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Needle Exchange

Social and Behavioral Models and Theories

Shannon Brown

on 10 April 2013

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Transcript of Needle Exchange

Needle Exchange Programs The Public Health Topic *Injecting drug use plays a major role in the spread of HIV infection.

* Approximately 34 million people are infected with HIV/AIDS in the world (World Health Organization [WHO], 2012).
* There are 15.9 million people in the world who are injection drug users (IDUs); 3.3 million of them are infected with HIV/AIDS (AVERT, 2013).
*There are at least 2.27 million IDUs in the United States and approximately 347,000 have HIV (Mathers et al., 2008).
*IDU's represent 8% of all new HIV cases in the U.S. (CDC, 2010).
*Male and female African Americans have the highest rates of HIV infections compared to Hispanics/Latinos and whites (U.S. Department of Health and Human Services [HHS], 2011). Injection Drug Use Explored Injecting is the cheapest and most effective way to administer drugs.

IDUs can use smaller doses of a drug and put it directly into the bloodstream, resulting in a quicker and more intense high than snorting, smoking, or eating the drug. HIV The first HIV outbreak was in the 1980's. Many cases were discovered in IDUs in the United States (Gottlieb, 2006).

HIV infection is a lentivirus that slowly and progressively breaks down the immune system until it loses the ability to function (AVERT, 2013; WHO, 2012).

HIV can be transmitted between humans through unprotected sexual behaviors, exchange of contaminated blood, sharing needles and syringes, and transmission from mother to child during the perinatal period (WHO, 2012).

HIV/AIDS epidemics have occurred in Latin America, Asia, and Europe due to the astronomical spread of injection drug use (WHO, 2004). In response to these epidemics, needle exchange programs were implemented. Needle Exchange Programs Needle exchange programs reduce the risk of HIV transmission by providing sterile syringes, removing used needles from circulation, and educating clients about the risk of reusing injection equipment.

The movement started in 1984 in Amsterdam and the first programs spread through Europe, Australia, and the U.S. By 2011, there were almost 200 syringe exchange programs operating in 34 states in the United States - a small number compared to other countries (Jarlais, D., Guardino, V., Nugent, A., Arasteh, K., & Purchase, D., 2011).

Due to political and social pressures, the U.S. government has been hesitant to allow federal funding for these programs. A Strategy to Reduce HIV/AIDS Among Injection Drug Users Needle Exchange Programs (NEPs) integrate two important public health problems - injection drug use and HIV/AIDS. IDUs high-risk lifestyle predisposes them to infection.

They may engage in risky behaviors like sharing injection equipment and having unprotected sex while under the influence of drugs (HHS, 2011).

Since many IDUs are unaware that they are HIV-positive during the first stage of HIV infection, it is unlikely that they will use additional precautions to protect their partners (WHO, 2012). History and Background Functions of a Needle Exchange Program There has been extensive research done on the effect NEPs have on reducing the spread of HIV.

NEPs serve two main functions:
1) provide drug users with access to injection equipment – needles, sterile water, alcohol swabs, and filters – for the safe injection or inhalation of drugs.
2) help the drug user obtain information, treatment, detoxification, social services, and primary health care. Current State of NEPs 2008 - 77 countries introduced NEPs to slow the spread of HIV/AIDS.

2011 - The U.S. had 221 NEPs in 34 states.
In comparison, Australia in 2011 had 3,000 NEPs.

The U.S. lifted the ban on providing federal funding to NEPs, but reversed their decision in 2011. Environmental Considerations In order for a needle exchange program to be successful, injection drug use must be a problem in the area, and community members must subscribe to the harm reduction theory.

Needle exchange addresses two extremely visible and provocative social problems in the environment today: illicit drug use and HIV/AIDS. These two problems are associated with behaviors deemed by many groups and cultures to be immoral: promiscuity, homosexuality, and injection drug use (Fernando, 1993).

=> COMMUNITY Public Health Players and how they influence the success of the programs A few of the public health players that support NEPs include: World Health Organization, United Nations Program on HIV/AIDS, United Nations Office on Drugs and Crime, American Medical Association, American Public Health Association, American Nurses Association, Society of Christian Ethics, and the U.S. Department of Health and Human Services. Public Health Perspective “An exhaustive review of the science in this area indicates that needle exchange programs can be an effective component in the global effort to end the epidemic of HIV disease.” - Harold Varmus, former director of the National Institute of Health

