extent of the HIV and hepatitis C epidemics

Needle exchange programs chase political as well as epidemiological dragons, carrying within them both implicit moral and political goals. In the exchange model of syringe distribution, injection drug users must provide used needles in order to receive new needles. Distribution and retrieval are co-existent in the exchange model. Likewise, limitations on how many needles can be received at a time compel addicts to have multiple points of contact with professionals where the virtues of treatment and detox are impressed upon them. The centre of gravity for syringe distribution programs needs to shift from needle exchange to needle distribution, which provides unlimited access to syringes. This paper provides a case study of the Washington Needle Depot, a program operating under the syringe distribution model, showing that the distribution and retrieval of syringes can be separated with effective results. Further, the experience of injecting drug users is utilized, through paid employment, to provide a vulnerable population of people with clean syringes to prevent HIV and HCV.

Although NSP or needle-syringe programmes often began on an exchange basis as a means to achieve political buy-in, there are few that have remained so for a variety of reasons. These include the ineffectiveness of the exchange model or of needle quotas in controlling HIV epidemics driven in part by injecting cocaine, which has a short duration of action and tends to be injected frequently when it is being injected. More significantly, a shift in thinking about risk behaviour in general and injecting behaviour more specifically has led to a focus on the risk environment. With respect to people who inject drugs, multi-person use of injecting equipment is more likely when needles and syringes are in short supply. Calling this ‘needle sharing’ implies that this is a positive social behaviour rather than one determined primarily by the availability of equipment. For 9 years after the first needle syringe programmes in Canada opened in Vancouver and Montreal, the Olympic City used an exchange model. Whether this contributed to the extent of the HIV and hepatitis C epidemics in Vancouver today remains a question but since 2000 needle syringe distribution has been decentralised to health clinics, peer support groups, homeless shelters, non-profit agencies and housing providers. By the way, the ‘Washington’ in this article is not D.C., USA!