Skip to main content
Public Health Reports logoLink to Public Health Reports
. 1998 Jun;113(Suppl 1):67–74.

Syringe exchange programs: lowering the transmission of syringe-borne diseases and beyond.

R Heimer 1
PMCID: PMC1307728  PMID: 9722811

Abstract

OBJECTIVE: This chapter attempts to describe the factors influencing the transmission of syringe-born viruses, to review the effects of syringe exchange programs (SEPs) in terms of these factors, and to explore the gamut of health-promoting activities of SEPs. RESULTS: The chapter is divided into six sections: biological factors in syringe-borne viral transmission, behavior and viral transmission, quantifying viral transmission, preventing viral transmission, impediments to preventing viral transmission, and research for preventing viral transmission. Understanding how biological and behavioral factors influence transmission of human immunodeficiency virus (HIV) and hepatitis builds a framework to investigate the epidemiology and the impact of SEPs on disease transmission. Even under circumstances in which these programs do not appear to be effective, understanding the implications of the biological and behavioral factors can contribute to our understanding of program benefits and limitations. Furthermore, program benefits may not be restricted to direct effects on disease transmission. Many programs offer services to drug injectors that include risk reduction training, facilitated entry into substance abuse treatment, and medical care. CONCLUSIONS: SEPs can reduce the transmission of syringe-borne viruses without increasing illicit drug use. However, lack of resources, acceptance, and consequently, protection of many of those at risk when they are most vulnerable have hampered program effectiveness. New studies need to be designed to explicate the full measure of program benefit within covered communities and identify the means by which SEPs can expand benefit to individuals at greatest risk.