“I’ll be looking at all of the issues, and seeing what makes sense and where….It’s clear to me that syringe exchange has played an important role in reducing the HIV epidemic in New York City.” – Thomas Frieden, director of the CDC "A growing body of evidence indicates that needle exchange reduces the HIV risk, leads participants to avoid needle sharing and practice safer sex, and encourages them to enter treatment.” – Margaret Hamburg – FDA Commissioner “I believe needle exchange is another important method of the prevention of HIV/AIDS transmission” – Barack Obama The Evidence "A study conducted between 1978 and 1999 compared HIV prevalence in 103 cities around the world: HIV prevalence decreased by an average of 19% per year in the cities that had needle and syringe programs. In the cities that didn’t introduce these programs, the HIV prevalence increased by an average of 8% per year" (Dolan, MacDonald, Silins, & Topp, 2005). If the U.S. had adopted the programs in 1987 and expanded them until 1995 (following Australia’s example) then between 4,400 and 10,000 HIV infections could have been prevented. This would have saved the U.S. health system between 240 and 540 million dollars (Lurie & Drucker, 1997). "Studies in London, England, Seattle, Washington, and New Haven, Connecticut found that drug users attending these centers were 5 times more likely to enter drug treatment" (Gay Men's Health Crisis, 2009) . "Studies in San Francisco, California have proven that harm reduction interventions don’t increase drug use or rates of injecting equipment, and also do not negatively impact drug treatment. Also, in countries with less severe penalties for drug possession there are not higher rates of use and the drug users are more likely to seek medical attention, treatment, rehabilitation, and have a decreased risk of contracting or spreading HIV/AIDS or other infections" (Ontario Harm Reduction Distribution Program, 2013). Social and Behavioral Models/Theories Possible Eventual Solutions They Work. Let's Use Them! Non- reusable syringes - If these syringes are introduced universally IDUs will not be able to spread infection of HIV/AIDS as easily. This could potentially save many lives and reduce healthcare costs that would otherwise been spent on treating HIV patients. *GBCHealth Coalition

*Pfizer pharmaceuticals

Developed by Fischer and Fischer

Information by itself can be enough to change some IDUs behavior, but most need motivation and behavioral skills before their risk for HIV decreases (Fisher & Fisher, 1992).

A study found that 82% of drug users who participated in a program and received information about AIDS changed their behavior by reducing how much they share drug injection equipment, resulting in significantly less risk of acquiring HIV (Des Jarlais, Friedmann, Hagan, & Friedman, 1996).
Theory that aims to decrease the negative outcomes of injecting drug use, but it does not focus on stopping an IDU from using drugs.

Kaplan, Khoshood, & Heimer (1994) found that NEPs constantly decrease needle sharing and shorten the length of time a needle circulates among IDUs.

NEPs help to reduce the harm of drug injecting behavior among IDUs and the community. The Information-Motivation Behavioral Skills Model for HIV Prevention Harm Reduction References Initiatives AVERT. (2013). The origin of HIV and AIDS. Retrieved from http://www.avert.org/origin-aids-hiv.htm

Centers for Disease Control and Prevention [CDC]. (2010). Estimated HIV incidences in the United States. Retrieved from http://www.cdc.gov/hiv/surveillance/resources/reports/ 2010supp_vol17no4/

Dolan, K. MacDonald, M., Silins, E. & Topp, L. (2005). Needle and syringe programs: A review of the evidence. Canberra: Australian Government Department of Health and Ageing. Retrieved from http://www.health.gov.au/internet/main/publishing.nsf/content/ BF779AA5E45815C6CA25712400081717/$File/review.pdf

Fernando, M. D. (1993). AIDS and intravenous drug use. Westport, CT: Praeger.

Gay Men’s Health Crisis. (2009). Syringe exchange: An effective tool in the fight against HIV and drug abuse. Retrieved from http://www.gmhc.org/files/editor/file/SEP_report.pdf

Gottlieb M.S. (2006). Pneumocystis pneumonia—Los Angeles. American Journal of Public Health, 96 (6), 980–981. doi:10.2105/AJPH.96.6.980

Kent H. (1996) Harm-reduction strategies weapon of choice in BC's battle with drug addiction. Canadian Medical Association Journal 155, 571-573. Research has never found evidence that NEPs increase injection drug use or the incidence of HIV among IDUs (Kent, 1996). Join Adam Reilly, Planned Parenthood HIV coordinator, and Dr. Judith Feinberg, University of Cincinnati Infectious Diseases Center, to advocate for NEPs in Cincinnati. References Continued Lurie, P. & Drucker, E. (1997). An opportunity lost: HIV infections associated with lack of a national needle-exchange programme in the USA. Lancet, 349, 604-608.

Mathers, B., et al (2008). Global epidemiology of injecting drug use and HIV among people who inject drugs: a systematic review. The Lancet, 372(9651), 1733-1745. doi:10.1016/S0140-6736(08)61311-2

Ontario Harm Reduction Distribution Program. (2013). Needle exchange FAQs. Retrieved from http://www.ohrdp.ca/resources/needle-exchange-faqs/

U.S. Department of Health and Human Services [HHS]. (2011). HIV/AIDS basics. Retrieved from http://aids.gov/hiv-aids-basics/index.html

World Health Organization [WHO]. (2004). Advocacy guide: HIV/AIDS prevention among injecting drug users. Retrieved from http://www.who.int/hiv/pub/advocacy/en/advocacy guideen.pdf

World Health Organization [WHO]. (2012, November). HIV/AIDS. Retrieved from http://www.who.int/hiv/en/ Shannon Brown, Aubrey Culp, Mandy DiSalle, Evie Kontopos, and Sean Pembleton
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