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A Survey of National Syringe Services Programs: Issues, Expe

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Jessica Flen

on 13 March 2015

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Transcript of A Survey of National Syringe Services Programs: Issues, Expe

Syringe Sharing Behavior Among
Injection Drug Users
A Survey of National Syringe Services
Programs: Issues, Experiences, and Resolutions
Jessica Flen, MPH Candidate

Survey Collection
Community Buy In: Issues
Linkages: Issues
Tracking Utilization of the Program
Gerold Dermid-Gray, MBA
Academic Advisor and Committee Chair

Julia Peek, MHA
Agency Representative and Committee Member

Wei-Chen Tung, PhD, RN
Graduate School Representative and Committee Member

Kristen Clements-Nolle, PhD, MPH
School of Community Health Sciences Representative and Committee Member

Nevada Division of Public and Behavioral Health

Community Buy In: Resolutions
Additional Words of Wisdom
203 programs from the 2012 North American Syringe Exchange Network Database
Between 1.2 and 2.5 million injection drug users in the United States
2.1% of Nevadans have used injection drugs in their lifetime

3.4% of Nevada youth (grades 9-12) reported injecting illegal drugs
26% of HIV cases in females and 13% among males

15% of HBV cases

2.7 to 3.9 million HCV cases
Young age
Female gender
Depressed state
Low socioeconomic status
Homelessness or transiency

Adolescents/older users
Behavior of peers

Shooting galleries
Syringe services programs
Activities of Syringe Services Programs
Access to clean syringes
Disposal of used syringes
Linkages to substance abuse treatment
Disease testing, treatment, and prevention
Linkages to medical and mental health care
Senate Bill 410
US Syringe Services Programs (2012)
Reduce HIV infections
Increase access to care and optimize health outcomes
Reduce HIV related disparities
Law Enforcement: Issues
Until recently, none of these programs existed in Nevada
"There is a
shortage of beds
and getting a client into care is sometimes

Survey Respondent

Education and ongoing training
Community clean ups
"Any steps that you can take to ensure this
[early] training
throughout law enforcement officers training academy, the
better off
you will be.”

Survey Respondent
Promotion and outreach

Community meetings

Community clean ups
"We counter this by doing neighborhood sweeps twice a week, where people are complaining about finding syringes, and just do our part to show that we are
all about safety for the community

Survey Respondent
Listen to client feedback

Constant evaluation and integration of new ideas

Advocate and be flexible

Hire appropriate staff and volunteers

Be flexible
when working with humans on the margins of society. Do not underestimate your clients. In spite of what society says, most injection drug users actually want to be
alive and healthy
, and will take steps to keep themselves safe. If you are seeing them at your exchanges, you've already succeeded.
Any step towards positive change is to be celebrated.

Survey Respondent
Resource Guide be made available to every new program in Nevada

Needs based distribution model

Nevada Syringe Services Program Guidelines be made more clear
Overdose prevention
Education and training
Linkages to care data
Practice: Nevada Division of Public and Behavioral Health
Orientation and training for new programs
Ensure compliance with Senate Bill 410 and reporting guidelines
Hold information
Evaluate linkages
recognize ongoing needs
Practice: Syringe Services Programs
Peer delivery/secondary exchange

Diverse staff
and volunteers
Law Enforcement
Memorandums of Understanding

Community Buy In
Open house
Regular community clean ups

National Directory of Drug and Alcohol Abuse Treatment Programs, published by Substance Abuse and Mental Health Service Administration
Time constraints

New Mexico

Mixed approach to survey collection
Web link and phone calls

Phone calls were made by two interviewers
Differences in probing questions
E3 - Identify individual, organizational, and community concerns, assets, resources and deficits for social and behavioral science interventions
Cultivated resources from programs in the nation to address the gap in Nevada

