Reducing Injecting Related Harm:
Reducing Injecting Related Harm: Consensus Statement on Best Practice
Over 200 studies, conducted around the world, were reviewed by the World Health Organisation, in 2004.1 The conclusion of the review was that there is “compelling evidence that increasing availability of injecting equipment reduces transmission of human immunodeficiency virus (HIV).” 2 3
This review, and other studies, have also found that increasing injecting equipment supply through syringe ‘exchange’ and other means:
Early introduction of needle exchange in the UK averted an HIV epidemic. 8 However, hepatitis C was already endemic amongst injecting drug users when needle exchange was introduced, and incidence (the number of people who catch the virus) and prevalence (the number of people with) of hepatitis C has remained high. 9
There is evidence that HIV incidence and prevalence is rising.10 In order to reduce transmission of these viruses, we must work to increase supply, and reduce sharing of syringes and other items associated with the risk of blood borne virus transmission.
Essential service elements
A range of injecting equipment, paraphernalia and facilities for the safe disposal of used equipment should be available from a range of centre based specialist services, pharmacy needle exchanges, outreach (including peer delivered and secondary needle exchange) and other services that are:
Specialist needle exchange programmes, with suitably trained staff, should be available in every area to provide:
All needle exchange programmes must:
1 World Health Organisation. Policy Brief: Provision of sterile injecting equipment to reduce HIV transmission. Geneva: 2004 Accessible via: www.who.int/hiv/pub/advocacy/en/provisionofsterileen.pdf
2 MacDonald M. et al. “Effectiveness of needle and syringe programmes for preventing HIV transmission.” International Journal of Drug Policy: 2003, 14(5–6), p. 353–357. American Journal of Public Health. Dec; 89(12): 1852–4.
3 Gibson DR, Brand R, Anderson K, Kahn JC, Perales D, Guydish J. Two- to sixfold decreased odds of HIV risk behaviour associated with use of syringe exchange. Journal of Acquired Immune Deficiency Syndromes, 2002; 31: 237–242.
4 Hagan H, Des Jarlais DC, Friedman SR, Purchase D, Alter MJ. Reduced risk of hepatitis B and hepatitis C among injection drug users in the Tacoma syringe exchange program. American Journal of Public Health, 1995; 85(11): 1531–1537.
5 Doherty MC, Junge B, Rathouz P, Garfein RS, Riley E, Vlahov D: The effect of a needle exchange program on numbers of discarded needles: A 2-year follow-up. American Journal of Public Health 2000, 90: 936–939.
6 Stimson G V, Alldritt L J, Dolan K A, et al. (November 1988) Injecting Equipment Exchange Schemes Final Report. Monitoring Research Group, University of London, Goldsmiths College.
7 Health Outcomes International Pty Ltd in association with the National Centre for HIV Epidemiology and Clinical Research and Professor Michael Drummond, Centre of Health Economics, York University. Return on investment in needle and syringe programs in Australia. Australian Commonwealth Department of Health and Ageing, 2002.
8 Robertson J R, Bucknall A B V, Welsby P D et al (1986) An epidemic of AIDS-related virus (HTLV lll/ LAV) infection among intravenous drug abusers in a Scottish general practice. British Medical Journal, 292: 527–30
9 Ashton M. “Hepatitis C and needle exchange: part 1 – the dimensions of the challenge” Drug and Alcohol Findings: 20
10 Judd A, Hickman M, Jones S et al. (2004) Incidence of hepatitis C virus and HIV among new injecting drug users in London: prospective cohort study. BMJ, doi:10.1136/bmj.38286.841227.7c (published 12 November 2004)