Skip to main content
PMC home page
Journal of Urban Health : Bulletin of the New York Academy of Medicine logoLink to Journal of Urban Health : Bulletin of the New York Academy of Medicine
. 2003 Jun;80(2):302–320. doi: 10.1093/jurban/jtg033

The impact of needle-exchange programs on the spread of HIV among injection drug users: A simulation study

J M Raboud 1,2,✉, M C Boily 4, J Rajeswaran 5, M V O’Shaughnessy 6,7, M T Schechter 8,7
PMCID: PMC3456277  PMID: 12791806

Abstract

Objective. To determine the impact of the implementation of a needle-exchange program (NEP) on the spread of human immunodeficiency virus (HIV) in an injection drug user (IDU) community. We conducted a Monte Carlo simulation study of a theoretical population of 10,000 IDUs. The population was followed monthly from 1984 to 2000. HIV was assumed to be transmitted only by needle sharing. The NEP was introduced in 1989 and evaluated over a period of 11 years. The impacts of the proportion of the population attending the NEP, the risk level of IDUs attending the NEP, the reduction in needle-sharing frequency, and the number of new needle-sharing partners acquired at the NEP on prevalence and incidence of HIV were determined. Increasing the proportion of the population who always attend the NEP and eliminating needle-sharing incidents among IDUs who always attended the NEP were the most effective ways of reducing the spread of HIV. Attracting high-risk users instead of lower risk users to the NEP also reduced the spread of HIV, but to a lesser extent. NEPs are effective at reducing the spread of HIV; even under the worst case scenario of low risk users more likely to attend the NEP, one additional partner per month as a result of attending the NEP, and poor NEP attendance, the estimated prevalence was still less than that from the scenario without an NEP. Under our model, NEPs were shown to reduce the spread of HIV significantly. Efforts should be focused on getting as many IDUs as possible to become regular NEP attenders and stop sharing needles rather than partially reducing the frequency of sharing by a larger number of IDUs.

Keywords: HIV transmission, Injection drug user, Monte Carlo simulation, Needle-exchange program

Full Text

The Full Text of this article is available as a PDF (160.4 KB).

