Data and public health decision making on HIV prevention in injection drug users.

Abstract

In this issue, Neaigus et al.1 present interesting data comparing sources of injection equipment, injecting risk behavior, human immunodeficiency virus (HIV) prevalence, hepatitis C virus (HCV) prevalence, and risk behavior among injecting drug users (IDUs) from Newark, NJ, and New York City. Newark is only 10 mi (16 km) from New York City, but at the time of data collection, the two cities had radically different environments with respect to obtaining sterile injection equipment for injecting drugs. At the time of data collection (2004–2006), New York City had both large-scale syringe exchange programs and the Expanded Syringe Access Program through which drug users can legally purchase needles and syringes at pharmacies without a prescription, while Newark had neither syringe exchange nor legal pharmacy purchase. As expected, IDUs in Newark were much less likely to obtain needles and syringes from guaranteed safe sources (exchanges and pharmacies; adjusted odds ratio [AOR] = 0.004, 95% confidence interval [CI] = 0.001 to 0.01), much more likely to report receptive syringe sharing (AOR = 2.3, 95% CI = 1.1 to 5.0), much more likely to be HIV seropositive (AOR = 3.2, 95% CI = 1.6 to 6.1), and much more likely to be HCV seropositive (AOR = 3.0, 95% CI = 1.8 to 4.9). These data should be seen as a continuation of differences that emerged with the legal expansion of syringe exchange programs in New York City in the mid-1990s. In a 1996 study, the adjusted hazard ratio of HIV incidence among IDUs attending the exchanges compared to IDUs not attending exchanges in the New York/New Jersey metropolitan area was 3.5 (95% CI = 1.3 to 9.1).2 As noted in the article of Neaigus et al.,1 New Jersey recently passed a law permitting up to six syringe exchange programs in the state. This law included an extra $10 million for drug abuse treatment programs in the state but did not include any funding for syringe exchange programs. As of March 2008, the New Jersey syringe exchange programs were struggling. Only three had opened, and only one program—Atlantic City—was attracting large numbers of clients.3 The Atlantic City program was relatively well funded, had additional support from a local acquired immunodeficiency syndrome (AIDS) service organization, and was utilizing staff from a nearby drug treatment program.4 That most of the New Jersey programs were struggling is also not surprising. In addition to the startup difficulties, the lack of public funding is strongly associated with both fewer syringes exchanged and fewer services offered by syringe exchange programs in the USA.5,6