STAGE 5. Defining the action plan

What steps should be completed?

Step 1: Specify intervention actions

SYRINGE EXCHANGE PROGRAMMES (SEP)

The implementation of harm reduction strategies in many countries since the early 1990s (notably, SEP among injecting drug users) reduced the incidence of human immunodeficiency virus (HIV) infection or kept the prevalence of the infection low in this population.¹ A report written for the World Health Organization in 2004² on the effectiveness of SEP in preventing HIV/AIDS infection in injecting drug users gave a clearly positive result for these programmes, concluding that:

• The availability and use of sterile injection equipment by intravenous drug users substantially reduces HIV infection.
• There is no clear evidence of any significant unintended negative effects.
• SEP are profitable.
• SEP have additional benefits, other than reducing HIV infection, and these include increasing recruitment for treatment and possibly also helping improve basic health care.

Access to syringes in pharmacies as a complement to exchange programmes reduces injection-related hazardous behaviours. The combination of replacement treatments (methadone or buprenorphine) and SEP also helps reduce the incidence HIV and hepatitis C virus (HCV) transmission.³

However, a subsequent review of the scientific literature⁴ to determine the strength of evidence for the results of SEP concluded that they are beneficial, but the level of evidence is moderate. Along the same lines, a recent meta-analysis⁵ indicates that evidence for the effectiveness of these programmes is weaker than had been attributed, particularly in preventing HCV transmission, as the reduction in hazardous injecting behaviour seems insufficient to counteract the high levels of transmission of the infection. More studies are required to determine the coverage of interventions required to achieve sustained changes in HIV and HCV transmission. Including elements of peer education, and community support and participation also seems essential for these programmes to succeed.⁶ If you plan to implement a SEP in your community, One Step@a Time suggests that you consult the World Health Organization guide to starting and managing these programmes: 

 

References:

1 Degenhardt L, Mathers B, Vickerman P et al. (2010). Prevention of HIV infection for people who inject drugs: why individual, structural, and combination approaches are needed. Lancet. 376: 285–301.

2  Wodak A et al. (2004). Effectiveness of sterile needle and syringe programming in reducing HIV/AIDS among injecting drug users. Geneva: WHO.

3 Turner KM et al. (2011). The impact of needle and syringe provision and opiate substitution therapy on the incidence of hepatitis C virus in injecting drug users: pooling of UK evidence. Addiction. 106(11): 1978-1988.

4 Tilson H, Aramrattana A, Bozzette S, et al. (2007). Preventing HIV infection among injecting drug users in high risk countries: an assessment of the evidence. Institute of Medicine of the National Academy of Sciences, Washington, DC.

5. Palmateer N, Kimber J, Hickman M et al. (2010). Evidence for the effectiveness of sterile injecting equipment provision in preventing hepatitis C and human immunodeficiency virus transmission among injecting drug users: a review of reviews. Addiction. 105(5): 844–859.

6 Grebely J & Dore GD. (2011). Prevention of Hepatitis C Virus in Injecting Drug Users: A Narrow Window of Opportunity. Journal of Infectious Diseases. Advance Access published January 31, 1-4.