Advocacy and coverage of needle exchange programs: results of a comparative study of harm reduction programs in Brazil, Bangladesh, Belarus, Ukraine, Russian Federation, and China

Dave Burrows

doi:10.1590/s0102-311x2006000400025

Abstract

To prevent or mitigate an AIDS epidemic among injecting drug users (IDUs), effective activities need to be implemented on a large enough scale to reach and assist sufficient numbers of drug users and thereby change their risk behaviors related to drug use and sex. Recent work by UNAIDS on "high coverage sites", adopting the above strategies, has shown that one of the key elements in achieving high coverage is ongoing and sophisticated advocacy. High coverage harm reduction sites were studied through literature search and site visits, including key informant interviews, review of service statistics, and data analysis, in order to document the steps that led to scaling up, the way coverage was defined in these sites, and the lessons learned from their efforts. Syringe-exchange programs can achieve high coverage of IDUs. Monitoring to determine regular reach (those who are in regular contact with harm reduction services) should be added to uniform data collection carried out by harm reduction programs. Advocacy is crucial to achieving high coverage.

Highlights

To prevent or mitigate an AIDS epidemic among injecting drug users (IDUs), effective activities need to be implemented on a large enough scale to reach and assist sufficient numbers of drug users and thereby change their risk behaviors related to drug use and sex
The following features were found to be common to the high coverage programs studied: (1) harm reduction principles used to develop programs suited to the context; (2) prioritized, staffed, and funded advocacy; (3) support from the general community and its government representatives, religious leaders, and other opinion leaders; (4) a crucial role for law enforcement; (5) funding that facilitated expansion to achieve high coverage; (6) sustained funding; (7) context-appropriate differences in ways of approaching injecting drug users and the services most likely to attract them to a program; (8) replication of a single program to address IDUs in other districts, cities, provinces; (9) convenience of access; (10) involvement of Regular reach HIV prevalence/
The most important conclusion of this study is that effective activities to address AIDS among IDUs can be and are implemented at high coverage levels in developing and transitional countries

Summary

Introduction

To prevent or mitigate an AIDS epidemic among injecting drug users (IDUs), effective activities need to be implemented on a large enough scale to reach and assist sufficient numbers of drug users and thereby change their risk behaviors related to drug use and sex. Recent work by UNAIDS on “high coverage sites”, adopting the above strategies, has shown that one of the key elements in achieving high coverage is ongoing and sophisticated advocacy. High coverage harm reduction sites were studied through literature search and site visits, including key informant interviews, review of service statistics, and data analysis, in order to document the steps that led to scaling up, the way coverage was defined in these sites, and the lessons learned from their efforts. Syringe-exchange programs can achieve high coverage of IDUs. Monitoring to determine regular reach (those who are in regular contact with harm reduction services) should be added to uniform data collection carried out by harm reduction programs. Advocacy is crucial to achieving high coverage

Methods

Results

Conclusion