Problem
HIV continues to be a public health concern
- Nearly 1.1 million people in the US
- 1 in 6 are unaware they are infected
- 636,000 deaths (United States)
In 2011 IDUs accounted for 10% of newly diagnosed HIV infections
Injection Drug Use is one of the most efficient methods of HIV transmission
- Globally, 15.9 million people are IDU
- Among women 57% of AIDS cases related to IDU
- 4,852/9,443 children living with AIDS in 2004 were born to women who used IV drugs or had sex with an IDU
- Contagious inflammatory liver disease
- increasing cause of morbidity and mortality in the US
For every 100 individuals infected with HCV
- 75-80 will develop chronic infection
- 60-70 will develop chronic liver disease
- 5-20 will develop cirrhosis
- 1-5 will die from cirrhosis or liver cancer
associated health care cost are estimated to be $360 billion annually
- 3.2 million infected
- many are not aware
- rates are increasing
- Bloomington up 25%
- Why?
"We stand at the precipice of a grave threat to our public health... It affects people from all walks of life, in every state, in every country. And unless we do something about it soon, it will kill more people than AIDS." Dr. C. Everett Koop
Injection drug use remains the most common mode of transmission...
- Originated in San Francisco in the 1970's
- to prevent "yellow jaundice" and abscess
- throughout the 80's, more opened
- supported by private donors and state departments of health
primary goal is to stem the spread of HIV & HCV
March 2009
- 184 NEPs in 36 states
- exchanged 29.1 syringes annually
- combined budget of 21.3 million
2012
- Congress passes HR2055
- banning use of federal money for distribution of syringes to be used for any illegal drug
The United States is the only country in the world ban use of government money for NEPs
- Increase in crime/drug activity
- dirty syringes found on street, parks, and schoolyards
- disorderly behavior/fights
- increased homicide in adjacent area
Vancouver business complained of 10% drop in sales after NEP opened
Moral concerns
- Drug use is wrong
- kids get wrong message
- care providers break oath
- IDUs have multiple health issues
- NEPs provide linkage to care
- clients of NEPs report feeling "comfortable", "safe", and "supported"
- this develops trusting relationships
Ancillary Services
- 77% offered referrals to substance abuse programs
- 72% offered HIV screening
- Many provide syringe cleaning supplies
Beth Israel Detox Unit NEP
- 1990-2002
- 3651 IDUs
- HIV prev. baseline: 50%
- Decreased to 17% in 2002
- HCV/HCV coinfection decreased fom 53% to 13%
- 29 cities with NEP
- 52 Cities without NEP
- with: 5.8% decrease in HIV
- without: 5.9% increase in HIV
- One time use of syringes remains the most effective way to prevent HIV/HCV
Syringe use and NEPs
- Kerr et al. found positive impact on syringe behavior
- syringe borrowing fell 20.1% to 9.2%
- syringe lending fell 19.1% to 6.8%
Needle Exchange Programs:
The Argument For and Against
Greg Carter MSN, RN, CNS
My opinion
- NEPs are essential in addressing HIV/HCV in IDUs
- NEPs are similar to delaying first sexual encounter
- linking into care is the only way to effect change
Needle Exchange Programs
- NEP may offer syringes with or without "exchanging" used materials
- research shows 1:1 is not an effective strategy...
- many are now community based and somewhat mobile
Argument Against
Argument For
Hepatitis C