H9 - Develop strategies to motivate others for collaborative problem solving, decision making, and evaluation
Resource guide driven by collected data
Resource Guide
1. Centers for Disease Control and Prevention. HIV Surveillance Report, 2010; vol. 22. Published March, 2012. Available at: http://www.cdc.gov/hiv/topics/surveillance/resources/reports. Accessed February 8, 2014
2. Daniels, D., Grytdal, S., & Wasley, A. (2009). Surveillance for Acute Viral Hepatitis, United States, 2007. Department of Health and Human Services, Centers for Disease Control and Prevention.
3. Mathers, B. M., Degenhardt, L., Ali, H., Wiessing, L., Hickman, M., Mattick, R. P., Meyers, B., Ambekar, A., & Strathdee, S. A. (2010). HIV prevention, treatment, and care services for people who inject drugs: a systematic review of global, regional, and national coverage. The Lancet, 375(9719), 1014-1028.
4. Substance Abuse and Mental Health Services Administration. Department of Health and Human Services, (2014). Special data extraction received on March 4, 2014.
5. Division of Public and Behavioral Health. Department of Health and Human Services, Office of Public Health Informatics and Epidemiology. (2014). 2013 nevada youth risk behavior survey report. Retrieved from website: http://chs.unr.edu/subpages/research/ documents/February2013NevadaYRBSReport.pdf
6. Pouget, E. R., Deren, S., Fuller, C. M., Blaney, S., McMahon, J. M., Kang, S. Y., ... & Vlahov, D. (2005). Receptive syringe sharing among injection drug users in Harlem and the Bronx during the New York State Expanded Syringe Access Demonstration Program. JAIDS Journal of Acquired Immune Deficiency Syndromes, 39(4), 471-477.
7. Broz, D., Pham, H., Spiller, M., Wejnert, C., Le, B., Neaigus, A., & Paz-Bailey, G. (2013). Prevalence of HIV Infection and Risk Behaviors Among Younger and Older Injecting Drug Users in the United States, 2009. AIDS and Behavior, 1-13.
8. Sherman, S. G., Latkin, C. A., & Gielen, A. C. (2001). Social factors related to syringe sharing among injecting partners: a focus on gender. Substance use & misuse, 36(14), 2113-2136.
9. Evans, M. J. L., Hahn, J. A., Page-Shafer, M. K., Lum, M. P. J., Stein, M. E. S., Davidson, M. P. J., & Moss, A. R. (2003). Gender differences in sexual and injection risk behavior among active young injection drug users in San Francisco (the UFO Study). Journal of Urban Health, 80(1), 137-146.
10. Conner, K. R., Pinquart, M., & Gamble, S. A. (2009). Meta-analysis of depression and substance use among individuals with alcohol use disorders. Journal of substance abuse treatment, 37(2), 127-137.
11. Galea, S., & Vlahov, D. (2002). Social determinants and the health of drug users: Socioeconomic status, homelessness, and incarceration. Public health reports, 117(1), s135-s145.
12. German, D. R., Davey, M., & Latkin, C. (2007). Residential transience and hiv risk behaviors among injection drug users. AIDS and Behavior, 11, s21-s30.
13. Unger, J., Kipke, M., De Rosa, C., Hyde, J., Ritt-Olson, A., & Montgomery, S. (2006).
Needle-sharing among young iv drug users and their social network members: The influence of the injection partner's characteristics on HIV risk behavior. Addictive Behaviors, 31, 1607-1618.
14. De, P., Cox, J., Boivin, J. F., Platt, R. W., & Jolly, A. M. (2007). The importance of social networks in their association to drug equipment sharing among injection drug users: a review. Addiction, 102(11), 1730-1739.
15. Bailey, S. L., Ouellet, L. J., Mackesy-Amiti, M. E., Golub, E. T., Hagan, H., Hudson, S. M., ... & Garfein, R. S. (2007). Perceived risk, peer influences, and injection partner type predict receptive syringe sharing among young adult injection drug users in five US cities. Drug and Alcohol Dependence, 91, S18-S29.
16. Tobin, K., Davey-Rothwell, M., & Latkin, C. (2010). Social-level correlates of shooting gallery attendance: A focus on networks and norms. AIDS and Behavior, 14, 1142-1148.
17. Macalino, G. E., Springer, K. W., Rahman, Z. S., Vlahov, D., & Jones, T. S. (1998). Community-based programs for safe disposal of used needles and syringes. JAIDS Journal of Acquired Immune Deficiency Syndromes, 18, S111-S119.
18. Office of National AIDS Policy. The White House, Office of National AIDS Policy. (2010). National hiv/aids strategy for the united states. Retrieved from website: http:// www.whitehouse.gov/sites/default/files/uploads/NHAS.pdf
19. Office of National Drug Control Policy, (2012). Federal funding ban on needle exchange programs. Retrieved from website: http://www.whitehouse.gov/blog/2012/01/05/federal-funding-ban-needle-exchange-programs
20. http://harmreduction.org/about-us/principles-of-harm-reduction/
21. Aspinall, E. J., Nambiar, D., Goldberg, D. J., Hickman, M., Weir, A., Van Velzen, E., ... & Hutchinson, S. J. (2013). Are needle and syringe programmes associated with a reduction in HIV transmission among people who inject drugs: a systematic review and meta-analysis. International journal of epidemiology, dyt243.
22. Ariyakumar, D., Chamberlain, S., Mcquie, H., & Flores, M. (2013). Nevada Division of Public and Behavioral Health, Office of Public Health Informatics and Epidemiology. Syringe services program guidelines.
Decriminalizes the possession of hypodermic devices

Syringe services programs in Nevada
Nevada Guidelines December 2013 :
Collection and disposal
The goal of this project was to help new programs in Nevada
Complete an assessment of at least 50 existing syringe services programs
Examine data and extract common themes
Develop a resource guide

Ten open ended questions:
Working with law enforcement
Bolstering community buy in
Linking clients with services
Tracking utilization of programs
Hepatitis B Virus (HBV)
Hepatitis C Virus (HCV)
Public Health Problem
Nevada Syringe Services Programs Reporting Procedures
Harm Reduction
Harm reduction is a set of practical strategies and ideas aimed at
reducing negative consequences
associated with drug use. Harm reduction is also a movement for
social justice
built on a belief in, and respect for, the rights of people who use drugs.
Semiannual reports
Number of participants in the time period

Demographic data for clients

Number of syringes collected and distributed
United States
Law enforcement

Community buy in

Relationships with services in the community

Full time case manager

Client relationships

In-house services
Linkages: Resolutions
Effectiveness of Syringe Services Programs
Cost Effectiveness of Syringe Services Programs
Law Enforcement: Resolutions
Syringe Exchange:
Dispose of used syringes
Obtain sterile syringes at no cost

Syringe Services Program:
Syringe exchange
Referrals to treatment
Nevada Division of Public and Behavioral Health
8, 9
13, 15
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