Syringe exchange reduces new illicit Estonian drug use
MedWire News: A large-scale syringe-exchange program has successfully decreased illicit injected drug use and HIV prevalence in a region of Eastern Europe that is experiencing a drug-related HIV epidemic, report researchers.
"The estimated number of adults and children living with HIV in Eastern Europe and Central Asia rose to 1.5 million in 2008, a 66% increase from 2001," write Anneli Uusküla (University of Tartu, Estonia) and co-workers.
The increase is particularly marked in three countries in the region, Estonia, the Russian Federation, and Ukraine, which each have adult HIV prevalence that exceeds 1% of the general population, the researchers add in the journal BMC Public Health.
The transmission of HIV in these countries is thought to be primarily via the sharing of needles to inject drugs, a problem that authorities have attempted to solve with syringe-exchange programs, opioid-substitution therapy, and antiretroviral therapy.
To gauge the effectiveness of syringe exchange in particular, the authors collated data from interviews with 1027 individuals enrolled on such a program in Tallinn, Estonia, as well as from the Estonian National Institute for Health Development databases.
Analysis of the data showed that most of the users of the program were male and aged between 24 and 27 years. There was an increase in the number of needles exchanged by the program between 2005 and 2009, from 230,000 to 770,000. This is equivalent to approximately 70 syringes per user of the program.
Over the same period of time, the proportion of new injectors, defined as those who had been using needles for less than 3 years, decreased significantly from 21% to 12% of the total users. The researchers suggest this may explain the decrease in HIV incidence among new needle users, from 18 per 100 person-years of drug use in 2005 to nine per 100 person-years of drug use in 2009.
Overall HIV infection prevalence was stable over the study period, at around 50%.
Writing in the journal BMC Public Health, the authors say their report is one of the first to demonstrate the effectiveness of syringe-exchange programs in a "transitional" country that is experiencing rapid economic change.
The authors add that their results agree with previous studies that contradict the idea that syringe-exchange programs encourage the injection of drugs. This was particularly important to demonstrate in a middle-income country "where resistance to large-scale harm reduction for drug users remains strong," the investigators conclude.
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By Philip Ford