with access to SEPs without limits had lower syringe re‐use but not lower syringe sharing; and that among non‐SEP users, no significant differences in injection risk were observed among IDUs with and without pharmacy access to syringes. Conclusion We found that greater legal access to syringes, if accompanied by limits on the number of syringes that can be exchanged, purchased and possessed, may not have the intended impacts on injection‐related infectious disease risk among IDUs.     

Correlates of Receptive and Distributive Needle Sharing Among Injection Drug Users in Kabul,Afghanistan

We describe receptive and distributive needle/syringe sharing among injection drug users (IDUs) in Kabul, Afghanistan. In this cross-sectional study, IDUs completed an interviewer-administered questionnaire. Logistic regression identified correlates of needle sharing in the last six months. Receptive and distributive sharing in the last six months were reported by 28.2% and 28.7% of participants, respectively, and were both independently associated with reported difficulty obtaining new syringes (Receptive sharing: AOR = 2.60, 95% CI: 1.66–4.06; Distributive: AOR = 1.56, 95% CI: 1.02–2.39). Receptive and distributive sharing are common among IDU in Kabul; scaling up availability of sterile, no-cost injecting equipment is urgently needed.     

Correlates of receptive and distributive needle sharing among injection drug users in Kabul, Afghanistan

We describe receptive and distributive needle/syringe sharing among injection drug users (IDUs) in Kabul, Afghanistan. In this cross-sectional study, IDUs completed an interviewer-administered questionnaire. Logistic regression identified correlates of needle sharing in the last six months. Receptive and distributive sharing in the last six months were reported by 28.2% and 28.7% of participants, respectively, and were both independently associated with reported difficulty obtaining new syringes (Receptive sharing: AOR = 2.60, 95% CI: 1.66-4.06; Distributive: AOR = 1.56, 95% CI: 1.02-2.39). Receptive and distributive sharing are common among IDU in Kabul; scaling up availability of sterile, no-cost injecting equipment is urgently needed.     

Multiple access to sterile syringes for injection drug users: vending machines, needle exchange programs and legal pharmacy sales in Marseille, France

OBJECTIVE: In Marseille, southeastern France, HIV prevention programs for injection drug users (IDUs) simultaneously include access to sterile syringes through needle exchange programs (NEPs), legal pharmacy sales and, since 1996, vending machines that mechanically exchange new syringes for used ones. The purpose of this study was to compare the characteristics of IDUs according to the site where they last obtained new syringes. METHODS: During 3 days in September 1997, all IDUs who obtained syringes from 32 pharmacies, four NEPs and three vending machines were offered the opportunity to complete a self-administered questionnaire on demographics, drug use characteristics and program utilization. RESULTS: Of 485 individuals approached, the number who completed the questionnaire was 141 in pharmacies, 114 in NEPs and 88 at vending machines (response rate = 70.7%). Compared to NEP users, vending machine users were younger and less likely to be enrolled in a methadone program or to report being HIV infected, but more likely to misuse buprenorphine. They also had lower financial resources and were less likely to be heroin injectors than both pharmacy and NEP users. CONCLUSIONS: Our results suggest that vending machines attract a very different group of IDUs than NEPs, and that both programs are useful adjuncts to legal pharmacy sales for covering the needs of IDUs for sterile syringes in a single city. Assessment of the effectiveness and cost-effectiveness of combining such programs for the prevention of HIV and other infectious diseases among IDUs requires further comparative research.     

Syringe exchange, injecting and intranasal drug use

Objective   To assess trends in injecting and non-injecting drug use after implementation of large-scale syringe exchange in New York City. The belief that implementation of syringe exchange will lead to increased drug injecting has been a persistent argument against syringe exchange.
Methods   Administrative data on route of administration for primary drug of abuse among patients entering the Beth Israel methadone maintenance program from 1995 to 2007. Approximately 2000 patients enter the program each year.
Results   During and after the period of large-scale implementation of syringe exchange, the numbers of methadone program entrants reporting injecting drug use decreased while the numbers of entrants reporting intranasal drug use increased ( P  < 0.001).
Conclusion   While assessing the possible effects of syringe exchange on trends in injecting drug use is inherently difficult, these may be the strongest data collected to date showing a lack of increase in drug injecting following implementation of syringe exchange.     

Continued transmission of hepatitis B and C viruses, but no transmission of human immunodeficiency virus among intravenous drug users participating in a syringe/needle exchange program

The virological efficacy of a syringe/needle exchange program was evaluated in a cohort incidence study. Of 698 intravenous drug users (IVDUs) initially recruited, 15 (2.1%) were HIV-positive at baseline. Adequate follow-up was possible in 515 (74%) and showed no new cases of HIV infection during a median of 31 months. Most IVDUs had been previously exposed to HBV (anti-HBc-positive 70.1%) and HCV (anti-HCV-positive 90.7%). Of those 159 IVDUs negative at baseline for anti-HBc and/or anti-HCV, 56 (35%) seroconverted to one or both viruses during follow-up, corresponding to 11.7 seroconversions/100 y at risk for HBV and 26.3 seroconversions/100 y for HCV. Multiple logistic regression analysis showed hepatitis seroconversion to correlate with imprisonment during the study (OR 2.2; 95% CI 1.04-4.74), absence of drug-free periods (OR 5.7; CI 1.44-22.3) and frequent syringe/needle exchanges (OR 1.31; CI 1.02-1.7). The absence of HIV spread was probably partly due to the low prevalence of HIV-infected IVDUs in the city. Despite free syringes and needles, both HBV and HCV continued to spread at high rates. Nevertheless, syringe/needle exchange programs, coupled with monitoring of serostatus provide good surveillance and are valuable for further assessment of remaining risks.     

美沙酮维持治疗与针具交换干预措施的现况及进展

注射吸毒一直是我国艾滋病（AIDS）传播的主要途径。对于吸毒人群,美沙酮维持治疗与针具交换工作是有效地控制该人群艾滋病病毒（HIV）流行的两项重要干预措施。该文对我国美沙酮维持治疗与针具交换工作开展近况,国内外的干预实践研究进展、效果分析以及存在的问题,进行了综述。     

Factors associated with persistent high-risk syringe sharing in the presence of an established needle exchange programme

Vancouver has experienced an explosive HIV epidemic despite the presence of a needle exchange programme (NEP). We sought possible explanations for high-risk syringe sharing among Vancouver injection drug users over the period January 1999 to October 2000. Overall, 14% of participants reported high-risk sharing. Although acquiring needles exclusively from the NEP was independently associated with less sharing, we identified several risk factors for persistent sharing, including difficulty accessing sterile needles, bingeing, and frequent cocaine injection.