This document discusses the use of needle exchange programs (NEPs) to reduce the transmission of blood borne infectious diseases among injection drug users. It provides background on harm reduction policies and the diseases transmitted by needle sharing. Research shows that NEPs in New York City were associated with declines in HIV and HCV infections from 1990-2001. Supporters believe NEPs save money and increase access to health services, while opponents argue they enable drug use. The ANA supports NEP availability as part of disease prevention efforts.
Lowering Bloodborne Infections through Needle Exchange Programs
1. Policy & Politics:
Lowering the Incidence of Blood Borne Infectious
Diseases through use of Needle Exchange
Programs
Leila Thomas
Rivier University
2. Harm Reduction
Harm reduction– a public health
policy acknowledging people in a
given population will partake in
risky behavior (unsafe sex, illegal
drugs, etc.) and aims to reduce
the negative consequences such
as illness and spread of disease
to the community.
Needle Exchange Program
3. Injection Drug Use
Injection drug use is associated with
increased rates of blood borne diseases and
infectious processes due to needle sharing
and poor hygiene/lack of aseptic technique
(Des Jarlais, et al., 1988)
Most prominent disease transmitted are
HIV, Hepatitis B, HepatitsC most often from
direct needle sharing and multi-person use
(Vlahov, 1998)
Once-only use of sterile needles/syringes is
the safest and most effective method in
limiting disease transmission to the
community (Normand, et al., 1995)
4. Research Indicates…
Des Jarlais et al (2005) researched the rates
of HCV and HIV infections among injection
drug users in New York City from the period of
1990-2001 with NEP.
The published findings indicate that HIV and
HCV declined in New York City due to the
expansion of the needle exchange programs.
Specifically, HIV prevalence declined from
54% to 13% and HCV declined from 90% to
63% overall.
5. Supporters believe…
Research indicates that implementing needle exchange programs
actually save money (CDC, 2005).
Exposure to other health promotional services offered at the clinics
whether it is drug cessation programs, counseling or disease
screenings.
In addition to a DECLINE in blood borne diseases
6. Opponents Believe…
Needle exchange programs increase drug
use
Object to providing needles on a moral
basis (GOP feels it is condoning IV drug
use)
Budget
7. Legislation
Current status of legislation – NO federal funding
towards needle exchange programs
Supporters - part of the presidential and
democratic party platform
Summary
8. ANA’s Position Statement
The American Nurses Association SUPPORTS the
availability of needle exchange programs
9. How do we get involved?
Education
Increase awareness
10. References
Des Jarlais, D.C., Friedman, S.R., Stoneburner L (1988). HIV Infection and Intravenous Drug Use: Critical
Issues in Transmission Dynamics, Infection Outcomes, and Prevention. Clinical Infectious Disease. 10
(1): 151-158.
Vlahov, D (1998). The Role of Needle Exchange Programs in HIV Prevention. Public Health Reports. 113: 75-
80.
Normand, J., Vlahov, D., Moses L. (1995). Preventing HIV transmission: The Role of Sterile Needles and
Bleach. Washington: National Academies Press.
Centers for Disease Control and Prevention. (2004). Program Operations Guidelines for STD Prevention:
Community and Individual Behavior Change Interventions. Retrieved from:
www.cdc.gov/std/program/GL-2001.htm.
Rehm, J., Fischer, B. (2010). Harm Reduction: Evidence, Impact and Challenges. Retrieved from:
http://www.emcdda.europa.eu/publications/monographs/harm-reduction.
Centers for Disease Control and Prevention (2005). Syringe Exchange Programs. Retrieved from:
http://www.cdc.gov/idu/facts/aed_idu_syr.pdf
Occupational Safety and Health Administration (2011). OSHA’s Bloodborne Pathogens Standard. Retrieved
from: http://www.osha.gov/OshDoc/data_BloodborneFacts/bbfact01.pdf
11. References
Des Jarlais, D.C., Perlis, T. Arasteh, K., Torian, L., Hagan, H., Beatrice, S., Smith, L., (2005).
