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Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence (2007)

Chapter: Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange

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Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
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Appendix D
Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange (NSE)

Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
×

TABLE D-1 Case-Control Studies

Study

Description

Sample Size (n)

*Hagan et al., 1995

Examines the association between use of syringe exchange and hepatitis B and C in IDUs.

Cases: 28 IDUs with acute hepatitis B; 20 IDUs with acute hepatitis C.

Controls: IDUs with no markers of exposure to hepatitis B or C (n=38 and 26, respectively).

*Patrick et al., 1997

Identifies determinants of HIV seroconversion among IDUs during a period of rising prevalence in Vancouver despite the prevalence of NSE and outreach.

Cases: IDUs with a new positive HIV test after January 1, 1994, and a negative test within the prior 18 months (n=89).

Controls: required 2 negative tests during the same period (n=192).

Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
×

Outcome Measures

Results

Limitations

Syringe exchange use; hepatitis B and C infection.

75% of case patients with hepatitis B and 26% of control subjects had never used the exchange; similar proportions were found for the hepatitis C case and control groups. After adjustment for demographic characteristics and duration of drug use, nonuse of the exchange was associated with a six-fold greater risk of hepatitis B (OR=5.5; 95% CI: 1.5–20.4) and a sevenfold greater risk of hepatitis C (OR=7.3; 95%CI: 1.6–32.8).

  • Source population were IDUs in Pierce County (Washington) and were at risk for developing hepatitis B or C.

  • May have been differences between the injection practices of cases and controls which may have resulted in uncontrolled confounding.

  • Cases and controls may have differed in their use of other strategies (bleach, syringe purchase in pharmacies, etc.) to prevent infection.

  • The Tacoma syringe exchange’s role as the primary source of HIV prevention for local IDUs may have contributed to the magnitude of the association between syringe exchange and risk of viral hepatitis.

Determinants of HIV seroconversion.

Multivariate analysis showed borrowing syringes, unstable housing, and injecting ≥ 4 times daily to be independently associated with seroconversion. Protective associations were found between sex with opposite gender and tetrahydrocannabinol use.

  • Cases may have had differential recall of events than controls.

  • Self-reported data.

  • Study focused on incident cases of HIV and systematically excluded populations in which HIV is already highly prevalent.

  • Statistical power was limited with respect to ability to do subgroup analyses.

Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
×

Study

Description

Sample Size (n)

van Ameijden et al., 1992

Assesses risk factors for HIV seroconversion among IDU and investigates if HIV prevention services in Amsterdam have a protective effect on HIV seroconversion.

Cases: 31 IDU seroconverters

Controls: 202 seronegative IDUs

*Indicates an article selected by the Committee for relevance or sound study design.

Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
×

Outcome Measures

Results

Limitations

HIV seroconversion

No evidence was found that receiving daily methadone treatments at methadone posts and obtaining new needles/ syringes via the NSE were protective. Three independent risk factors for seroconversion were found in logistic regression: living >10 years in Amsterdam (OR=2.45; 95% CI: 1.09–5.53); first injection less than/equal to 2 years ago (OR=3.43; 95% CI: 1.20–9.81); and injecting mainly at home (OR=0.39; 95% CI: 0.18–0.88).

  • Self-reported data.

  • Small statistical power and the need to dichotomize most variables because of the small number of seroconverters.

  • Only persons who visited two times or more were included, and these persons may be different from those who visited only once or those who never visited.

Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
×

TABLE D-2 Prospective Cohort Studies

Study

Description

Sample Size (n)

*Bluthenthal et al., 2000

Determines whether use of syringe exchange is associated with cessation of syringe sharing among high-risk injecting drug users.

340 high-risk injection drug users.

*Bruneau et al., 1997

Assesses the association between risk behavior and HIV seroprevalence and seroincidence among IDUs in Montreal. The association was examined in three risk assessment scenarios using intensive covariate adjustment for confounders: a cross-sectional analysis of NSE use at entry as a determinant of seroprevalence; a cohort analysis of NSE use at entry as a predictor of subsequent seroconversion; and a nested case-control analysis of NSE participation during follow-up as a predictor of seroconversion.

974 HIV-negative IDUs.

Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
×

Outcome Measures

Results

Limitations

Syringe sharing; use of syringe exchange.

At follow-up interview, 60% reported quitting syringe sharing. IDUs who began using the syringe exchange were more likely to quit sharing syringes (AOR=2.68; 95% CI: 1.35–5.33), as were those who continued using the syringe exchange program (AOR=1.98; 95% CI: 1.05–3.75).

  • Participants not randomly selected.

  • Biases associated with self-reported data regarding sensitive and stigmatized behavior.

  • Comparison group was made up of IDUs at high risk who reside in a community with syringe access limited to NSE.

HIV seroprevalence and seroincidence.

In the cohort study, there were 89 incident cases of HIV infection, with a cumulative probability of HIV seroconversion of 33% for NSE users and 13% for nonusers (p<0.0001). In the nested case-control study, consistent NSE use was associated with HIV seroconversion during follow-up (OR=10.5; 95% CI: 2.7-41.0).

  • Study is observational and was not specifically designed to evaluate the efficacy of NSE in preventing HIV infection.

  • Findings not generalizable because of the type of recruitment and the differences between participants and those lost to follow-up.

  • Possible misclassification bias.

Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
×

Study

Description

Sample Size (n)

*Bruneau et al., 2004

Identifies factors associated with sustained cessation of injection, and examines the relationship between sustained cessation and prior injection frequency between 1995 and 1999 in Montreal.

1,004 IDUs.

Cox et al., 2000

Presents findings of an Irish follow-up study to establish the effectiveness of syringe exchanges as a strategy to prevent HIV in IDUs.

370 IDUs who attended the Merchants Quay Projects Health Promotion Unit, between May 1997 and October 1998.

Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
×

Outcome Measures

Results

Limitations

Sustained injection cessation.

18.5% of IDUs reported a period of sustained injection cessation during the study period. Attending NSEs or pharmacies appeared to be a modifier of the relation between cessation and prior injection frequency. (OR=0.68; 95% CI: 0.42–1.12) for IDUs who injected 30–100 times in the month prior to interview and attended NSEs or pharmacies. (OR=0.07; 95% CI: 0.01–0.30) for IDUs who did not use these services.

