Needle exchange is a public health program for injection drug users (IDU). It is an important component of a comprehensive set of programs designed to reduce the spread of HIV and other blood-borne infections among injection drug users, their families and communities. Nationally, about a third of all people living with AIDS acquired HIV infection directly or indirectly through injection drug use: either from sharing injection equipment, having unprotected sex with an injection drug user, or transmission to children born to injection drug users.
Needle exchange programs provide new, sterile syringes and clean injection equipment in exchange for used, contaminated syringes. They also get drug users into drug treatment and health care. Other services include testing for HIV, hepatitis, TB and other infections to which drug users are prone; treatment readiness counseling and case management services; education about harms associated with drug use and how to minimize them; and safe disposal of contaminated equipment.
Seattle’s program began operating in 1989. Currently Public Health operates exchange programs in six areas of King County. Community-based agencies operate two additional programs.
Why does King County have a needle exchange program?
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There are about 18,000 IDU who live in King County. Needle exchange is the most effective strategy available to prevent HIV in IDU who are not in treatment. It also protects non-injecting family members and sex partners. Without a vaccine or a cure, prevention is the only tool we have to control the spread of HIV. Public Health provides needle exchange for four reasons:
- Needle exchange reduces blood-borne diseases in our communities without increasing drug use. Several studies have shown compelling evidence that needle exchange programs decrease HIV and hepatitis transmission, but do not increase the use of injection drugs.1
- Preventing HIV infection in injection drug users also prevents HIV in women and newborn children. Many women are at risk for HIV because of their own injection drug use or because they are sexual partners of injection drug users. King County has had only one case of mother-to-child transmission in the last 10 years.
- By working with injection drug users, we can help get them into drug treatment.
- Finally, Public Health safely disposes of all contaminated syringes turned in to the exchange. This reduces the number of discarded syringes on our sidewalks and in our bus stops, yards, parks and play grounds. Our goal is to get used syringes out of circulation as quickly as possible. The longer a syringe remains in circulation, the more opportunities there are for that syringe to pass on a blood-borne disease.
Is needle exchange successful?
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YES. HIV infection among IDU has been shown to increase 6% per year on average in cities that do not have needle exchange. In contrast, HIV declined 6% per year among IDU in cities that have exchange programs.2 An Australian survey found that HIV prevalence declined 19% per year in cites with needle exchange compared to an 8% increase in cities that did not have exchange programs3. In King County, the rate of HIV infection among IDU has remained low and stable for the past sixteen years, with only 3% of the local IDU population infected.
King County’s program has also been successful in getting IDU off the streets and into drug treatment. In the last three years, we successfully placed 691 people in drug treatment and provided emergency funding support to keep an additional 307 people in treatment who were facing discharge because of inability to pay. We are on track to place over 350 needle exchange clients in treatment in 2008.
How much does needle exchange cost?
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King County spends $1.1 million/year on the needle exchange program. In contrast, life-time medical cost to treat one person who has HIV is estimated to be $385,2004. By preventing infections in just three people per year, the needle exchange program more than pays for itself. By preventing HIV infections in just 1% of IDUs in King County, the program saves $70 million in HIV-related medical costs. In this light needle exchange provides both a public health and an economic benefit to the residents of Seattle and King County.
Who pays for needle exchange?
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The needle exchange is funded by disease prevention funds provided by Washington State, King County and the City of Seattle. Community-based agencies that provide needle exchange In King County may also receive private donations and grants from private foundations.
1Wodak A, Cooney A (2006). Do Needle Syringe Programs Reduce HIV Infection Among Injecting Drug Users: A Comprehensive Review of the International Evidence. Journal of Substance Use & Misuse, 41:777-813. Studies cited include: National Comission on AIDS (1991), Centers for Disease Control and Prevention (1993), General Accounting Office (1994), Office of Technology Assessment of the U.S. Congress (1995), National Institutes of Health Consensus Panel (1997), U.S. Department of Health & Human Services (2001), Institute of Medicine of the National Academy of Science (2001).
2Hurley, SF, Jolley, DJ, Kalidor, JM (1997). Effectiveness of needle-exchange programmes for prevention of HIV infection. The Lancet, 348:987-991.
3Health Outcomes International (HOI), National Center for HIV Epidemiology and Clinical Research, Drummond, M (2002). Return on Investment in Needle and Syringe Programs in Australia. Canberra: Commonwealth Department of Health and Ageing.
4Schackman, BR et al. (2006). The Lifetime Cost of Current Human Immunodeficiency Virus Care in the United States. Medical Care, 44,11:990-997.
