NEEDLE EXCHANGE PROGRAM

Needle exchange program being set up at the community centre

Needle exchange program being set up at the community centre

Introduction

Needle exchange programs (NEPs) have been associated with a decrease in HIV prevalence, incidence, and needles among injecting drug users (IDUs), and can serve as a bridge to drug treatment (Heimer, 1998, Brooner et al., 1998, Strathdee et al, 1999 and Shah et al., 2000). Addiction treatment, particularly opioid agonists schemes, such as methadone is effective in reducing the frequency of drug injection, and then, the incidence of HIV infection (Metzger and Navaline, 2003) and tuberculosis (Snider et al., 1999). Since only 15-20% of IDUs enrolled in drug treatment programs at any time in the U.S. (Metzger and Navaline, 2003), an increase in the number and proportion of drug users in treatment is an important public health goal.

Although IDUs actively seek referrals for drug treatment in the NSP (Heimer, 1998, Brooner et al., 1998, Strathdee et al., 1999 and Shah et al., 2000), many barriers remain, such as the lack of third party reimbursement, transportation and child care (Brooner et al., 1998). In Baltimore, Maryland, 3400 methadone slots are available each year, an estimated 35,000 heroin users, 400 of which are subsidized by the city health department and are reserved for IDUs attending Baltimore NEP. In a previous study, the participants of the NEP, at least one third of IDUs who received treatment voucher attended their intake appointment (Riley et al., 2002). We conducted a randomized study to determine whether the addition of case management services in the Baltimore NEP could increase the proportion of injecting drug users entering drug treatment, relating the PIN to the services available.

Ethical analysis

For over a decade, needle exchange programs functioned as an integral element of harm reduction strategies in communities around the world. Great superiority of the data confirmed its effectiveness as an intervention in HIV transmission and as a strategy to attract drug abusers in substance abuse programs. Evidence that such programs do not increase drug use or distribution, nor an increase in crime, is also convincing. Virtually every U.S. professional medical, health and science community publicly supported the needle exchange as an important harm reduction strategy.

Nevertheless, despite the documented effectiveness, as well as history and precedent of more than 120 active U.S. programs, needle exchange remains a contentious issue. Moral and ethical problems remain and questions community standards occurs when local programs are considered. Thus, for programs to succeed, it is necessary, they are developing within the community.

There is the ethical and moral urgency to consider the possibility of needle exchange as a harm reduction strategy in Jacksonville. About 40% of all HIV / AIDS cases in Duval County can be traced intravenous drug users. More than 25% of new HIV infections are transmitted through IVDU. An increasing number of those newly infected are women and children who are indirectly and unknowingly victims of those drug abusers.

As with any patient that ultimately lead to them, and in this case, the ...