  • Majority of study participants were cocaine addicts.

  • Self-reported data.

  • Possible misclassification bias of outcome and exposure.

  • Source population was dependent upon self-selection.

Frequency of injection; needle sharing; condom use.

Significant reduction in the frequency of injection; evidence of positive behavior change in relation to improved injection practices. No substantial change in respondents’ self-reported sharing of injecting paraphernalia or condom use.

  • Self-reported data.

  • Possible selection bias.

Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
×

Study

Description

Sample Size (n)

Des Jarlais et al., 1996

Uses meta-analytic techniques to combine HIV incidence data from three studies: the Syringe Exchange Evaluation, the Vaccine Preparedness Initiative, and the National AIDS Demonstration Research program (NADR).

Syringe Exchange Evaluation study, n=280; Vaccine Preparedness Initiative cohort, n=133 continuing exchangers and n=188 non-exchangers; and the NADR, n=1029.

Donoghoe et al., 1989

Uses a questionnaire to measure changes in sexual behavior among syringe exchange clients over 2–4 months.

142 NSE clients.

Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
×

Outcome Measures

Results

Limitations

HIV incidence.

HIV incidence among continuing exchange users in the Syringe Exchange Evaluation was 1.58 per 100 person-years at risk (95% CI: 0.54–4.65). Among continuing NSE users in the Vaccine Preparedness Initiative HIV incidence was 1.38 per 100 person-years at risk (95% CI: 0.23–4.57). Incidence among non-users of the exchange in the Vaccine Preparedness Initiative was 5.26 per 100 person-years at risk (95% CI: 2.41, 11.49). In the NADR cities it was 6.23 per 100 person-years at risk (95% CI:4.4, 8.6). Not using an NSE was associated with a hazard ratio of 3.35 (1.29, 8.65) for incidence of HIV infection, compared with using an NSE, in a multivariate proportional hazards analysis.

  • Important local conditions that created a strong contrast in the risk for HIV infection between syringe-exchange participants and non-participants.

  • No causal link between participation in an NSE and lower HIV incidence can be established.

Number of sexual partners; condom use.

Number of participants having no sexual partners increased from 23% to 31%; number having multiple partners decreased from 26% to 21%; and the number having regular partners increased slightly from 49% to 52%. Overall, 79% reported not using condoms.

  • Self-reported data.

  • Reported changes were not significant.

Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
×

Study

Description

Sample Size (n)

*Gibson et al., 2002

Compares HIV risk behavior of exchange clients with that of non-clients in San Jose, California, and determines if NSE use is protective against high-risk injection behavior.

212 untreated opiate-addicted IDUs.

Hagan and Thiede, 2000

Studies the influence of the Seattle NSE on sharing of drug injection equipment, to identify potential gaps in risk reduction and to understand in greater detail the lack of an association between exchange use and risk of HBV or HCV transmission.

1,582 IDUs who met eligibility criterion: injecting at least once during the month prior to follow-up.

*Hart et al., 1989

Monitors the number of clients, visits made, and syringes dispensed and returned at an NSE in London from November 1987 to October 1988.

133 needle exchange clients.

Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
×

Outcome Measures

Results

Limitations

Frequency of injection; borrowed syringe; borrowed un-sterilized syringe; syringe borrowed only from HIV-negative regular sexual partner; used NSE in past 30 days; got syringes from other sources in past 30 days; injected speedball.

Both univariate and multivariate analysis of the impact of NSE on HIV risk at follow-up revealed a more than two-fold protective effect. In a second multivariate analysis, the odds of HIV risk behavior were decreased more than six-fold for IDUs without other sources of syringes.

  • Attrition from baseline to follow-up rendered the sample less representative.

  • Small sample size.

  • Grouping of other sources of syringes in the data analysis, since these sources may have been heterogeneous in terms of the risks they pose to IDUs.

Sharing of drug injection equipment (syringes, drug cookers, filtration cotton); NSE use.

In univariate and multivariate analyses, NSE use was associated with a lower likelihood of injection with a used syringe (AOR 0.7; 95% CI: 0.5–0.9). There was no association between NSE use and cooker or cotton sharing, or between NSE use and use of a common syringe to divide drugs.

  • Self-reported data.

  • Large loss to follow-up (but follow-up rate is still high).

HIV infection; injection risk behavior; sexual risk behavior.

The rate of lending and borrowing used injecting equipment fell, both compared with rates before entry to the NSE and during the study. Frequency of injection did not increase and there was reduced incidence of abscesses. There was a reduction in the proportion of clients with multiple sex partners.

  • Changes were not significant

  • Self-reported data.

Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
×

Study

Description

Sample Size (n)

*Hartgers et al., 1992

Studies factors related to regular participation in the Amsterdam syringe exchange and the borrowing of syringes.

131 HIV seronegative IDUs.

Huo et al., 2005

Examines the changes in multi-person use of drug injection paraphernalia during the mid-1990s in Chicago.

794 street-recruited IDUs.

Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
×

Outcome Measures

Results

Limitations

Frequency of injection; borrowing needles and/or syringes.

29% of the IDUs reported borrowing syringes in the past 4–6 months. Users at increased risk of borrowing were previous borrowers, long-term moderate/heavy alcohol users, current cocaine injectors, and drug users without permanent housing. Regular clients of NSE were found more often to be frequent long-term injectors, and borrowed slightly less often than other users (not statistically significant even after controlling for confounders).

  • Sample included only HIV-negative IDUs (those at risk for acquiring HIV).

  • Self-reported data.

  • Small sample size.

Five injection equipment sharing practices: receptive sharing, syringe-mediated sharing, and sharing of cookers, cotton filters, or rinse water.

During follow-up the proportion of all sharing behaviors decreased significantly, especially receptive syringe sharing. Participation in an NSE was associated with a one-third decrease in syringe and syringe-mediated sharing, but there was no association with sharing of cookers.

  • Convenience sample of IDUs in Chicago.

  • Significant number of participants were lost to follow-up.

  • Self-reported data.

  • Study not designed to evaluate NSE.

Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
×

Study

Description

Sample Size (n)

*Mansson et al., 2000

Evaluates the virological efficacy of a needle and syringe exchange program in Malmo, Sweden.

