Solutions for IDU

(46)

Intravenous drugs account for 54.5% of the HIV/AIDS cases in Hartford County, (table 1.4) and 57.4% of the cases in Hartford alone (37). A very strong correlation of .8297 also exists in the county between drug abuse violations and HIV/AIDS. These facts illustrate the enormous impact that this group has on Hartford’s HIV/AIDS rates, and show that the success of the current prevention efforts in the area has been limited to date.

There is concrete evidence that syringe exchanges can reduce the rate of HIV among intravenous drug users (30). According to the NIH, needle exchange programs contribute to 80% reductions in risk behaviors in injecting drug users. A reduction in HIV transmission has also been found to decrease by 30% in areas with syringe exchange programming (19). In one study, clients participating in a syringe exchange program in New Haven reported a remarkable increase in safe needle behavior—the average circulation time of the used needles decreased from around two weeks to less than three days (22), and a study of injection drug users in Hartford, called COPE II, showed that the percentage of drug users that reported sharing needles went down from 37.7% to 17% after 6 months of participation in a syringe exchange program (25). These studies illustrate the effectiveness of needle exchange programs. Since it is legal in Hartford to carry 30 syringes at once (if you are participating in an SEP) as well as purchase up to 10 syringes per pharmacy visit without a prescription (34), it makes sense that these programs help to reduce the spread of the virus via needle sharing.

Although Hartford already has an existing needle exchange program, I feel it can be improved on several levels. With an abundance of methamphetamine, crack and heroin use, it is important that the programs be available and tailored to the specific needs to help out these drug using populations (6).

The present Needle Exchange Program that is run by AIDS Project Hartford, while in existence, is non-descript; the only available information to the general public appears to be severely limited. All that is upfront in terms of the NEPs availability is its starting location (the AIDS Project Hartford building), and that a van is used, with stops at various (unsaid) locations in the city of Hartford (39). A previous study of intravenous drug users in Hartford found that there was insufficient access to sterile syringes despite the fact that there an established needle exchange, as well as legal access to nonprescription syringes pharmacies (25). That said, it’s inevitable that publicity and access need to be dramatically improved.

Hartford’s current NEP faces an extreme challenge. Though Hartford has the highest rate of AIDS in the county, surrounding towns such as Bloomfield, New Britain, Bristol, Rocky Hill, Manchester and East Hartford also exhibit high incidences of the disease. Hartford’s needle exchange program currently does not serve these towns, so one simple solution in lowering these rates would be to expand the program by either obtaining another van for this “Greater Hartford area,” or to allow the existing van to travel farther distances to include these surrounding towns in their service area.

The current needle exchange program can also be improved by changing or modifying its hours of operation. While police can’t interfere with anyone participating in an exchange program carrying a syringe (on the streets) in Connecticut (23), many drug users presumably would still not carry their paraphernalia in the light of day. In addition to this, crack cocaine injection has been found to be most prevalent among the white, better educated, and more likely employed (33) and this population may be afraid to use the van during the day for fear of public scrutiny. The use of the van could be more effective if it operated in the middle of the night (36), perhaps from 1 a.m. to 5 a.m. This is a time when, not only might drug users be more in their “element,” but have the ability to be more discrete, and simultaneously reduce some qualms about being stigmatized (8).

Connecticut is lucky in that for every used needle exchanged, a new, sterile one can be given in return (19). Not all states permit this. Some in fact, don’t even permit needle exchanges, because those state governments feel that rather than being a saving grace, the availability of new syringes will encourage drug users to continue their habits (30). However, many studies have suggested that syringe exchanges that don’t limit the amount of syringes exchanged have proven to be more likely to discourage syringe reuse among IDUs (34). I agree with this latter study and feel that the implementation of the needle exchange program in Connecticut has helped to somewhat limit the spread of HIV. It makes sense to take advantage of these findings, and implement them strongly in a community that is suffering from this disease.

One thing that is not in existence but surely could make an impact in Hartford is a Satellite Syringe Exchangers (SSE) program. Satellite syringe exchangers are recruited IDUs from the community who have voluntarily decided to help others by exchanging and delivering clean needles and education materials through this peer education program. Those who participate as SSEs have the experience of injecting drugs themselves, and have expressed a willingness to reduce their own risk behaviors while simultaneously helping others (42). SSEs are able to reach IDUs that may have not been willing to go out to the needle exchange van for fear of stigma (7), or can’t get to one of the (ONLY) three locations in Hartford where the NEP van stops (41). An SSE program seems to serve the health interests of IDUs very efficiently since these ‘secondary’ syringe exchangers have an awareness of the risk behaviors the IDUs exhibit and therefore are able to connect with these people. Satellite syringe exchangers help to bridge public health and the infected HIV population greatly, widening the impact of needle exchanges services and messages on their communities through their work (42).