References

  • 1.Bardsley J, Turvey J, Blatherwick J. Vancouver’s needle exchange program. Can J Public Health. 1990;81:39–45. [PubMed] [Google Scholar]
  • 2.Hartgers C, Ameijden EJ, Hoek JA, Coutinho RA. Needle sharing and participating in the Amsterdam syringe exchange programme among HIV seronegative injecting drug users. Public Health Rep. 1992;107:675–681. [PMC free article] [PubMed] [Google Scholar]
  • 3.Kaplan EH. Needle exchange or needless exchange? The state of the debate. Infect Agents Dis. 1992;1:92–98. [PubMed] [Google Scholar]
  • 4.Jarlais DC, Paone D, Friedman SR, Peyser N, Newman RG. Regulating controversial programs for unpopular people: methadone maintenance and syringe exchange programs. Am J Public Health. 1995;85:1577–1584. doi: 10.2105/AJPH.85.11.1577. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 5.Needle-exchange programmes in the USA: time to act now [editorial]. Lancet. 1998; 351;75. [PubMed]
  • 6.Bruneau J, Lamothe F, Franco E, et al. 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;146:994–1002. doi: 10.1093/oxfordjournals.aje.a009240. [DOI] [PubMed] [Google Scholar]
  • 7.Archibald CP, Ofner M, Strathdee SA, et al. Factors associated with frequent needle exchange program attendance in injection drug users in Vancouver, Canada. J Acquir Immun Defic Syndr Hum Retrovirol. 1998;17:160–166. doi: 10.1097/00042560-199802010-00010. [DOI] [PubMed] [Google Scholar]
  • 8.Hahn JA, Vranizan KM, Moss AR. Who uses needle exchange?. A study of injection drug users in treatment in San Francisco, 1989–1990. J Acquir Immun Defic Syndr Hum Retrovirol. 1997;15:157–164. doi: 10.1097/00042560-199706010-00010. [DOI] [PubMed] [Google Scholar]
  • 9.Miller CL, Tyndall M, Spittal P, et al. Risk-taking behaviours among injecting drug users who obtain syringes from, pharmacies, fixed sites and mobile van needle exchanges. J Urban Health. 2002;79:257–265. doi: 10.1093/jurban/79.2.257. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 10.Bastos FI, Strathdee SA. Evaluating effectiveness of syringe exchange programmes: current issues and future propects. Soc Sci Med. 2000;51:1771–1782. doi: 10.1016/S0277-9536(00)00109-X. [DOI] [PubMed] [Google Scholar]
  • 11.Valente TW, Foreman RK, Junge B, Vlahov D. Needle-exchange participation, effectiveness, and policy: syringe relay, gender and the paradox of public health. J Urban Health. 2001;78:340–349. doi: 10.1093/jurban/78.2.340. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 12.Lurie P, Drucker E. An opportunity lost: HIV infections associated with lack of a national needle-exchange programme in the USA. Lancet. 1997;349:604–608. doi: 10.1016/S0140-6736(96)05439-6. [DOI] [PubMed] [Google Scholar]
  • 13.Hurley SF, Jolley DJ, Kaldor JM. Effectiveness of needle-exchange programmes for prevention of HIV infection. Lancet. 1997;349:1797–1800. doi: 10.1016/S0140-6736(96)11380-5. [DOI] [PubMed] [Google Scholar]
  • 14.Laufer FN. Costdeffectiveness of syringe exchange as an HIV prevention strategy. J Acquir Immunune Defic Syndr. 2001;28:273–278. doi: 10.1097/00042560-200111010-00012. [DOI] [PubMed] [Google Scholar]
  • 15.Makulowich GS. Cost effectiveness of SEPs. AIDS Patient, Care STDs. 1998;12:151–152. doi: 10.1089/apc.1998.12.151. [DOI] [PubMed] [Google Scholar]
  • 16.Manzon L, Rosario M, Rekart ML. HIV seroprevalence among street involved Canadians in Vancouver. AIDS Educ Prev. 1992;Fall:86–89. [PubMed] [Google Scholar]
  • 17.Harvey E, Strathdee SA, Patrick DM, et al. A qualitative investigation into an HIV outbreak among injection drug users in Vancouver, British Columbia. AIDS Care. 1998;10:313–321. doi: 10.1080/713612412. [DOI] [PubMed] [Google Scholar]
  • 18.Strathdee SA, Patrick DM, Currie S, et al. Needle exchange is not enough: lessons from the Vancouver injection drug use study. AIDS. 1997;11:F59–F65. doi: 10.1097/00002030-199708000-00001. [DOI] [PubMed] [Google Scholar]
  • 19.Burns SM, Brettle Rp, Gore SM, Peutherer JF, Robertson JR. The epidemiology of HIV infection in Edinburgh related to the injecting of drugs: an historical perspective and new insight regarding the past incidence of HIV infection derived from retrospective HIV antibody testing of stored samples of serum. J Infect. 1996;32:53–62. doi: 10.1016/S0163-4453(96)80010-7. [DOI] [PubMed] [Google Scholar]
  • 20.Rhodes T, Ball A, Stimson GV, et al. HIV infection associated with drug injecting in the newly independent states, eastern Europe: the social and economic context of epidemics. Addiction. 1999;94:1323–1336. doi: 10.1046/j.1360-0443.1999.94913235.x. [DOI] [PubMed] [Google Scholar]
  • 21.Choopanya K, Vanichseni S, Jarlais DC, et al. Risk factors and HIV seropositivity among injecting drug users in Bangkok. AIDS. 1991;5:1509–1513. doi: 10.1097/00002030-199112000-00014. [DOI] [PubMed] [Google Scholar]
  • 22.Jarlais DC, Friedman SR, Choopanya K, Vanichseni S, Ward TP. International epidemiology of HIV and AIDS among injecting drug users. AIDS. 1992;6:1053–1068. doi: 10.1097/00002030-199210000-00001. [DOI] [PubMed] [Google Scholar]
  • 23.Kaplan EH. Needles that kill: modelling human immunodeficiency virus transmission via shared drug injection equipment in shooting galleries. Rev Inf Dis. 1989;11:289–298. doi: 10.1093/clinids/11.2.289. [DOI] [PubMed] [Google Scholar]
  • 24.Greenhalgh D, Hay G. Mathematical modelling of the spread of HIV/AIDS amongst injecting drug users. IMA J Math Appl Med Biol. 1997;14:11–38. [PubMed] [Google Scholar]