515 IDUs.

Marmor et al., 2000

Develops methods for identifying IDUs with accelerating injection habits, so that they may be referred to counseling and treatment. Investigates behavioral correlates of accelerating injection habits, including NSE use.

328 seronegative IDUs.

Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
×

Outcome Measures

Results

Limitations

HIV, HBV, HCV seroconversion.

No new HIV infections occurred during a median follow-up of 31 months. Of 159 IDUs negative at baseline for HBV and/or HCV, 35% seroconverted to one or both viruses during follow-up. Multiple logistic regression analysis correlated hepatitis sero-conversion with imprisonment during the study (OR 2.2; 95%CI: 1.04–4.74), absence of drug-free periods (OR=5.7; CI: 1.44–22.3), and frequent needle and syringe exchanges (OR=1.31; 95% CI: 1.02–1.7).

  • Absence of spread of HIV in this program may have been influenced by other factors such as the low prevalence of HIV infection among IDUs in Southern Sweden.

  • Many of hepatitis seroconverters report imprisonment during the study.

Drug injection rates (accelerating, decelerating, stable); syringe exchange use (consistent, sporadic, non-user).

All groups of syringe exchange users showed significantly decelerating drug injection. Rates of decline were significantly less among consistent syringe exchange users than sporadic or nonusers of syringe exchanges. 30% of consistent NSE users had accelerating rates of drug injection as compared to 9% of nonusers and 17% of sporadic users.

  • Self-reported data.

  • Possible selection bias.

Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
×

Study

Description

Sample Size (n)

*Monterroso et al. 2000

Assesses HIV prevalence and incidence in IDUs and evaluates some of the behaviors and programs street-recruited IDUs employ for HIV prevention.

2,306 IDUs (available at follow-up) in Baltimore, New York, Chicago, San Jose, Los Angeles, and Connecticut (women’s correctional facility).

*Ouellet et al., 2004

Assesses associations between needle exchange program use and drug injection practices in Chicago between 1997 and 2000.

558 regular NSE users (obtained at least half of their needles from an NSE) and 175 IDUs who did not use an NSE.

Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
×

Outcome Measures

Results

Limitations

HIV-related risk behaviors.

Not using previously used needles was substantially protective against HIV seroconversion (RR=0.29; 95% CI: 0.11–0.80) and in a multivariate model was significantly associated with use of NSEs (AOR=2.08). Reduction of injection frequency was protective against seroconversion (RR=0.33), and this behavior was associated with participation in drug treatment programs (AOR=3.54).

  • Problems recruiting and then re-recruiting large numbers of IDUs in several US cities.

  • High dropout rate.

Frequency in the past 6 months of injecting with a needle used by another person; providing a used needle to another person; backloading; sharing cookers, cotton, or rinse water with others.

In multivariate analysis, regular NSE users, compared with non-users, were less likely to receptively share needles (AOR=0.30; 95% CI: 0.19–0.46); lend used needles (AOR=0.47; 95% CI: 0.31–0.71); share cookers (AOR=0.39; 95% CI: 0.25–0.61); cottons (AOR=0.48; 95% CI: 0.32–0.72); or water (AOR=0.41; 95% CI: 0.27–0.63); or use a needle for > 1 injection (AOR=0.15; 95% CI: 0.08–0.27). Among those who shared needles, regular NSE users were significantly more likely to do so for a smaller proportion of injections, with fewer partners and persons socially closer, and to have always bleached used needles before injecting.

  • Possible selection and dilution biases.

  • Temporal relationship of risk behaviors and NSE use is uncertain.

  • Sample was not randomly selected.

  • Self-reported data.

Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
×

Study

Description

Sample Size (n)

*Safaeian et al., 2002

Investigates the extent to which differential misreporting of NSE attendance could bias risk estimates. From 1994 to 1997, self reports of NSE attendance from participants in a prospective study in Baltimore were compared with NSE records.

1,315 participants in prospective study.

*Schechter et al., 1999

Investigates the association between NSE attendance and higher HIV prevalence rates among IDUs in Vancouver to determine whether NSE was causally associated with the spread of HIV.

694 IDU (HIV-negative at recruitment and had injected illicit drugs within the past month).

*Schoenbaum et al., 1996

Studies injection behavior of IDUs who did and did not utilize a local needle exchange in the Bronx, New York City.

904 IDUs attending a methadone treatment program who injected between 1985 and 1993.

Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
×

Outcome Measures

Results

Limitations

Self-reports of NSE attendance.

35% had registered with the Baltimore NSE. There was 86.7% concordance between self-reported and actual NSE use; 11% reported NSE attendance but did not attend (over-reported); and 2.2% reported not attending NSE but did attend (under-reported). Persons who over-reported NSE attendance were more likely to have injected frequently, denied needle sharing, and been an HIV seroconverter (AOR=1.83; 95%CI: 1.11–3.01).

  • Unlikely to have eliminated misclassification altogether because secondary exchange is common in Baltimore.

  • Could not pinpoint the exact date when HIV seroconverters became consciously aware of their diagnosis.

Injection risk behaviors, sexual risk behaviors, needle exchange use.

Cumulative HIV incidence was significantly elevated in frequent NSE attendees. Only 1 out of 498 respondents cited the NSE as the site of meeting new sharing partners. There was no increase in risk behaviors among frequent attendees. Frequent attendees were more likely to report: unstable housing, frequent cocaine injection, sex trade involvement, injecting in shooting galleries, and incarceration within the past 6 months.

  • Self-reported data.

  • Vancouver NSE opened several years prior to the initiation of study.

Use of NSE, injection behavior.

21.9% of participants used the NSE. Exchange users shared needles less than non-users (p<0.05 in 1993). The HIV seroconversion rate was similar among needle exchange users and non-users (1.77 vs. 1.69 per 100 person-years).

  • Sample may not be representative of the population (methadone program clients).

Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
×

Study

Description

Sample Size (n)

*Strathdee et al., 1997

Describes prevalence and incidence of HIV-1, HCV and risk behaviors in a cohort of IDUs in Vancouver.

1,006 IDUs who had injected illicit drugs within the previous month recruited from street outreach.

van Ameijden and Coutinho, 1998

Examines whether the decrease in HIV incidence and injecting risk behaviors is ongoing in Amsterdam (1986-1997), and studies the determinants of injecting risk behaviors.

