Do Needle Syringe Programs Reduce HIV Infection Among Injecting Drug Users.

3/30/16
The Needle Exchange program
Currently, there is an estimated 350,000 regular injection drug consumers in America, people at risk of contracting lethal blood-borne infections, approximately 1.2 million US residents live with AIDS, and more than a quarter of HIV/AIDS cases in persons aged over 13 are associated with intravenous drug injections. More alarming is that an estimated 61% of cases of HIV/AIDS in women occurs due to injection of drug use or through a sexual interaction with a victim of injection based HIV. Moreover, in America AIDS is attributed as the second foremost cause of death in the African-American women sub population and the third cause of death in the African-American men. Apart from HIV/AIDS, IDUs are at a grave risk of contracting other blood borne diseases as Hepatitis B and C, with hepatitis B infecting 140,000 and 320,000 each and every year in the US killing 5,000 to 6,000 of the population. These statistics shows a dangerous trail of events, and unless an action is taken, the values will still soar higher. Both official and unofficial needle exchange programs are established in various countries and revered as essential components of a comprehensive initiative towards combatting the spread of HIV/AIDS and other blood-borne diseases in IDUs. NEP presents a controversial topic in the United States; surrounded by public opinion, congressional decisions on funding and societal norms that esteem to reduce the menace of drugs and substance abuse in the United States. This paper will give a summary of the reasons towards acceptance of NEP, reasons against it and a personal review of the effectiveness of the NEP program.
The NEP refers to an exchange program where intravenous drug users (IDUS) are provided with sterilized syringes and injection paraphernalia in exchange for their used needles. The used system is then treated as a dangerous bio-medical discarded and safely confiscated. The NEP initiative is a primary form of a pragmatic harm reduction. NEP health initiative shifted the focus away from the drug consumption itself and rates of use to the consequence of the adversity resulting from the drug use. What drives NEP is that most IDUS are either unable or unwilling to halt drug injection (Strathdee et al 225). Therefore, the provision of a sterile needle is a straightforward and inexpensive way of minimizing the risks of blood-borne transferrable disease spread. Moreover, harm reduction recognizes that abstinence is a possible and desirable outcome, but accepts secondary interventions that reduce the harm, but drug use is not terminated. The needle exchange programs are conventionally instituted with information campaigns, HIV and hepatitis C counseling campaigns and various outreach strategies in view of establishing and maintaining contact with the marginalized drug users. That is, the central aim of this initiative is harm reduction to the drug users, acquaintances and close associates.
Apart from ensuring safe injection, the NEP program is instituted to provide advice and pertinent information through a variety of public health facets. The program provides tips on safer injection practices, advises on the reduction of harm resulting from drug and substance abuse, advice on managing and overcoming drug overdose, and contains information on safe handling and disposal of injecting equipment. Moreover, the initiative is accepted in that it provides treatment services such as access to drug treatment as the OST (opioid substitution therapy), as well as encouragement to switching to safer drug use.
In contrast to its advantages, the idea of providing sterile syringes to drugs users has received widespread debate and criticisms in the United States, primitively anchored on the concept of zero tolerance to illicit drugs. From this view, drugs and substances are perceived as immoral and criminal that should receive punishment instead of medical intervention that requires a prevention and treatment. Interesting research by Vlahov et al. shows that an estimated 47% of the citizens of the United States think that the war on drugs has failed, but funny that they do not want to relinquish these efforts (Vlahov et. al 53). In other words, the NEP is considered a bridge towards drug abuse treatment. However, from this standpoint, it is tragic that a nation that has established its reputation for zero tolerance for illicit drug consumption has instituted programs that block drugs users from availing themselves of rehabilitation and other services that can help them quit drug and substance abuse.
The Congress banned the funding for the program in 1988, later lifted the prohibition in 2009, and later reinstated in 2011 (Holtzman, et al. 69). Although the federal funds cannot be used directly towards these measures, the fund can go to other costlier expenditures associated with the program such as staff, vans, referral and outreach services. Besides the congressional ban that was lifted in 2011, the NEP program further suffers from logistical challenges. In the US, 47 countries have drug and paraphernalia laws that exclusively prohibit the sale, distribution and possession of syringes that are known to facilitate illegal drug consumption. Moreover, 8 states further require a prescription for the purchase of syringes and possession, while 23 states maintain pharmacy regulations restricting access to syringes. The breakdown further shows that only 16 states have only retail access to the syringes, and 22 states have no clear legal framework that dictates sterile syringe access (Holtzman, et al. 69). However, such restrictions have been lifted with various states allowing for pharmacies to dispose of style syringes, dawn to a new future.