Full text

PDF
72

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bruneau J., Lamothe F., Franco E., Lachance N., Désy M., Soto J., Vincelette J. High rates of HIV infection among injection drug users participating in needle exchange programs in Montreal: results of a cohort study. Am J Epidemiol. 1997 Dec 15;146(12):994–1002. doi: 10.1093/oxfordjournals.aje.a009240. [DOI] [PubMed] [Google Scholar]
  2. Burris S., Finucane D., Gallagher H., Grace J. The legal strategies used in operating syringe exchange programs in the United States. Am J Public Health. 1996 Aug;86(8):1161–1166. doi: 10.2105/ajph.86.8_pt_1.1161. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Centers for Disease Control (CDC) Risk behaviors for HIV transmission among intravenous-drug users not in drug treatment--United States, 1987-1989. MMWR Morb Mortal Wkly Rep. 1990 Apr 27;39(16):273–276. [PubMed] [Google Scholar]
  4. Centers for Disease Control and Prevention (CDC) Update: syringe-exchange programs--United States, 1996. MMWR Morb Mortal Wkly Rep. 1997 Jun 20;46(24):565–568. [PubMed] [Google Scholar]
  5. Chaisson R. E., Moss A. R., Onishi R., Osmond D., Carlson J. R. Human immunodeficiency virus infection in heterosexual intravenous drug users in San Francisco. Am J Public Health. 1987 Feb;77(2):169–172. doi: 10.2105/ajph.77.2.169. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Chitwood D. D., Griffin D. K., Comerford M., Page J. B., Trapido E. J., Lai S., McCoy C. B. Risk factors for HIV-1 seroconversion among injection drug users: a case-control study. Am J Public Health. 1995 Nov;85(11):1538–1542. doi: 10.2105/ajph.85.11.1538. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Choo Q. L., Kuo G., Weiner A. J., Overby L. R., Bradley D. W., Houghton M. Isolation of a cDNA clone derived from a blood-borne non-A, non-B viral hepatitis genome. Science. 1989 Apr 21;244(4902):359–362. doi: 10.1126/science.2523562. [DOI] [PubMed] [Google Scholar]
  8. Choopanya K., Vanichseni S., Des Jarlais D. C., Plangsringarm K., Sonchai W., Carballo M., Friedmann P., Friedman S. R. Risk factors and HIV seropositivity among injecting drug users in Bangkok. AIDS. 1991 Dec;5(12):1509–1513. doi: 10.1097/00002030-199112000-00014. [DOI] [PubMed] [Google Scholar]
  9. D'Aquila R. T., Peterson L. R., Williams A. B., Williams A. E. Race/ethnicity as a risk factor for HIV-1 infection among Connecticut intravenous drug users. J Acquir Immune Defic Syndr. 1989;2(5):503–513. [PubMed] [Google Scholar]
  10. Des Jarlais D. C., Hagan H., Friedman S. R., Friedmann P., Goldberg D., Frischer M., Green S., Tunving K., Ljungberg B., Wodak A. Maintaining low HIV seroprevalence in populations of injecting drug users. JAMA. 1995 Oct 18;274(15):1226–1231. doi: 10.1001/jama.274.15.1226. [DOI] [PubMed] [Google Scholar]
  11. Des Jarlais D. C., Marmor M., Paone D., Titus S., Shi Q., Perlis T., Jose B., Friedman S. R. HIV incidence among injecting drug users in New York City syringe-exchange programmes. Lancet. 1996 Oct 12;348(9033):987–991. doi: 10.1016/s0140-6736(96)02536-6. [DOI] [PubMed] [Google Scholar]
  12. Donahue J. G., Nelson K. E., Muñoz A., Vlahov D., Rennie L. L., Taylor E. L., Saah A. J., Cohn S., Odaka N. J., Farzadegan H. Antibody to hepatitis C virus among cardiac surgery patients, homosexual men, and intravenous drug users in Baltimore, Maryland. Am J Epidemiol. 1991 Nov 15;134(10):1206–1211. doi: 10.1093/oxfordjournals.aje.a116023. [DOI] [PubMed] [Google Scholar]
  13. Garfein R. S., Vlahov D., Galai N., Doherty M. C., Nelson K. E. Viral infections in short-term injection drug users: the prevalence of the hepatitis C, hepatitis B, human immunodeficiency, and human T-lymphotropic viruses. Am J Public Health. 1996 May;86(5):655–661. doi: 10.2105/ajph.86.5.655. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Gleghorn A. A., Doherty M. C., Vlahov D., Celentano D. D., Jones T. S. Inadequate bleach contact times during syringe cleaning among injection drug users. J Acquir Immune Defic Syndr. 1994 Jul;7(7):767–772. [PubMed] [Google Scholar]
  15. Gostin L. O., Lazzarini Z., Jones T. S., Flaherty K. Prevention of HIV/AIDS and other blood-borne diseases among injection drug users. A national survey on the regulation of syringes and needles. JAMA. 1997 Jan 1;277(1):53–62. [PubMed] [Google Scholar]
  16. Groseclose S. L., Weinstein B., Jones T. S., Valleroy L. A., Fehrs L. J., Kassler W. J. Impact of increased legal access to needles and syringes on practices of injecting-drug users and police officers--Connecticut, 1992-1993. J Acquir Immune Defic Syndr Hum Retrovirol. 1995 Sep 1;10(1):82–89. [PubMed] [Google Scholar]
  17. Hagan H., Jarlais D. C., Friedman S. R., Purchase D., Alter M. J. Reduced risk of hepatitis B and hepatitis C among injection drug users in the Tacoma syringe exchange program. Am J Public Health. 1995 Nov;85(11):1531–1537. doi: 10.2105/ajph.85.11.1531. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Heimer R., Bluthenthal R. N., Singer M., Khoshnood K. Structural impediments to operational syringe-exchange programs. AIDS Public Policy J. 1996 Winter;11(4):169–184. [PubMed] [Google Scholar]
  19. Heimer R., Kaplan E. H., Khoshnood K., Jariwala B., Cadman E. C. Needle exchange decreases the prevalence of HIV-1 proviral DNA in returned syringes in New Haven, Connecticut. Am J Med. 1993 Aug;95(2):214–220. doi: 10.1016/0002-9343(93)90263-o. [DOI] [PubMed] [Google Scholar]