879 IDUs.

van den Hoek et al., 1989

Determines whether drug users are able to change their risk behavior and if risk reduction occurred, whether this can be ascribed to the prevention campaign or to the effect of serological testing and counseling during the study in Amsterdam from 1985 to1988.

263 IDUs.

Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
×

Outcome Measures

Results

Limitations

Prevalence and incidence of HIV-1 and HCV.

Prevalence rates of HIV-1 and HCV were 23% and 88%, respectively. Estimated HIV incidence was 18.6 per 100 person-years. Independent predictors of HIV-positive serostatus were low education, unstable housing, commercial sex, borrowing needles, being an established IDU, injecting with others, and frequent NSE attendance.

  • Estimate of incidence could have been biased upward by selective return for follow-up of those at highest risk of HIV.

  • No comparison studies of HIV incidence among IDU in Vancouver prior to the introduction of NSE in 1988.

  • Self-reported data.

HIV incidence; injection risk behaviors.

A large initial (1986–1991) risk reduction occurred concerning borrowing and lending needles, multiple needle use, and frequent injecting. From 1991to 1993 onwards there was no substantial further risk reduction. HIV incidence followed the same trend.

  • Due to study design, causal relationships between interventions and outcome cannot be established.

Drug-related risk behaviors.

No increase in the proportion injecting drugs or the frequency of drug use. There was a decrease in sharing of used needles/ syringes. Use of the NSE increased over time.

  • Participants may not represent general population of drug users in Amsterdam.

  • Self-reported data.

Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
×

Study

Description

Sample Size (n)

van Haastrecht et al., 1996

Evaluates the role of behavioral and other variables, both as risk factors for death from all causes and as risk factors for pre-AIDS mortality in IDUs in Amsterdam.

632 treated and untreated IDUs.

*Vertefeuille et al., 2000

Determines whether enrollment in an NSE was associated with reduction(s) in high-risk injection practices among HIV seropositive drug users in Baltimore.

112 HIV-positive NSE participants.

*Vlahov et al., 1997

Determines whether enrollment in the Baltimore NSE was associated with short-term reduction in risky injection practices.

221 NSE participants.

Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
×

Outcome Measures

Results

Limitations

Mortality.

The study recorded 77 deaths. In IDUs, HIV-positive serostatus, age above 40, and the use of benzodiazepines several times daily were significantly associated with an elevated risk of death, for both death from all causes and death preceding AIDS diagnosis. Daily use of methadone and participation in NSEs were not associated with lower mortality rates.

  • Misclassification may have occurred.

  • Vital status of some participants could not be determined, particularly because of moving out of Amsterdam.

  • Bias may occur when mortality is associated with censoring.

  • Mortality may be a poor indicator of HIV risk.

Drug injection practices; location of injection; syringe disposal; and drug use.

Self-reported lending of used syringes to others decreased (34% vs. 15.5%, p=0.001), borrowing of syringes from others decreased (23.2% vs. 11.1%, p=0.002), and reported participation in drug treatment increased (8% vs. 18.8%, p=0.01)

  • Lack of external comparison group.

  • All NSE participants were self selected into NSE.

  • Self reported data.

  • Lack of comprehensive utilization statistics for NSE participants.

Drug-related risk.

From baseline, 2-week, and 6-month follow-up visits, significant reductions were reported in use of a previously used syringe (21.6%, 11%, 7.8%, respectively), lending of one’s used syringe to a friend (26.7%, 18.4%, 12%, respectively), and several indirect sharing activities.

  • No external comparison group.

  • Self-selected participants.

  • Self-reported data.

Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
×

Study

Description

Sample Size (n)

*Wood et al., 2002

Seeks explanations for high-risk sharing (defined as borrowing a used needle from someone other than the intimate sexual partner in the previous 6 months) among Vancouver IDUs between January 1999 and October 2000.

776 IDUs reporting drug use in the past 6 months.

Wood et al., 2003

Evaluates the risk profile of the population served by the Vancouver Area Network of Drug Users (VANDU) needle exchange, and determines the factors associated with acquiring syringes from VANDU. VANDU is an unsanctioned all-night needle exchange program on a street corner in an IDU-concentrated neighborhood.

587 active IDUs.

*Indicates an article selected by the Committee for relevance or sound study design.

Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
×

Outcome Measures

Results

Limitations

High-risk needle sharing (defined as borrowing a used needle from someone other than the intimate sexual partner in the previous 6 months).

Logistic regression analysis found that difficulty gaining access to clean needles (AOR= 3.36), bingeing (AOR= 1.82), frequent cocaine injection (AOR=1.76), and male sex (AOR=1.89) were all independently associated with high risk sharing. Being married (AOR=0.49) and acquiring needles exclusively from a NSE (AOR=0.46) were negatively associated with sharing.

  • Participants not included in this study had different characteristics than those who were included (single, younger, HIV negative).

  • Self-reported data.

Use of NSE; drug-related risk behaviors.

165 participants reported using the VANDU exchange. Participants using the VANDU were more likely to frequently inject cocaine, inject in public, and require help injecting. Use of the exchange was also associated with safe syringe disposal.

  • Self-reported data.

  • Study design was unable to allow determination of why the NSE was able to reach the highest risk IDUs.

Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
×

TABLE D-3 Ecological Studies

Study

Description

Sample Size (n)

Amundsen et al., 2003

Discusses the effectiveness of legal access to needles and syringes versus HIV counseling and testing in Denmark, Norway, and Sweden.

HIV prevention programs for IDUs in Denmark, Norway, and Sweden.

*Des Jarlais et al., 2005a

Assesses trends in HIV, HCV, and HIV/HCV infection among IDU from 1990 to 2001 in NYC. This time period included a large expansion of syringe exchange (from 250,000 to 3,000,000 syringes exchanged annually).

For HCV testing, n=72 in 1990–1991 and 412 in 2000–2001.

Des Jarlais et al., 2000

Assesses trends in HIV risk behaviors among IDUs in NYC from 1990 to 1997 in a large drug detoxification treatment program (n=2,588) and a research storefront (n=2,701) located in a high drug use area.

5,289 IDUs.

Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
×

Outcome Measures

Results

Limitations

HIV incidence rates over time (1980–1996).

Results suggest that a high level of HIV counseling and testing might be more effective than legal access to needles and syringes (needle exchange programs). Sweden and Norway have higher levels of HIV counseling and testing and have significantly lower incidence rates of HIV among IDUs than Denmark where there was legal access to needles and syringes and a lower level of counseling and testing.

  • Susceptible populations may be smaller than the number of IDUs at each time interval; difficult to compare the sharing of used or non-sterile drug injection equipment between countries.

  • Lower incidence rates in Sweden and Norway may be caused by other factors than differences in the levels of HIV counseling and testing and legal access to needles/syringes.

HIV and HCV status.

From 1990 to 2001, HIV prevalence declined from 80% to 59% among sero-negative individuals, and from 90% to 63% overall. HCV prevalence declined significantly.

  • Participants were IDUs entering detoxification at Beth Israel and do not represent a random sample of IDUs in NYC.

  • Did not conduct confirmatory testing of HCV-positive individuals.

  • The expansion of syringe exchange must be considered a natural experiment, not a randomized clinical trial.

Any unsafe sex with casual partner; any unsafe sex with primary partner; any distributive needle sharing; any receptive needle sharing; any sharing at last injection.

The three injection risk behaviors declined significantly over time (p<0.01) at each site. Pooled data shows all five risk behaviors declined significantly (p<0.01). Participation in NSEs and HIV counseling and testing increased greatly from 1990 to 1997.

  • Self-reported data.

  • Causal relationship between expansion of programs and decline in risk behaviors is not established.

Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
×

Study

Description

Sample Size (n)

*Des Jarlais et al., 1995

Describes prevention activities and risk behaviors in five cities (Glasgow, Scotland; Lund, Sweden; Sydney, Australia; Tacoma, Washington; and Toronto, Ontario) where HIV is present in the IDU population, but sero-prevalence has remained less than 5% during at least 5 years.

5 cities.

*Hurley et al., 1997

Compares changes over time in HIV seroprevalence in IDUs in cities (n=81) worldwide, with (n=29) and without (n=52) NSEs.

81 cities.

Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
×

Outcome Measures

Results

Limitations

Identification of prevention measures, drug-related risk behaviors.

There were three common prevention components present in all five cities: (1) implementation of prevention activities when HIV seroprevalence was low; (2) provision of sterile injection equipment; and (3) community outreach to IDUs. Moderate levels of risk behavior continued with one-third or more of IDUs reporting recent unsafe injections.

  • In the selection of the cities, it is possible that cities conducting sufficient research to determine stable low seroprevalence are more likely to be concerned with HIV infection among IDUs and have implemented some type of prevention program.

  • Difficulty establishing causal analyses of HIV prevention among IDUs.

HIV seroprevalence.

On average, seroprevalence increased 5–9% per year in the 52 cities without NSEs, and decreased by 5–8% per year in the 29 cities with NSEs. The average annual change in seroprevalence was 11% lower in cities with NSEs (95% CI: −17.6, –3.9; p=0.004).

  • Analysis does not take into account the stage of epidemics.

  • Seroprevalence data were collected according to different protocols in diverse populations.

  • Cities were selected for analysis by the existence of HIV seroprevalence surveys, and bias may have been introduced by the decision to do a survey.

  • HIV seroprevalence may have remained low in some of the cities with NSEs, regardless of their introduction.

  • It was not possible to separate the effects of implementation of NSEs from the other HIV prevention strategies.

Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
×

Study

Description

Sample Size (n)

*MacDonald et al., 2003

Uses an ecological study design to determine change in HIV prevalence among IDUs between cities (total n=99) with (n=36) and without (n=63) NSEs.

99 cities.

*Indicates an article selected by the Committee for relevance or sound study design.

Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
×

Outcome Measures

Results

Limitations

HIV seroprevalence.

HIV prevalence decreased by 18.6% per year in cities that introduced NSEs, and increased by 8.1% in cities that had never introduced NSEs.

In cities with an initial HIV prevalence less than 10%, the mean annual weighted increase in HIV prevalence was 32.1% in cities that did not introduce NSEs as compared to a mean annual decrease of 7.8% in cities with NSEs.

  • Seroprevalence data used were collected according to different protocols and in diverse populations.

  • Recruitment through NSEs might provide access to less dependent injectors than those recruited through treatment.

  • Cities were selected for analysis by the existence of HIV seroprevalence surveys, and bias may have been introduced by the decision to do a survey.

  • It was not possible to separate the effects of implementation of NSEs from the other HIV prevention strategies.

  • HIV seroprevalence may have remained low in some of the cities with NSEs, regardless of their introduction.

Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
×

TABLE D-4 Selected Serial Cross-Sectional Studies

Study

Description

Sample Size (n)

Des Jarlais et al., 2005b

Estimates HIV incidence among IDUs in NYC from 1990 to 2002 to assess the impact of an expansion of syringe exchange services, using the Serologic Testing Algorithm for Recent HIV Seroconversion (STARHS) system.

3,651 IDUs.

Hammett et al., 2006

Evaluation of an intervention (peer education and provision of clean needles through distribution and pharmacy vouchers) in the cross-border region of China and Vietnam.

Surveys conducted prior to the start of the intervention and at 6, 12, 18, and 24 months thereafter.

Van Ameijden et al., 1994

Studies trends in injecting risk behavior from 1986 to 1992 in Amsterdam.

616 IDUs.

Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
×

Outcome Measures

Results

Limitations

HIV incidence.

HIV incidence declined from 3.55/100 person-years at risk (PYAR) from 1990 to 1992 to 2.63/100 PYAR from 1993 to 1995, to 1.05/100 PYAR from 1996 to 1998, and to 0.77/100 PYAR from 1999 to 2002 (p<0.001). There was a strong linear relationship between the annual numbers of syringes exchanged and estimated HIV incidence.

  • Limitations of STARHS include:

  • Need larger sample size to accurately calculate incidence using STARHS.

  • Potential for false negative HIV results because EIA is less sensitive and may fail to detect antibodies in some cases.

Program coverage of IDUs; IDUs’ risk behaviors; HIV prevalence among IDUs during the first 24 months after the intervention was initiated.

