Needle and Syringe Exchange

Programs in Australia

Needle and Syringe Exchange

 Case study

Needle and syringe program (NSEP) in

New South Wales (NSW), Australia
 History
• 1985 Informal exchange started in Sydney
• 1985 AIDS Outreach Bus – aim to reach sex
workers, injecting drug users, street kids
• 1986 Pharmacy fitpack* scheme in NSW
• November 1987 NSEP trial in NSW
• 1988 program commenced in NSW
*fitpacks are hard plastic boxes given out with needles and syringes
to ensure safe disposal
Needle and Syringe Exchange
 Rationale
• Some people will continue to inject
• People must be given knowledge and skills to
make informed choices about risk behaviours
• Community faces a greater danger from
widespread HIV infection than from the effects of
drug use
• Aim to reduce physical and psychosocial harm
from drug use
Needle and Syringe Exchange
 Characteristics
• Voluntary exchange
• Give safe disposal container with needles
– sharps containers or “fitpacks”
• Provide other single use injecting equipment
(water, alcohol swabs, cotton wool swabs)
• Also provide information, education and referral
• Initiates contact with health system
Needle and Syringe Exchange
 Public Sector Program
• Directed by NSW Health Department
• Operational responsibility with Area Health
Services
• 300 outlets in hospitals, community health and
drug and alcohol services, and associated NGOs
• Services from fixed premises and outreach and
mobile services

Needle and Syringe Exchange

 Pharmacy Fitpack Scheme
• Established in 1986 by Pharmacy Guild
• Relaunched in 1990 with funding from NSW
Health Department
• Exchange or purchase needles and syringes
• About 530 retail pharmacies participate

Needle and Syringe Exchange

 Outcomes

• Rate of HIV in (non homosexual or bisexual

male) IDU about 2% (<5% in all studies)
• 1991 study estimated that 3000 cases of HIV
prevented in Australia that year by NSEP
• 9 million needles distributed in NSW in 1998

Needle and Syringe Exchange

 HIV prevalence at needle and syringe
programs, 2002, by sexual orientation
30
25
Prevalence (%)

20
15
10
5
0
Heterosexual Bisexual Homosexual
HIV Male HIV Female
Source: Collaboration of Australian Needle and Syringe Programs
Needle and Syringe Exchange
 Outcomes - 1
Evaluation of 2nd National HIV Strategy - 1994
Found NSEP programs:
• cost effective
– estimated $10 million per year spent saved
2,900 HIV infections and $270 million
– (underestimated because only considering HIV not hepatitis B
or C)
• had prevented large scale HIV epidemic among IDU and
therefore among the wider community
Feachem 1995

Needle and Syringe Exchange

 Outcomes - 2
Estimated cost = $122 million to end 2000

Prevented:
25,000 cases of HIV
21,000 cases of hepatitis C
Saved:
Between $2.4 and 7 billion

Needle and Syringe Exchange

 Effectiveness of NSEP
• Study of 81cities in 4 continents 1988 - 1993
• HIV seroprevalence
– increased 5.9% per year in 52 cities without NSEP
– decreased 5.8% per year in 29 cities with NSEP
– average annual change 11% lower in cities with NSEP
Conclusion - strong support for effectiveness
of NSEP
Hurley, Jolley & Kaldor 1997
Needle and Syringe Exchange
 Effectiveness of NSEP 2
• Repeated in 2003
• Study of 99 cities globally
• HIV seroprevalence
– increased 8.1% per year in cities without NSEP
– decreased 18.6% per year in cities with NSEP

MacDonald et al (2003) International Journal of Drug Policy 14 (5-6) December: 353-357

Needle and Syringe Exchange

NSEP is less effective in preventing HCV because:

• Hepatitis C (HCV) more easily transmitted

• HCV may be transmitted by other injecting
equipment and practices
• Greater pool of HCV in community
• Many infected before start using NSEP

Needle and Syringe Exchange

 Criticisms Responses
• Leads to increase drug use • No evidence in studies
• Encourages drug use • Acknowledges the reality
• Condones drug use • Contact allows education
and referral for treatment
• Discarded needles a risk • No HIV infections
documented

Needle and Syringe Exchange

 Issues
• To reduce needle sharing further must consider the social
relationships within which it occurs
• Increase in cocaine injection means increased risk
– more injections, more blood contact, more chaotic
• Safe injecting rooms and heroin prescription
• Legalisation of some drugs

Needle and Syringe Exchange

 Needle exchange - US
• Average lifetime treatment for HIV +ve person $155,000
• Providing sterile injection equipment to IDU in the US
along with the costs of syringe disposal - estimated
would cost just over $423 million per year
• This policy would cost an estimated $34,278 per HIV
infection averted
• Other figures for needle exchange only, range from
$3,000 to $50,000 per infection averted, according to the
recent IOM report on HIV prevention
http://www.cdc.gov/hiv/partners/PSP/AppendixC-1.htm

Needle and Syringe Exchange

 Needle exchange - US

• In 2011, 221 syringe exchange programs known in US1

• The CDC agrees that programs cut the spread of HIV
without increasing the instances of drug addiction.
• All states now allow either needle exchange or sale of
needles without prescription
(New Jersey was the last and has the highest proportion
of infected drug users)
1. http://www.statehealthfacts.org/comparetable.jsp?ind=566&cat=11

Needle and Syringe Exchange

 Needle exchange - US

• In December 2009 the 21 year ban on using

federal funding for needle exchange programs
was finally lifted
(though no extra funding was allocated)
• In December 2011, the ban was re-instated

Needle and Syringe Exchange

 Needle exchange - US

• In January 2016, the ban was partially lifted again

• Funds can now be used to pay for vans, staff, and
all supplies but NOT for the needles and syringes
themselves
http://www.huffingtonpost.com/leana-wen-md/repeal-of-
federal-ban-on-_b_9126368.html

Needle and Syringe Exchange