  20. Heimer R., Khoshnood K., Jariwala-Freeman B., Duncan B., Harima Y. Hepatitis in used syringes: the limits of sensitivity of techniques to detect hepatitis B virus (HBV) DNA, hepatitis C virus (HCV) RNA, and antibodies to HBV core and HCV antigens. J Infect Dis. 1996 Apr;173(4):997–1000. doi: 10.1093/infdis/173.4.997. [DOI] [PubMed] [Google Scholar]
  21. Kaplan E. H. A method for evaluating needle exchange programmes. Stat Med. 1994 Oct 15;13(19-20):2179–2187. doi: 10.1002/sim.4780131923. [DOI] [PubMed] [Google Scholar]
  22. Kaplan E. H., Heimer R. A circulation theory of needle exchange. AIDS. 1994 May;8(5):567–574. doi: 10.1097/00002030-199405000-00001. [DOI] [PubMed] [Google Scholar]
  23. Kaplan E. H., Heimer R. A model-based estimate of HIV infectivity via needle sharing. J Acquir Immune Defic Syndr. 1992;5(11):1116–1118. [PubMed] [Google Scholar]
  24. Kaplan E. H. Needles that kill: modeling human immunodeficiency virus transmission via shared drug injection equipment in shooting galleries. Rev Infect Dis. 1989 Mar-Apr;11(2):289–298. doi: 10.1093/clinids/11.2.289. [DOI] [PubMed] [Google Scholar]
  25. Levine O. S., Vlahov D., Nelson K. E. Epidemiology of hepatitis B virus infections among injecting drug users: seroprevalence, risk factors, and viral interactions. Epidemiol Rev. 1994;16(2):418–436. doi: 10.1093/oxfordjournals.epirev.a036161. [DOI] [PubMed] [Google Scholar]
  26. Lurie P., Drucker E. An opportunity lost: HIV infections associated with lack of a national needle-exchange programme in the USA. Lancet. 1997 Mar 1;349(9052):604–608. doi: 10.1016/S0140-6736(96)05439-6. [DOI] [PubMed] [Google Scholar]
  27. Lurie P. Invited commentary: le mystère de Montréal. Am J Epidemiol. 1997 Dec 15;146(12):1003–1010. doi: 10.1093/oxfordjournals.aje.a009227. [DOI] [PubMed] [Google Scholar]
  28. Moss A. R., Vranizan K., Gorter R., Bacchetti P., Watters J., Osmond D. HIV seroconversion in intravenous drug users in San Francisco, 1985-1990. AIDS. 1994 Feb;8(2):223–231. doi: 10.1097/00002030-199402000-00010. [DOI] [PubMed] [Google Scholar]
  29. Moudgil T., Daar E. S. Infectious decay of human immunodeficiency virus type 1 in plasma. J Infect Dis. 1993 Jan;167(1):210–212. doi: 10.1093/infdis/167.1.210. [DOI] [PubMed] [Google Scholar]
  30. Perlman D. C., Perkins M. P., Solomon N., Kochems L., Des Jarlais D. C., Paone D. Tuberculosis screening at a syringe exchange program. Am J Public Health. 1997 May;87(5):862–863. [PubMed] [Google Scholar]
  31. Resnick L., Veren K., Salahuddin S. Z., Tondreau S., Markham P. D. Stability and inactivation of HTLV-III/LAV under clinical and laboratory environments. JAMA. 1986 Apr 11;255(14):1887–1891. [PubMed] [Google Scholar]
  32. Robles R. R., Colón H. M., Sahai H., Matos T. D., Marrero C. A., Reyes J. C. Behavioral risk factors and human immunodeficiency virus (HIV) prevalence among intravenous drug users in Puerto Rico. Am J Epidemiol. 1992 Mar 1;135(5):531–540. doi: 10.1093/oxfordjournals.aje.a116320. [DOI] [PubMed] [Google Scholar]
  33. Schoenbaum E. E., Hartel D., Selwyn P. A., Klein R. S., Davenny K., Rogers M., Feiner C., Friedland G. Risk factors for human immunodeficiency virus infection in intravenous drug users. N Engl J Med. 1989 Sep 28;321(13):874–879. doi: 10.1056/NEJM198909283211306. [DOI] [PubMed] [Google Scholar]
  34. Shapshak P., McCoy C. B., Shah S. M., Page J. B., Rivers J. E., Weatherby N. L., Chitwood D. D., Mash D. C. Preliminary laboratory studies of inactivation of HIV-1 in needles and syringes containing infected blood using undiluted household bleach. J Acquir Immune Defic Syndr. 1994 Jul;7(7):754–759. [PubMed] [Google Scholar]
  35. Short L. J., Bell D. M. Risk of occupational infection with blood-borne pathogens in operating and delivery room settings. Am J Infect Control. 1993 Dec;21(6):343–350. doi: 10.1016/0196-6553(93)90400-x. [DOI] [PubMed] [Google Scholar]
  36. Strathdee S. A., Patrick D. M., Currie S. L., Cornelisse P. G., Rekart M. L., Montaner J. S., Schechter M. T., O'Shaughnessy M. V. Needle exchange is not enough: lessons from the Vancouver injecting drug use study. AIDS. 1997 Jul;11(8):F59–F65. doi: 10.1097/00002030-199708000-00001. [DOI] [PubMed] [Google Scholar]
  37. Titus S., Marmor M., Des Jarlais D., Kim M., Wolfe H., Beatrice S. Bleach use and HIV seroconversion among New York City injection drug users. J Acquir Immune Defic Syndr. 1994 Jul;7(7):700–704. [PubMed] [Google Scholar]
  38. Vlahov D., Astemborski J., Solomon L., Nelson K. E. Field effectiveness of needle disinfection among injecting drug users. J Acquir Immune Defic Syndr. 1994 Jul;7(7):760–766. [PubMed] [Google Scholar]
  39. Vlahov D., Junge B. The role of needle exchange programs in HIV prevention. Public Health Rep. 1998 Jun;113 (Suppl 1):75–80. [PMC free article] [PubMed] [Google Scholar]
  40. Vlahov D., Polk B. F. Perspectives on infection with HIV-1 among intravenous drug users. Psychopharmacol Bull. 1988;24(3):325–329. [PubMed] [Google Scholar]
  41. Zeldis J. B., Jain S., Kuramoto I. K., Richards C., Sazama K., Samuels S., Holland P. V., Flynn N. Seroepidemiology of viral infections among intravenous drug users in northern California. West J Med. 1992 Jan;156(1):30–35. [PMC free article] [PubMed] [Google Scholar]

Articles from Public Health Reports are provided here courtesy of SAGE Publications

RESOURCES