Drug-related risk behaviors declined in frequency, and HIV prevalence among IDUs remained stable in China and declined in Vietnam, over the 24 months since the intervention.

  • Based on non-random samples of IDUs.

  • Self-reported data.

  • Absence of control groups.

Borrowing and lending of injection equipment; reuse of needles and syringes.

Borrowing of injection equipment declined from 51% to 20%; lending of injection equipment declined from 46% to 10%; and reuse of needles and syringes declined from 63% to 39%. Indications were found that voluntary HIV testing led to less borrowing, lending, and reuse of equipment; and obtaining needles via NSE led to less reuse of needles/syringes.

  • Participants showing a high level of risk may have been selectively recruited earlier in time.

  • Selected only drug users who had injected in the preceding 6 months.

  • Self-reported data.

  • Outcomes of borrowing and lending are only roughly measured.

Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
×

Study

Description

Sample Size (n)

Watters et al., 1994

Evaluates an all-volunteer syringe exchange program in San Francisco using 11 semiannual cross-sectional surveys between December 1986 and June 1992.

5,644 IDUs recruited in two 21-day drug detoxification clinics and three street settings.

Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
×

Outcome Measures

Results

Limitations

Use of syringe exchange program; source of syringes; frequency of injection; initiation into drug injection; frequency of syringe sharing.

In 1992, 45% reported usually obtaining injection equipment from the syringe exchange, and 61% reported using the program within the past year. From December 1986 to June 1992, the median reported frequency of injection declined from 1.9 injections per day to 0.7 injections per day, and the percentage of new initiates into injection drug use decreased from 3% to 1%.

  • Self-reported data.

  • Identifies correlates of sharing syringes, but not causes of reduced sharing.

  • Targeted samples used were not true random samples.

Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
×

TABLE D-5 Selected Cross-Sectional Studies

Study

Description

Sample Size (n)

Hagan et al., 1993

Reports on the operation and effectiveness of the first legally operated syringe exchange program in the U.S. in Tacoma, Washington.

204 syringe exchange users.

Keene et al., 1993

Two-year study evaluates specialist- and community-based NSE in Wales from 1990–1991.

152 NSE attenders; 176 non-attenders.

Kerr et al., 2005

Examines factors associated with syringe sharing in a community-recruited cohort of illicit IDUs in a setting where a safer injection facility recently opened.

431 active IDUs.

Klee et al., 1991

Compares three groups of IDUs (on methadone treatment for more than 6 months, on methadone for less than 6 months, no methadone treatment) based on variables believed to be associated with sharing of injecting equipment.

98 IDUs receiving no treatment; 74 IDUs receiving methadone for > 6 months; 44 IDUs receiving methadone for < 6 months.

Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
×

Outcome Measures

Results

Limitations

Drug use; injection practices; unsafe injections.

Frequency of injection did not change, but the frequency of unsafe injection declined (from 56 to 30 times a month). There was no increase in illicit drug use.

  • Retrospective sampling.

  • Self-reported data.

  • 28% of potential subjects refused to participate because of the need to relieve withdrawal symptoms.

Syringe sharing in the last year and the last 4 months.

Only 9% of attenders had recently shared syringes in 1990 (10% in 1991) compared with 41% of non-attenders (39% in 1991). 80% of needles and syringes were returned.

  • Self reported data.

  • Comparison of two cross-sectional surveys.

Syringe sharing (borrowing or lending of a used syringe in the past 6 months).

Among participating IDUs, 11.4% reported sharing syringes. In logistic regression analyses, use of the safer injection facility was independently associated with reduced syringe sharing (AOR=0.30; 95% CI: 0.11–0.82; p=0.02), after adjustment for relevant sociodemographic and drug-use characteristics.

  • Findings could be due to residual confounding if the SIF had selected IDUs who were inherently at lower risk of syringe sharing.

  • Not a random sample.

  • Cannot establish causal relationship because of study design.

  • Self reported data.

Sharing of injecting equipment; use of NSE.

Regular use of needle exchange was associated with the passing on of used equipment to others.

  • Self-reported data.

  • Sample may not be representative of the population (methadone program clients).

  • Statistical analysis did not clarify the effect of NSE.

Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
×

Study

Description

Sample Size (n)

Longshore et al., 2001

Tests frequency of attendance at an NSE in Providence, Rhode Island, as a correlate of injection risk indicators.

248 IDUs.

Vazirian et al., 2005

Compares the risk behaviors of IDUs with differential exposure rates to an HIV outreach program in Tehran, Iran. The outreach program includes a needle and syringe exchange program.

213 IDUs and 85 non-IDUs.

Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
×

Outcome Measures

Results

Limitations

Sharing of needles, cookers, and cotton filters; cleaning of the skin before injecting; and use of bleach as a needle disinfectant.

Results showed that IDUs who attended the NSE less frequently were more likely to report needle sharing, less likely to report always cleaning their skin, and more likely to report sharing cookers (the NSE distributes cotton and cookers in addition to needles). There was no association between NSE attendance and using bleach as a disinfectant.

  • May have underestimated relevance of NSE attendance for skin cleaning.

  • Self-reported data.

  • Frequency of NSE attendance is not a sensitive measure.

  • IDUs were not randomly assigned to the NSE or a non-NSE control group, and NSE attendees were not randomly assigned to various frequencies of attendance.

Contact with outreach program; length of contact; number of syringes received; HIV risk characteristics.

Of those (37) who received few needles/syringes from the program, 18.9% reported using a shared needle or syringe at last injection. None of the 68 IDUs who received >7 syringes per week from the program shared a needle at last injection. There was no difference in the two groups in sharing of cookers, condom use during last sex, level of HIV knowledge, or history of HIV testing.

  • Study design does not allow authors to make causal associations.

  • Selection bias due to convenience sampling.

  • Self reported data.

Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
×

REFERENCES

Amundsen EJ, Eskild A, Stigum H, Smith E, Aalen OO. 2003. Legal access to needles and syringes/needle exchange programmes versus HIV counseling and testing to prevent transmission of HIV among intravenous drug users: A comparative study of Denmark, Norway and Sweden. European Journal of Public Health. 13(3):252–258.