According to Woodak and Cooney, a vociferous debate has been established in various states between the proponents of public health approach based on evidence and a criminal justice wing that is supposedly based on international drug treaties (Woodak and Cooney 778). However, is important to note that even the International Narcotics Control Board on article 14 of 1998 explains that parties can adopt appropriate mechanisms aimed at eliminating or reducing illicit demand for narcotics and psychotropic substances to reducing human suffering. Moreover, the ultimate purpose of the international organization is a reduction of harm poised by the narcotics. Woodak et al. further explain that the International Narcotics Control Board also commissioned a review of the legal status of the harm reduction initiative lest NEP does not fault the international narcotics and drugs control policies.
On personal opinion, the NEP initiative does not warrant a position in the moral abyss as postulated by the opponents. First, the initiative meets the Bradford Hill Criteria. The Hill criteria is an epediomologiacl tool, devised by English epidemiologist, Bradford Hill, used for assessing the interferences of causality from the epidemiological studies of association, and widely considered as the blueprint for assessing the strength of evidence for various public health interventions. Dowak and Cooney assessed the NEP under the hill criteria and determined that NEP assessed conservatively fulfills 6 of the nine Bradford Hill criteria and all the five additional criteria (Dowak and Cooney 790). This point establishes that the effectiveness of the NEP initiative in reducing HIV/AIDS is considered overwhelming. Moreover, on a closer look and literature review, there is no convincing evidence of any prime negative consequences of the NEP program. Extensive research covering a period of more than 2 decades fails to give a persuasive evidence that the NEP program increases the initiation of the frequency of consumption of illicit drug use. Furthermore, the fact that the NEP program considerably enhances the rate of prevention of other dangerous diseases like the hepatitis strain surges its importance apart from the fact that the programs can increase the recruitment of an addict into drug user interventions, and even possibly into a primary healthcare setting. However, the textual and evidence-based research shows that the NEP program on its own is not sufficient in controlling HIV/AIDS among the intravenous drug users and acquaintances. Evidence lacks for a single proactive intervention in HIV control. An aggregate effect comprising several interventions shows a popular success in combating the HIV/AIDS menace. The NEP program should be considered as a system that should be supported by a series of complementary measures if the nation wishes to reduce considerably and control HIV/AIDS infection among and from the intravenous drug users.
Finally, the NEP initiative is a product of hard work by activist and epidemiologists in a bid to place the program as a component of a comprehensive strategy to combat the HIV/AIDS epidemic among the injection drug users. The scientific case for the NEP initiative was established on a foundation of various factors as a careful epidemiologic investigation of the case, evaluation of feasible alternatives, a process of generation of hypotheses and studies as per the policy-makers and the vigor to proceed despite the political orientation towards drug and substance abuse. Discrediting the policy based on morals does not warrant space in the modern world and the advantages far much our weigh the demerits.
Works Cited
Wodak and Cooney. Do Needle Syringe Programs Reduce HIV Infection Among Injecting Drug Users: A Comprehensive Review of the International Evidence. 2006. 777-803. Copyright © 2006 Taylor & Francis Group, LLC ISSN: 1082-6084 (print); 1532-2491 (online) DOI: 10.1080/10826080600669579
Vlahov et al. Needle Exchange Programs for the Prevention of Human Immunodeficiency Virus Infection: Epidemiology and Policy. American Journal of Epidemiology. Copyright 2008 by the Johns Hopkins University Bloomberg School of Public Health. Pg. 23-77. Retrieved http://aje.oxfordjournals.org/
Strathdee, Steffanie A., et al. “Facilitating entry into drug treatment among injection drug users referred from a needle exchange program: Results from a community-based behavioral intervention trial.” Drug and alcohol dependence 83.3 (2006): 225-232.
Gindi, Renee M., et al. “Utilization patterns and correlates of retention among clients of the needle exchange program in Baltimore, Maryland.” Drug and alcohol dependence 103.3 (2009): 93-98.
Holtzman, Deborah, et al. “The influence of needle exchange programs on injection risk behaviors and infection with hepatitis C virus among young injection drug users in select cities in the United States, 1994–2004.”Preventive medicine 49.1 (2012): 68-73.