Reductions in Hepatitis C virus and HIV Infections Among Injecting Drug Users in New York
City, 1990-2001. AIDS, 19 (Suppl 3) S20-S25.
American Nurses Association (2013). Needle Exchange and HIV. Retrieved from:
http://nursingworld.org/MainMenuCategories/Policy-Advocacy/Positions-and-
Resolutions/ANAPositionStatements/Position-Statements-Alphabetically/Needle-Exchange-and-
HIV.html
Notas del editor
Harm reduction is a public health policy, which acknowledges that people in a given population will partake in risky behavior (unsafe sex, illegal drugs, etc.) and aims to reduce the negative consequences associated with that behavior, such as illness and spread of disease to the community. A clean needle exchange program enables injecting drug users to safely dispose of their used needles and pick up a new set of sterile needles, thereby eliminating its circulation in the community (Rehm, 2010). Usually these types of programs also offer disease screenings, vaccinations, and referrals to drug treatment programs
Des Jarlais et al (2005) researched the rates of HCV and HIV infections among injection drug users in New York City from the period of 1990-2001. Their objective was to observe trends in infectious disease rates during the expansion of the city’s needle exchange program, using injecting drug users entering the Beth Israel Drug Detoxification Program The published findings indicate that HIV and HCV declined in New York City due to the expansion of the needle exchange programs. Specifically, HIV prevalence declined from 54% to 13% and HCV declined from 90% to 63% overall.
Research indicates that implementing needle exchange programs actually save money when used in communities where the HIV seroprevalence exceeds 2.1 per 100 (CDC, 2005). On average, the cost per syringe distributed is approximately $0.97 compared to the medical costs of treating a person with HIV, approximately $190,000 (CDC, 2005). Because the needle exchange programs require regular visits for pick up and drop off of supplies, injecting drug users are exposed to other health promotional services offered at the clinics whether it is drug cessation programs, counseling or disease screenings. In addition to the notableDECLINE in blood borne diseases such as HIV, Hep C spread to the community.
Needle exchange programs increase drug useObject to providing needles on a moral basis (GOP feels it is condoning IV drug use)Budget
Banned from 1988- 2009. Banned again in 2011. On December 16, 2009, President Obama signed into law an end to the longstanding ban on most Federal funding for needle exchange programs, giving us more opportunities to stop the spread of HIV and other infections among injecting drug users (IDUs). The Administration continues to support a consistent policy that would allow Federal funds to be used in locations where local authorities deem needle exchange programs to be effective and appropriate. Unfortunately, Congress has reinstated the ban.The president is in favor of federal funding for needle exchange programs, but the GOP was influential in instating a BAN in December 2011.
Which INCLUDE: The adherence to public health and infection control guidelines Education about the transmission of HIV disease Confidential HIV testing with pre & post-test counseling Access for referral of injection drug users (IDUs) to treatment and rehabilitation services Access to needle exchange programs at the local community level The development of public policy to support needle exchange programs with access to health screening and drug treatment services The utilization of qualified health care providers, including nurses, as resources for quality, cost-effective program outcomes Continued research of the effectiveness of needle exchange programs which include access to primary health care screening and drug treatment.
It is recommended that public health centers throughout the country offer sterile syringes and disposal as part of a comprehensive drug treatment plan. Unfortunately because of the federal ban, we can only rely on private and local funding. For nurses in the public health sector, this information is a vital component in the treatment plan of drug users. Nurses not only act as the educator, care provider and advocate, but also the link to valuable resources that promote healthier lifestyles. By offering their injecting drug user patients proven effective methods of reducing infectious diseases (sterile syringes), nurses are bridging the health disparities gap. The nurse’s role is also to help educate the public the importance of harm reduction in disease reduction, and the stigma and misinformation that is so often intertwined.