Bluthenthal RN, Kral AH, Gee L, Erringer EA, Edlin BR. 2000. The effect of syringe exchange use on high-risk injection drug users: A cohort study. AIDS. 14(5):605–611.

Bruneau J, Lamothe F, Franco E, Lachance N, Desy M, Soto J, Vincelette J. 1997. High rates of HIV infection among injection drug users participating in needle exchange programs in Montreal: Results of a cohort study. American Journal of Epidemiology. 146(12):994– 1002.

Bruneau J, Brogly SB, Tyndall MW, Lamothe F, Franco EL. 2004. Intensity of drug injection as a determinant of sustained injection cessation among chronic drug users: The interface with social factors and service utilization. Addiction. 99(6):727–737.

Cox GM, Lawless MC, Cassin SP, Geoghegan TW. 2000. Syringe exchanges: A public health response to problem drug use. Irish Medical Journal. 93(5):143–146.

Des Jarlais DC, Hagan H, Friedman S, Friedmann P, Goldberg D, Frischer M, Green S, Tunving K, Ljungberg B, Wodak A, Ross M, Purchase D, Millson M, Myers T. 1995. Maintaining low HIV seroprevalence in populations of injecting drug users. Journal of the American Medical Association. 274(15):1226–1231.

Des Jarlais DC, Marmor M, Paone D, Titus S, Shi Q, Perlis T, Jose B, Friedman SR. 1996. HIV incidence among injecting drug users in New York City syringe-exchange programmes. Lancet. 348(9033):987–991.

Des Jarlais DC, Perlis T, Friedman SR, Chapman T, Kwok J, Rockwell R, Paone D, Milliken J, Monterroso E. 2000. Behavioral risk reduction in a declining HIV epidemic: Injection drug users in New York City, 1990-1997. American Journal of Public Health. 90(7): 1112–1116.

Des Jarlais DC, Perlis T, Arasteh K, Torian LV, Hagan H, Beatrice S, Smith L, Wethers J, Milliken J, Mildvan D, Yancovitz S, Friedman SR. 2005a. Reductions in hepatitis C virus and HIV infections among injecting drug users in New York City, 1990-2001. AIDS. 19(Suppl 3):S20–S25.

Des Jarlais DC, Perlis T, Arasteh K, Torian LV, Beatrice S, Milliken J, Mildvan D, Yancovitz S, Friedman SR. 2005b. HIV incidence among injection drug users in New York City, 1990 to 2002: Use of serologic test algorithm to assess expansion of HIV prevention services. American Journal of Public Health. 95(8):1439–1444.

Donoghoe MC, Stimson GV, Dolan KA. 1989. Sexual behaviour of injecting drug users and associated risks of HIV infection for non-injecting sexual partners. AIDS Care. 1(1): 51–58.

Gibson DR, Brand R, Anderson K, Kahn JG, Perales D, Guydish J. 2002. Two- to sixfold decreased odds of HIV risk behavior associated with use of syringe exchange. Journal of Acquired Immune Deficiency Syndromes. 31(2):237–242.

Hagan H, Thiede H. 2000. Changes in injection risk behavior associated with participation in the Seattle needle-exchange program. Journal of Urban Health. 77(3):369–382.

Hagan H, Des Jarlais DC, Purchase D, Friedman SR, Reid T, Bell TA. 1993. An interview study of participants in the Tacoma, Washington, syringe exchange. Addiction. 88(12): 1691–1697.

Hagan H, Des Jarlais DC, Friedman SR, Purchase D, Alter MJ. 1995. Reduced risk of hepatitis B and hepatitis C among injection drug users in the Tacoma syringe exchange program. American Journal of Public Health. 85(11):1531–1537.

Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
×

Hammett TM, Kling R, Johnston P, Liu W, Ngu D, Friedmann P, Binh KT, Dong HV, Van LK, Donghua M, Chen Y, Des Jarlais DC. 2006. HIV prevalence and HIV risk behaviors among injection drug users prior to and 24 months following implementation of cross-border interventions in Northern Vietnam and Southern China. AIDS Education and Prevention. 18:97–115.

Hart GJ, Carvell AL, Woodward N, Johnson AM, Williams P, Parry JV. 1989. Evaluation of needle exchange in central London: Behaviour change and anti-HIV status over one year. AIDS. 3(5):261–265.

Hartgers C, van Ameijden EJ, van den Hoek JA, Coutinho RA. 1992. Needle sharing and participation in the Amsterdam Syringe Exchange program among HIV-seronegative injecting drug users. Public Health Reports. 107(6):675–681.

Huo D, Bailey SL, Garfein RS, Ouellet LJ. 2005. Changes in the sharing of drug injection equipment among street-recruited injection drug users in Chicago, Illinois, 1994-1996. Substance Use and Misuse. 40(1):63–76.

Hurley SF, Jolley DJ, Kaldor JM. 1997. Effectiveness of needle-exchange programmes for prevention of HIV infection. Lancet. 349(9068):1797–1800.

Keene J, Stimson GV, Jones S, Parry-Langdon N. 1993. Evaluation of syringe-exchange for HIV prevention among injecting drug users in rural and urban areas of Wales. Addiction. 88(8):1063–1070.

Kerr T, Tyndall M, Li K, Montaner J, Wood E. 2005. Safer injection facility use and syringe sharing in injection drug users. Lancet. 366(9482):316–318.

Klee H, Faugier J, Hayes C, Morris J. 1991. The sharing of injecting equipment among drug users attending prescribing clinics and those using needle-exchanges. British Journal of Addiction. 86(2):217–223.

Longshore D, Bluthenthal RN, Stein MD. 2001. Needle exchange program attendance and injection risk in Providence, Rhode Island. AIDS Education and Prevention. 13(1): 78–90.

MacDonald M, Law M, Kaldor J, Hales J, Dore GJ. Effectiveness of needle and syringe programmes for preventing HIV transmission. 2003. International Journal of Drug Policy Sterile Syringe Access for Injection Drug Users in the 21st Century: Progress and Prospects. 4(5-6):353–357

Mansson AS, Moestrup T, Nordenfelt E, Widell A. 2000. Continued transmission of hepatitis B and C viruses, but no transmission of human immunodeficiency virus among intravenous drug users participating in a syringe/needle exchange program. Scandinavian Journal of Infectious Diseases. 32(3):253–258.

