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Responding to the HIV epidemic among injection drug users in Vancouver, Canada: evidence of best practice in needle exchange to prevent HIV risk behaviour
Presented by Thomas Kerr, Canada.
Kerr T.1, Small W.1, Fair B.1, Wood E.1
1BC Centre for Excellence in HIV/AIDS, Vancouver, Canada
Introduction: Vancouver, Canada was the site of an explosive epidemic among injection drug users (IDU), despite the fact that Vancouver had a large needle exchange program (NEP) in operation. A series have studies have suggested that a number of programmatic deficiencies in the NEP limited the preventative effect of this program locally. In response, in 2000, regional health authorities began to decentralize and expand the NEP, and moved away from a focus on exchange toward a focus on distribution.
Methods: Data concerning syringe sharing and difficulty in accessing sterile syringes for the period 1996-2002 was derived from the Vancouver Injection Drug Users Study (VIDUS), an open prospective cohort study involving over 1500 community-recruited IDU. Information concerning needle exchange policies and practices were obtained for the same period.
Results: Significant changes in the policies governing the delivery of NEP were implemented in 2001, including removal of limits on the number of syringes distributed, and an increase in the number of sites providing syringes. This was accompanied by an initial increase in the total volume of syringes distributed, and declines in the proportion of IDU reporting difficulty accessing syringes (from 8.7% at baseline to 6.0% in 2002) and sharing syringes (from 48.9% at baseline to 8.5% in 2002).
Conclusions: Efforts to improve the delivery NEP services through expanded access and removal of limits on the number of syringes distributed was accompanied by declines in reports of difficulty accessing and syringe sharing. These findings have implications for best practices in HIV prevention for IDU. However, our findings indicate the need for additional complimentary policies and programs to address ongoing syringe sharing.
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