  • 25.Atkinson J. A simulation model of the dynamics of HIV transmission in intravenous drug users. Computers Biomed Res. 1996;29:338–349. doi: 10.1006/cbmr.1996.0025. [DOI] [PubMed] [Google Scholar]
  • 26.Peterson D, Willard K, Altmann M, Gatewood L, Davidson G. Monte Carlo simulation of HIV infection in an intravenous drug user community. J Acquir Immun Defic Syndr. 1990;3:1086–1095. [PubMed] [Google Scholar]
  • 27.Kretzschmar M, Wiessing LG. Modelling the spread of HIV in social networks of IVDU. AIDS. 1998;12:801–811. doi: 10.1097/00002030-199807000-00017. [DOI] [PubMed] [Google Scholar]
  • 28.Iannelli M, Milner FA, Pugliese A, Gonzo M. The HIV/AIDS epidemics among drug injectors: a study of contact structure through a mathematical model. Math Biosci. 1997;139:25–58. doi: 10.1016/S0025-5564(96)00137-X. [DOI] [PubMed] [Google Scholar]
  • 29.Allard R. A mathematical model to describe the risk of infection from sharing injection equipment. J Acquir Immune Defic Syndr. 1990;3:1010–1016. [PubMed] [Google Scholar]
  • 30.Kaplan EH. Economic analysis of needle exchange. AIDS. 1995;9:1113–1119. doi: 10.1097/00002030-199510000-00001. [DOI] [PubMed] [Google Scholar]
  • 31.Anthony JC, Vlahov D, Nelson KE, Cohn S, Astemborski J, Solomon L. New evidence on intravenous cocaine use and the risk of infection with human immunodeficiency virus type 1. Am J Epidemiol. 1991;134:1175–1189. doi: 10.1093/oxfordjournals.aje.a116021. [DOI] [PubMed] [Google Scholar]
  • 32.Chaisson RE, Bacchetti P, Osmond D, Brodie B, Sande M, Moss AR. Cocaine use and HIV infection in intravenous drug users in San Francisco. JAMA. 1989;261:561–565. doi: 10.1001/jama.261.4.561. [DOI] [PubMed] [Google Scholar]
  • 33.Guadagnino V, Zimatore G, Izzi A, et al. Relevance of intravenous cocaine use in relation to prevalence of HIV, hepatitis B and C virus markers among intravenous drug abusers in southern Italy. J Clin Lab Immunol. 1995;47:1–9. [PubMed] [Google Scholar]
  • 34.Clark SJ, Saag MS, Decker WD, et al. High titers of cytopathic virus in plasma of patients with symptomatic primary HIV-1 infection. N Engl J Med. 1991;324:954–960. doi: 10.1056/NEJM199104043241404. [DOI] [PubMed] [Google Scholar]
  • 35.Daar ES, Moudgil T, Meyer RD, Ho DD. Transient high levels of viremia in patients with primary human immunodeficiency virus type 1 infection. N Engl J Med. 1991;324:961–964. doi: 10.1056/NEJM199104043241405. [DOI] [PubMed] [Google Scholar]
  • 36.Schacker TW, Hughes J, Shea T, Coombs RW, Corey L. Biological and virological characteristics of primary HIV infection. Ann Intern Med. 1998;128:613–620. doi: 10.7326/0003-4819-128-8-199804150-00001. [DOI] [PubMed] [Google Scholar]
  • 37.Wall SD, Olcott EW, Gerberding JL. AIDS risk and risk reduction in the radiology department. Am J Roentgenol. 1991;157:911–917. doi: 10.2214/ajr.157.5.1927808. [DOI] [PubMed] [Google Scholar]
  • 38.Kaplan EH, Heimer R. A model-based estimate of HIV infectivity via needle-sharing. J Acquir Immune Defic Syndr. 1992;5:1116–1118. [PubMed] [Google Scholar]
  • 39.Galli M, Musicco M. Mortality of intravenous drug users living in Milan, Italy: role of HIV-1 infection. COMCAT Study Group. AIDS. 1994;8:1457–1463. doi: 10.1097/00002030-199410000-00013. [DOI] [PubMed] [Google Scholar]
  • 40.Schechter MT, Strathdee SA, Cornelisse PGA, et al. Do needle exchange programmes increase the spread of HIV among injection drug users?: an investigation of the Vancouver outbreak. AIDS. 1999;13:F45–F51. doi: 10.1097/00002030-199904160-00002. [DOI] [PubMed] [Google Scholar]
  • 41.Guenter CD, Fonseca K, Nielson DM, Wheeler VJ, Pim CP. HIV prevalence remains low among Calgary’s needle exchange program participants. Can J Public Health. 2000;91:129–132. doi: 10.1007/BF03404928. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 42.Jarlais DC. Research, politics and needle-exchange. Am J Public Health. 2000;90:1392–1394. doi: 10.2105/ajph.90.9.1392. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 43.Jacobs P, Calder P, Taylor M, Houston S, Saunders LD, Albert T. Cost effectiveness of Streetworks’ needle exchange program of Edmonton. Can J Public Health. 1999;90:168–171. doi: 10.1007/BF03404500. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 44.Laurie ML, Green KL. Health risks and opportunities for harm reduction among injection drug using clients of Saskatoon’s needle-exchange programs. Can J Public Health. 2000;91:350–352. doi: 10.1007/BF03404805. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 45.Monterroso ER, Hamburger ME, Vlahov D, et al. Prevention of HIV infection in street-recruited injection drug users. The Collaborative Injection Drug User Study (CIDUS) J Acquir Immune Defic Syndr. 2000;25:63–70. doi: 10.1097/00042560-200009010-00009. [DOI] [PubMed] [Google Scholar]
  • 46.Rich JD, Foisie CK, Towe CK, McKensie M, Salas CM. High street prices of syringes correlate with strict syringe possession laws. Am J Drug Alcohol Abuse. 2000;26:481–487. doi: 10.1081/ADA-100100257. [DOI] [PubMed] [Google Scholar]
  • 47.Taussig JA, Weinstein B, Burris S, Jones TS. Syringe laws and pharmacy regulations are structural constraints on HIV prevention in the US. AIDS. 2000;14(suppl 1):S47–S51. doi: 10.1097/00002030-200006001-00007. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Urban Health : Bulletin of the New York Academy of Medicine are provided here courtesy of New York Academy of Medicine

RESOURCES