Syringe Exchange Programs: A Key Component of HIV Prevention
by Jeffrey Laurence, M.D.
December 13, 2007—A substantial portion of the AIDS epidemic in the U.S., much of Eastern Europe, and Asia is driven by injection drug use—specifically by users sharing contaminated equipment. Contaminated syringes account for 17 percent of new HIV infections in the U.S. and 10 percent of new cases worldwide. But the Centers for Disease Control and Prevention (CDC) estimates that two out of three such infections could be prevented if drug users had access to clean needles and “works,” the paraphernalia injection drug users use. In the November 9, 2007, issue of the CDC’s Morbidity and Mortality Weekly Report (MMWR) , amfAR–funded researcher Dr. Don Des Jarlais, along with amfAR Founding Chairman Mathilde Krim and amfAR’s Acting Director for Public Policy Monica Ruiz, reviewed syringe exchange programs.
These programs provide free sterile syringes and needles in exchange for used syringes in an effort to reduce transmission of blood-borne infections like HIV, hepatitis B, and hepatitis C. Extensive scientific evidence—much of which was provided by Dr. Des Jarlais’s group, supported by amfAR funding—demonstrates the efficacy of syringe exchange programs in suppressing new HIV infections without increasing drug use. Yet the U.S. remains the only industrialized country, apart from Sweden, that does not allow federal funding for such programs.
Despite these restrictive laws, a total of 185 syringe exchange programs operate in 36 states, the District of Columbia, and Puerto Rico. Des Jarlais's survey of 118 of these sites operating in 91 cities documented an increase in overall funding, and a dramatic increase specifically in public funding—from 37 percent of total program budgets in 1994-95 to 74 percent in 2005. As a result of these funding increases, many syringe exchange programs have expanded into large, community–based organizations that provide a variety of services. As documented in the MMWR report, many syringe exchange programs now offer a variety of related prevention services, including HIV testing and counseling, and condom distribution.
Des Jarlais and colleagues note that the vast majority of programs now also provide male condoms, HIV and hepatitis C education, and referrals to substance-abuse treatment. About 93 percent allow people to exchange syringes on behalf of another person, 83 percent offer female condoms, and nearly half provide vaccinations for hepatitis A and B (37 and 39 percent, respectively).
Although the number of syringes exchanged through these programs increased steadily from 1994 to 2002 these numbers inexplicably declined from 24.9 million in 2002 to 24.0 million in 2004, and 22.5 million in 2005. If federal barriers to dissemination of these programs were removed, many more lives might be saved.
amfAR has a long history of supporting syringe exchange programs through research, evaluation, and implementation. Des Jarlais’s MMWR article summarizes their successes, and outlines the need for their expansion.
Dr. Jeffrey Laurence is amfAR's senior scientific consultant for programs.