PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Needle-Exchange Programs”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 19 recordsLinked to original sources
PubMedDate not supplied

AIDS update: prevalence, prevention, and medical management.

This article summarizes the epidemiology of AIDS and human immunodeficiency virus (HIV) infection among intravenous drug abusers (IVDAs) in the United States and discusses the status of approaches to prevent HIV infection and to treat AIDS patients. Finally, the status of research of selected community-based prevention programs, such as needle-exchange programs and programs distributing bleach to IVDAs for needle and syringe cleaning, will be reviewed.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Reaching the unreached: targeting hidden IDU populations with clean needles via known user groups.

Needle exchange is a practical and important part of the Dutch prevention strategy to check the spread of HIV among injecting drug users (IDUs). However, needle-exchange programs are often tied to drug treatment programs that only reach a limited number of IDUs. To overcome this limitation, alternative designs are considered and initiated. This article describes a community-based approach to needle exchange that is built on empowerment of, and intense participation by, known IDUs to target unknown IDUs for delivery of clean needles. The needle-exchange patterns of the IDUs participating in this collective scheme are compared to those of other users who exchanged needles on an individual basis. It was found that this approach extended the reach of the program to a great degree and that it was well received in the IDU community. However, the results were negatively influenced by police activities aimed at closing down places where drugs were used and sold. It is concluded that engaging IDUs in peer-group-directed prevention efforts is both feasible and promising.

Acquired Immunodeficiency Syndrome↗
PubMed1991

HIV prevention among IVDUs in the Federal Republic of Germany: stability and change.

These comments on German drug and AIDS policy are based on the author's two decades of experience in the field of drug user treatment, on recent studies about the epidemiology and etiology of HIV among IVDUs, and on evaluative studies on demonstration projects. German drug use/user policy did not change much in the face of AIDS: no large maintenance or needle-exchange programs were initiated. This is because a well-prepared system of low-threshold methods targeted at IVDUs not ready to undergo treatment was in place before the epidemic. This system has been modified to integrate the aims of HIV prevention among IVDUs and is free of charge and available throughout the country.

Cocaine↗
PubMed1992

Needle exchange or needless exchange? The state of the debate.

Needle exchange programs have been implemented in many cities around the world to slow the spread of human immunodeficiency virus (HIV) infection among injecting drug users. Whether these programs are succeeding in reducing HIV incidence is a matter of debate, as is the appropriateness of sanctioning the provision of drug injection equipment in the midst of a "war on drugs." In a debate swollen with emotional arguments on both sides of the issue, scientific research is essential, lest discussion of needle exchange becomes needless exchange at the policy level. This article briefly outlines and critiques the common arguments for and against needle exchange. Following this, a new circulation theory of needle exchange is advanced, along with supporting evidence from an ongoing study in New Haven, CT, U.S.A. Finally, several open questions relating to the operation of needle exchange programs and the behavior of program clients are suggested for further investigation.

HIV Infections↗
PubMed1995

HIV incidence among New Haven needle exchange participants: updated estimates from syringe tracking and testing data.

This article provides updated estimates of the rate of new HIV infections among participants in New Haven's legal needle exchange program from syringe tracking and testing data. We previously reported that based on data collected from November 1990 through May 1992, the maximum likelihood incidence rate was zero with a 95% confidence interval of 0-10.2 new infections per 100 drug injectors per year. Expanding this data set through August 1993, the same statistical methods yield a maximum likelihood estimate of 1.63 new infections per 100 drug injectors per year with a 95% confidence interval of 0-7.2. Given these data, the null hypothesis of no new infections cannot be rejected, providing further support for the efficacy of New Haven's needle exchange program.

Confidence Intervals↗
PubMed1995

Regulating controversial programs for unpopular people: methadone maintenance and syringe exchange programs.

One third of all cases of the acquired immunodeficiency syndrome (AIDS) in the United States are associated with the injection of illicit drugs. There is mounting evidence for the effectiveness of syringe exchange programs in reducing human immunodeficiency virus (HIV) risk behavior and HIV transmission among injection drug users. Expansion of syringe exchange would require increased public funding and undoubtedly would include government regulation of syringe exchanges. An analogy is drawn with the present system of regulation of methadone maintenance treatment programs and possible regulation of syringe exchange programs. Specific recommendations are offered to reduce the likelihood of repeating the regulatory problems of methadone maintenance treatment in future regulation of syringe exchange programs.

Acquired Immunodeficiency Syndrome↗
PubMed2026

"It was good because they have a relationship with us": A qualitative study on low-threshold buprenorphine treatment at syringe services programs.

INTRODUCTION: Syringe service programs (SSPs) reach people who inject drugs with opioid use disorder (OUD) and are novel "low-threshold" venues to initiate buprenorphine treatment. The study investigated patients' experiences with SSP-initiated buprenorphine treatment, which could aid in improving buprenorphine treatment delivery at SSPs. METHODS: The study included 12 participants who completed qualitative exit interviews after a randomized controlled trial of buprenorphine treatment at SSPs. In the parent study, participants received buprenorphine treatment through an onsite model at an SSP or enhanced referral to a community health center based on the randomization sequence. Most participants started taking buprenorphine at home. Exit interviews included participants from both study arms, and the semi-structured interview guide focused on their experiences with clinicians, experiences initiating buprenorphine, prior experiences with OUD treatment, and perceptions about continuing buprenorphine treatment. Four researchers iteratively read, coded, and discussed each transcript, then they derived recurring themes using thematic analysis. RESULTS: Participants were mostly male, middle-aged, and 50% identified as Latino. Four main themes related to buprenorphine treatment initiation: 1) Onsite treatment facilitated buprenorphine prescription, but some participants also expressed a need for additional support; 2) Precipitated withdrawal complicated participants' buprenorphine initiation in both arms; 3) Participants largely experienced the SSPs as affirming and welcoming; and 4) Developing strong relationships with healthcare providers was critical to successful buprenorphine treatment initiation. CONCLUSIONS: The SSP-based model provided rapid access to buprenorphine prescriptions, but precipitated withdrawal was a common complication. Some participants desired additional support and guidance when they started taking buprenorphine at home. The findings point to a "low-threshold, high-touch" approach where participants receive expedited access to buprenorphine providers at SSPs but also additional support throughout the initiation process to avoid and/or manage precipitated withdrawal. Despite some challenges, SSP-based buprenorphine treatment was highly valued by study participants.

