Syringe Exchange Schemes Research Articles

The Pilot Syringe‐Exchange Project in England and Scotland: a summary of the evaluation*

SummaryThe Monitoring Research Group of Goldsmiths' College, London University, have published a research report on syringe exchange schemes. It was supported by the Department of Health and Social Security (London) and the Scottish Home and Health Department and assesses the evidence for the success of syringe exchange in England and Scotland. A summary of the report, by Dr Gerry Stimson and his colleagues, is published below, followed by four invited commentaries from experts who have seen the report. We are most grateful to them for these contributions.This 167‐page report is available from: Monitoring Research Group, Goldsmiths' College, New Cross, London SE14 6NW, U.K. at £7 if you are within the U.K. or £12 if your order comes from outside the U.K. These prices include postage and packing. The full reference for the report is: Injecting Equipment Exchange Schemes. Final Report.

Role of community pharmacies in prevention of AIDS among injecting drug misusers: findings of a survey in England and Wales.

To determine the current and potential roles of community pharmacists in the prevention of AIDS among misusers of injected drugs. Cross sectional postal survey of a one in four random sample of registered pharmacies in England and Wales. Project conducted in the addiction research unit of the Institute of Psychiatry, London. 2469 Community pharmacies in the 15 regional health authorities in England and Wales. Willingness of pharmacists to sell injecting equipment to known or suspected misusers of drugs; pharmacists' attitudes to syringe exchange schemes, keeping a "sharps" box for use by misusers of drugs, and offering face to face advice and leaflets; and opinions of community pharmacists on their role in AIDS prevention and drug misuse. 1946 Questionnaires were returned, representing a response rate of 79%. This fell short of the target of one in four pharmacies in each family practitioner committee area in England and Wales, and total numbers of respondents were therefore weighted in inverse proportion to the response rate in each area. The findings disclosed a substantial demand for injecting equipment by drug misusers. After weighting of numbers of respondents an estimated 676 of 2434 pharmacies were currently selling injecting equipment and 65 of 2415 (3%) were participating in local syringe exchange schemes; only 94 of 2410 pharmacies (4%) had a sharps box for used equipment. There was a high degree of concern among pharmacists about particular consequences of drug misusers visiting their premises, along with a widespread acceptance that the community pharmacist had an important part to play. Promoting the participation of community pharmacists in the prevention of AIDS among misusers of injected drugs is a viable policy, but several problems would need to be overcome before it was implemented.

Changes in HIV risk behaviour in clients of syringe-exchange schemes in England and Scotland

The impact of syringe-exchange schemes on the behaviour of injecting drug users was investigated through self-reported behaviour change. Fifteen syringe-exchange schemes in England and Scotland participated in a government-sponsored pilot programme from April 1987. Clients were provided with sterile injecting equipment and condoms, and with knowledge of HIV risks. One hundred and forty-two injecting drug users who first attended between April 1987 and March 1988 participated in a prospective interview-based survey with questions at two points in time. Measurements were self-reported attitudinal, knowledge and behavioural changes relevant to HIV infection and transmission. Many clients maintained or adopted low-risk behaviours: 79% sustained or adopted low or lower levels of syringe sharing. Trends identified include decreases in syringe-sharing, from 34 to 27%; using others' syringes (risk of infection) from 25 to 19%; passing on syringes (risk of transmission) from 30 to 25%. Many clients reported changes in sexual behaviour; those with sexual partners decreased from 77 to 69% and those with two or more sexual partners from 26 to 21%. However, non-use of condoms increased from 62 to 79%. Comparison groups of non-attenders showed higher levels of risk behaviour (59-62% sharing syringes, 86-88% with sexual partners). Overall, changes in HIV risk behaviour show small but encouraging trends and support arguments that injectors can be helped to change their behaviour, which could be of cumulative importance in reducing the spread of HIV.

‘The British System’: past, present and future

The British System is on the move again. As the significance of HIV infection amongst injecting drug users becomes apparent, so it is necessary for drug services to re-axamine their practice, identify new priorities if necessary, and adapt their style of work accordingly. The two reports on AIDS and Drug Misuse from the Advisory Council on the Misuse of Drugs give guidance on the necessary changes required in both specialist and generic services. The potentially beneficial role of prescribing is being re-examined; and ‘harm-reduction’ approaches are being incorporated into the clinical practice of established drug clinics, newer community drug teams and recent syringe exchange schemes. It is argued that there is value in working towards ‘intermediate goals’ other than abstinence, and that attention should be focused on the achievement of certain critical intermediate goals, such as the move from injectible to oral-only drug use. Consideration is also given to the practical and organisational problems whic...

Sexual behaviour of injecting drug users and associated risks of HIV infection for Non-injecting sexual partners

The sexual behaviour of 142 clients of syringe-exchange schemes was measured using a questionnaire interview based survey method. Two to four months later the questionnaire was repeated to provide measures of behavioural change. The majority of these clients were sexually active, 77% having one or more sexual partners in the 3 months prior to the first interview. Many of these clients (46% of those sexually active) had sexual partners who did not inject drugs. There is evidence that this group modified their sexual behaviour towards reducing their own risk of HIV infection, with more having no sexual partners (from 23% to 31%), a reduction in those having multiple partners (from 26% to 21%) and a slight increase in those with regular partners (from 49% to 52%). Not all clients in this group reduced their risk of infection by modifying their sexual behaviour. Some clients continued to engage in high risk sexual behaviour, having multiple partners (21%) and not using condoms (79%). Whilst overall there is evidence of changes in the sexual behaviour of the clients towards a reduced risk of infection, we have identified an associated increase in risk of transmission from them to their sexual partners. Drug injectors who continued to have sexual partners were more likely to have sexual partners who did not inject drugs.

HIV transmission risk behaviour of clients attending syringe-exchange schemes in England and Scotland.

SummaryBritish government strategy for the prevention of HIV transmission in injecting drug users includes experimental syringe‐exchange schemes for the provision of sterile injecting equipment to drug injectors who are unable or unwilling to stop injecting. This paper reports on the HIV risk behaviour of clients interviewed during the first year of the schemes. Most clients had accurate knowledge of the risk of infection from sharing syringes but few considered themselves to be at risk of HIV infection, 36% reported sharing needles and syringes at and shortly after intake. Most clients were sexually active and many had partners who did not inject drugs. The two main reasons for attendance were scarcity of injecting equipment and worry about AIDS. A majority of clients reported that they had already made changes in their injecting practices because of AIDS, and some reported changes in sexual behaviour. The study highlights the scale and nature of the task of helping drug injectors to charge their behaviour.

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.

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Syringe exchange schemes for drug users in England and Scotland.

In 1987 experimental schemes for distributing injecting equipment to intravenous drug users to help prevent the spread of the human immunodeficiency virus were started by the government. After six months the schemes were found to have been reasonably successful in attracting clients but were less successful in keeping them. It has been shown that equipment can be distributed to drug users on an exchange basis. Many of the clients who were attracted to these schemes had had no treatment or other help for their drug problems.

Who sets strategies to combat drug abuse.

Syringe and needle exchange schemes are among a package of new strategies demanded by the World Health Organisation to combat drug abuse, in response to the problem of HIV infection through contaminated needles. Between 20 and 25 per cent of AIDS cases in the US and Europe are associated with drug injecting behaviour, according to Dr Jonathan Mann, Director of the WHO Global Programme on AIDS and a member of a panel of experts from 23 countries set up by WHO to review the problem. The panel has called for more drug treatment programmes, a wider range of medical and non-medical treatments for drug addiction, and feasibility studies on syringe and needle exchange programmes.