Needle
Exchange Reduces HIV Transmission
SUMMARY
Montreal injection drug users who always acquired syringes
from needle exchanges or other safe sources had a significantly
lower likelihood of becoming infected with HIV. |
By
Liz Highleyman
Sharing
used syringes and other equipment for drug injection is one
of the most efficient means of transmitting HIV,
hepatitis B or C,
and other blood-borne pathogens. In an attempt to reduce infection
rates, numerous cities have established programs to distribute
clean needles to injection drug users (IDUs).
As reported in the May
1, 2011, American Journal of Epidemiology, Julie
Bruneau from the University of Montreal and colleagues examined
trends in HIV incidence, evaluated changes in risk behavior,
and assessed associations between syringe access programs
and HIV seroconversion among local IDUs.
Montreal was among the first North America cities to adopt
harm-reduction strategies such as needle exchange in the 1990s.
However, a 1995 study showed that HIV incidence was actually
higher among IDUs who used the exchanges -- an unexpected
finding. The Montreal Public Health Department subsequently
made changes to the programs, including doubling the number
of syringes available.
This prospective analysis included 2137 IDUs in Montreal who
were HIV negative at the time of enrollment between 1992 and
2008.
Results
 |
A
total of 148 IDUs became HIV positive within 4 years after
enrollment, for an overall incidence rate of 3.3 cases
per 100 person-years. |
|
HIV
incidence was 5.1 per 100 person-years in 2000, falling
to 0.4 per 100 person-years in 2007, then rising somewhat
to 1.8 per 100 person-years in 2008. |
|
HIV
incidence declined by 0.06 cases per 100 person-years
annually prior to 2000, followed by a more rapid annual
decrease of 0.24 cases per 100 person-years thereafter.
|
|
Observed
behavioral trends included increasing cocaine and heroin
use and decreasing proportions of IDUs reporting any syringe
sharing or sharing with a person known to be HIV positive.
|
|
In
a multivariate analysis, HIV seroconversion was associated
with male sex, unstable housing, intravenous cocaine use,
and sharing syringes or having sex with an HIV positive
partner. |
|
Always
acquiring syringes from safe sources conferred a reduced
risk of HIV infection among participants recruited after
2004, though this association was not statistically significant
for earlier participants. |
"The
evolution of the policies has led to a reduction in HIV incidence,"
Bruneau told the Montreal Gazette. "Our study really
shows that adapting services and opening new ways of reaching
out to drug users that are at risk of HIV infection is the
way to go."
5/10/11
Reference
J Bruneau, M Daniel, M Abrahamowicz, et al. Trends in human
immunodeficiency virus incidence and risk behavior among injection
drug users in montreal, Canada: a 16-year longitudinal study.
American Journal of Epidemiology 173(9):1049-1058 (abstract).
May 1, 2011.
Other Source
A Derfel. Needle exchange helps cut HIV rate. Montreal
Gazette. April 22, 2011.