Humans↗
PubMed1995

Methadone treatment and risk of HIV infection in drug users without legal access to clean injection equipment.

The particular situation of the Swiss canton of Vaud (population 550,000) provides favourable observational conditions to assess the efficacy of a methadone treatment scheme in reducing the risk of human immunodeficiency virus (HIV) infection among drug users. On the one hand, the canton has a long tradition of methadone treatment dispensed by medical practitioners. On the other hand, no legal access to clean injection equipment was provided up to 1989. For the 754 drug addicts having entered at least one course of treatment at the end of 1988, HIV status was assessed through two surveys conducted at mid-1986 and at end 1988 among the private practitioners and in the screening centers, hospitals, medico-social institutions and prisons. The overall annual HIV seroconversion rate shifted only slightly from 13% in the first study period (1984 to mid-1986) to 11% in the second period (mid-1986 to end 1988). In both periods, patients no longer on treatment, mostly stable abstainers, were the less exposed to HIV infection with a relative risk of 0.65 (p < 0.05). For those still on treatment, the risk of infection was associated directly (p < 0.001) with the frequency of courses and inversely (p < 0.001) with the duration. Between patients with more than 18 months spent on treatment and those with less than 6 months, the relative risk gradient was 0.8 and 1.4 before mid-1986 and widened out to 0.3 and 2.1 later on. This is mainly due to an increasing HIV incidence among newcomers into treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1995

AIDS and injecting drug use in the United Kingdom, 1987-1993: the policy response and the prevention of the epidemic.

This paper assesses policy development, service changes and trends in HIV infection and risk behavior among injecting drug users (IDUs) in the United Kingdom. In 1986, the U.K. was faced with the possible rapid spread of HIV infection among IDUs. The combination of an outbreak of HIV infection with prevalence levels of 50% or more in Edinburgh, the recent diffusion of drug injecting, and high levels of syringe-sharing risk behaviour, suggested that HIV infection might spread rapidly through IDU populations. HIV prevention activities commenced in 1986 and developed in 1987. The first report on AIDS and Drugs Misuse by the Advisory Council on the Misuse of Drugs in 1988 was a major catalyst for change. It supported and legitimized emergent views on new ways of working with drug users. Between 1988 and 1993 innovative public health projects increased the ability to target vulnerable populations through syringe distribution, expansion of methadone treatment and outreach to hard-to-reach populations. There were major changes in service philosophy and practices, as ideas of harm minimization, accessibility, flexibility and multiple and intermediate goals were developed. There is evidence that these public health projects encouraged extensive changes in the health behaviour of IDUs. There have been major reductions in syringe-sharing risk behaviour and sharing syringes is no longer the norm. Evaluation of specific interventions (e.g. syringe-exchange) shows their importance in encouraging reductions in risk behaviour. Levels of HIV infection in IDUs remain low by international standards. Outside of London rates of about 1% have been reported; London has a low and declining prevalence of infection to around 7% in 1993; previous high levels in Edinburgh (55%) have since declined to 20%. Britain has to date avoided the rapid increase in HIV infection among injectors that has occurred in many parts of the world. The same period saw the continuation of high prevalence levels in New York and many European cities, and the explosive spread of HIV in many countries in south-east Asia. This paper acknowledges the difficulties is proving links between social interventions and epidemic prevention. It argues that there is prima facie evidence for the success of public health prevention, that the collection of intervention approaches in the U.K. had a significant impact on IDUs behaviour, and that this has helped prevent an epidemic of HIV infection among IDUs. The U.K. experience adds to the growing evidence of the significance of early interventions in encouraging behaviour change and in limiting the spread of HIV infection.

Acquired Immunodeficiency Syndrome↗
PubMed1995

The preparedness to share injecting equipment: an analysis using vignettes.

This paper reports on the use of vignettes to study drug injectors' preparedness to share injecting equipment. Separate vignettes referring to borrowing and passing on injecting equipment have been submitted to 505 injecting drug users in Glasgow. Injectors were asked to identify their own likely response in each of the situations described within the vignettes. It was shown that even among those injectors not reporting any actual sharing in the last 6 months a significant proportion would still be prepared to share injecting equipment within certain situations. The preparedness to share injecting equipment was seen to be influenced by such factors as social distance, sex and length of time injecting. It is suggested that even in situations where drug injectors may have modified their behaviour in the direction of lower levels of reported sharing, a propensity to share may remain. This suggests the continuing need to provide injectors with easy access to sterile injecting equipment; in addition, services working with injecting drug users may need to focus not only upon actual sharing behaviour but also upon what we have described here as the preparedness to share. Indeed, the latter dimension should stand as a warning to services of the potential for sharing injecting equipment to increase in the future.

Acquired Immunodeficiency Syndrome↗