Preventing the spread of HIV in injecting drug users: The experience of syringe-exchange schemes in England and Scotland.

Abstract

In 1987 the UK government launched experimental schemes for distributing injecting equipment to injecting drug users in order to help prevent the spread of Human Immunodeficiency Virus. This paper reports on the first few months of the schemes, and provides some initial evidence of changes in clients' risk behaviours. The schemes have been reasonably successful in attracting clients, but are less successful in retaining them. Schemes have demonstrated that equipment can be distributed to clients on an exchange basis. Schemes have reached new groups of clients, including many without previous or current treatment contact or other help for their drug problems. The baseline assessment of clients found that most had accurate knowledge of the risk of infection from sharing injecting equipment. Most thought that they were at low risk of infection. Syringe sharing in the last four weeks was reported by 36%. A minority engaged in multiple sharing. Most clients were sexually active and many had partners who did not inject drugs. The main reason for attendance was worry about AIDS, and a majority of clients reported that they had already made changes in their injecting practices because of AIDS. Some reported changes in sexual behaviour. A sample of clients followed-up at 2-4 months indicates a reduction in syringe sharing.