NEEDLE EXCHANGE

PROGRAMS
Needles as a Host

HIV transmission through intravenous drug use

Blood left in syringe
Reusing paraphernalia

Can cause
HIV/ AIDS
Hepatitis B

90% of injection drug users have Hepatitis C

 Heroin Epidemic
Wilmington: The most dangerous small city in the country (Gentry 2015).
Interstate 95 is used to transport drugs (Delaware Drug Threat Assessment
2002)
The Problem

In many states, clean needles cannot be purchased without a

prescription and carrying needles is illegal
Even where legal, many IDUs cannot afford needles
Many people are not aware of the risks

25 states need prescription

Political contention
Costs

Healthcare
Lost productivity
Crime
Accidents
= more than $50 billion/ year

50% of HIV infections come from drug injections

Delaware consistently ranks among top 10 states for per-capita HIV
infections
 Policy Criteria
Public Health
1. Decrease the amount of people
infected with HIV/ AIDS
2. Reduce injection drug use
3. Decrease the costs to society
4. Decrease the amount of sexual
partners who are infected by
drug users
5. Reduce government spending
Law Enforcement
1. Reduce injection drug use
2. Decrease the amount of people
infected with HIV/ AIDS
3. Decrease the costs to society
4. Reduce government spending
5. Get people off the street
Needle Exchange Programs

Successful in other countries

In a study of 81 cities, those without needle exchange saw HIV

infection rates increase by 5.9%/year on average. In cities with
needle exchange, the rate decreased by 5.8%/year.

In San Francisco, a 5 year study showed decreased use among IDUs

enrolled in a needle exchange program, and the percentage of new
IDUs decreased from 3%/year to1%/year.
How NEPs Work

IDUs a non-threatening, public location to bring a dirty needle and

exchange it for a sterile one
Can encourage people to find help, counseling, and testing
Works for risk reduction and incidence reduction
Provide clean needles for people who dont have access to
Clean needles/ prescriptions
Healthcare for HIV
Drug abuse counseling
Delawares Programs

2006 Needle Exchange Pilot Program

Failed to pass for 10 years

One-for-one exchange
Clients have ID Card
If caught with needles, card will prevent arrest
Also provides tracking tool to measure results

Made permanent in 2011

 Interdependent Social System

Homelessness
Rx/ opioids
IV Drug Abuse HIV/ AIDS NEPs

Mass Increased
Crime/ Unsafe sex;
incarceration/ healthcare
violence Teenage pregnancy
mandatory costs
minimums
Policies

Where should they be placed?

How to get funding?
How to deal with HIV outbreaks?
If you choose to do nothing, how else would you combat the increase
of drug spread and addiction?
If you choose to have the needle exchange programs, should there be
restrictions for who can take part in the program? Who/ how do we
decide this?
Rural Areas vs. Cities
Costs and Benefits?
 References
Centers for Disease Control and Prevention. HIV Testing Survey, 2001. Atlanta: U.S. Department of Health and
Human Services, Centers for Disease Control and Prevention; 2004; Special Surveillance Report Number 1:
[5,18].
Connolly, J. (2012, October 1). The High Point Strategy: Cure for Wilmington's Drug Problem. Retrieved
September 15, 2015, from http://townsquaredelaware.com/2012/10/01/the-high-point-strategy-cure-for-
wilmingtons-drug-problem/
Delaware Drug Threat Assessment. (2002, March 15). Retrieved September 14, 2015, from
http://www.justice.gov/archive/ndic/topics/ndtas.htm
Fisher-Klein, J. (2015). Analyzing needle exchange. In class lecture.
Gentry, J. (2014, March 28). Wilmington ranks as most dangerous small city. Retrieved September 16, 2015,
from http://www.delawareonline.com/story/onlyindelaware/2014/03/28/wilmington-dangerous-city-
crime/6982629/
Taylor, A. (2014, June 14). Heroin in Delaware: Cheap, pure, plentiful. Retrieved September 15, 2015, from
http://www.delawareonline.com/story/news/local/heroindelaware/2014/06/14/delaware-heroin-
problems/10468289/
Strathdee, S. (2015, July 30). Threading the Needle - How to Stop the HIV Outbreak in Rural Indiana NEJM.
Retrieved November 13, 2015, from http://www.nejm.org/doi/full/10.1056/NEJMp1507252
Why is injecting drug use a risk for HIV transmission? (2015). Retrieved November 13, 2015, from
http://www.aidsmap.com/Why-is-injecting-drug-use-a-risk-for-HIV-transmission/page/1324128/