Marmor M, Shore RE, Titus S, Chen X, Des Jarlais DC. 2000. Drug injection rates and needle-exchange use in New York City, 1991-1996. Journal of Urban Health. 77(3): 359–368.

Monterroso E, Hamburger M, Vlahov D, Des Jarlais DC, Ouellet L, Altice F, Byers R, Kerndt P, Watters J, Bowser B, Fernando MD, Holmberg S. 2000. Prevention of HIV infection in street recruited injection drug users. Journal of Acquired Immune Deficiency Syndromes. 25:63–70.

Ouellet L, Huo D, Bailey SL. 2004. HIV risk practices among needle exchange users and nonusers in Chicago. Journal of Acquired Immune Deficiency Syndromes. 37(1):1187– 1196.

Patrick DM, Strathdee SA, Archibald CP, Ofner M, Craib KJ, Cornelisse PG, Schechter MT, Rekart ML, O’Shaughnessy MV. 1997. Determinants of HIV seroconversion in injection drug users during a period of rising prevalence in Vancouver. International Journal of STDs and AIDS. 8(7):437–445.

Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
×

Safaeian M, Brookmeyer R, Vlahov D, Latkin C, Marx M, Strathdee SA. 2002. Validity of self-reported needle exchange attendance among injection drug users: Implications for program evaluation. American Journal of Epidemiology. 155(2):169–175.

Schechter MT, Strathdee SA, Cornelisse PG, Currie S, Patrick DM, Rekart ML, O’Shaughnessy MV. 1999. Do needle exchange programmes increase the spread of HIV among injection drug users?: An investigation of the Vancouver outbreak. AIDS. 13(6):F45–F51.

Schoenbaum EE, Hartel DM, Gourevitch MN. 1996. Needle exchange use among a cohort of injecting drug users. AIDS. 10(14):1729–1734.

Strathdee SA, Patrick DM, Currie SL, Cornelisse PG, Rekart ML, Montaner JS, Schechter MT, O’Shaughnessy MV. 1997. Needle exchange is not enough: Lessons from the Vancouver injecting drug use study. AIDS. 11(8):F59–F65.

van Ameijden EJ, Coutinho RA. 1998. Maximum impact of HIV prevention measures targeted at injecting drug users. AIDS. 12(6):625–633.

van Ameijden EJ, van den Hoek JA, van Haastrecht HJ, Coutinho RA. 1992. The harm reduction approach and risk factors for human immunodeficiency virus (HIV) seroconversion in injecting drug users, Amsterdam. American Journal of Epidemiology. 136(2):236–243.

van Ameijden EJ, van den Hoek AR, Coutinho RA. 1994. Injecting risk behavior among drug users in Amsterdam, 1986 to 1992, and its relationship to AIDS prevention programs. American Journal of Public Health. 84(2):275–281.

van den Hoek JA, van Haastrecht HJ, Coutinho RA. 1989. Risk reduction among intravenous drug users in Amsterdam under the influence of AIDS. American Journal of Public Health. 79(10):1355–1357.

van Haastrecht HJ, van Ameijden EJ, van den Hoek JA, Mientjes GH, Bax JS, Coutinho RA. 1996. Predictors of mortality in the Amsterdam cohort of human immunodeficiency virus (HIV)-positive and HIV-negative drug users. American Journal of Epidemiology. 143(4):380–391.

Vazirian M, Nassirimanesh B, Zamani S, Ono-Kihara M, Kihara M, Ravari SM, Gouya MM. 2005. Needle and syringe sharing practices of injecting drug users participating in an outreach HIV prevention program in Tehran, Iran: A cross-sectional study. Harm Reduction Journal. 2:19.

Vertefeuille J, Marx MA, Tun W, Huettner S, Strathdee SA, Vlahov D. 2000. Decline in self-reported high-risk injection-related behaviors among HIV-seropositive participants in the Baltimore needle exchange program. AIDS and Behavior. 4(4):381–388.

Vlahov D, Junge B, Brookmeyer R, Cohn S, Riley E, Armenian H, Beilenson P. 1997. Reductions in high-risk drug use behaviors among participants in the Baltimore needle exchange program. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology. 16(5):400–406.

Watters JK, Estilo MJ, Clark GL, Lorvick J. 1994. Syringe and needle exchange as HIV/AIDS prevention for injection drug users. Journal of the American Medical Association. 271(2):115–120.

Wood E, Tyndall MW, Spittal PM, Li K, Hogg RS, Montaner JS, O’Shaughnessy MV, Schechter MT. 2002. Factors associated with persistent high-risk syringe sharing in the presence of an established needle exchange programme. AIDS. 16(6):941–943.

Wood E, Kerr T, Spittal PM, Small W, Tyndall MW, O’Shaughnessy MV, Schechter MT. 2003. An external evaluation of a peer-run “unsanctioned” syringe exchange program. Journal of Urban Health. 80(3):455–464.

Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
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Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
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Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
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Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
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Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
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Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
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Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
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Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
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Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
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Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
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Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
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Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
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Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
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Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
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Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
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Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
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Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
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Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
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Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
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Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
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Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
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Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
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Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
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Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
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Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
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Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
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Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
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Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
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Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
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Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
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Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
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Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
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Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
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Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
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Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
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Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
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Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
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Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
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Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
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Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
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Suggested Citation:"Appendix D Tables Summarizing the Evidence on Multi-Component HIV Prevention Programs That Include Needle and Syringe Exchange." Institute of Medicine. 2007. Preventing HIV Infection Among Injecting Drug Users in High-Risk Countries: An Assessment of the Evidence. Washington, DC: The National Academies Press. doi: 10.17226/11731.
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Next: Appendix E Additional Thoughts on a Community Randomized Trial of Multi-Component HIV Prevention Programs »
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Drug dependence is a complex, chronic, relapsing condition that is often accompanied by severe health, psychological, economic, legal, and social consequences. Injecting drug users are particularly vulnerable to HIV and other bloodborne infections (such as hepatitis C) as a result of sharing contaminated injecting equipment. All drug-dependent individuals, including injecting drug users (IDUs), may be at increased risk of HIV infection because of high-risk sexual behaviors. There are an estimated 13.2 million injecting drug users (IDUs) world-wide—78 percent of whom live in developing or transitional countries. The sharing of contaminated injecting equipment has become a major driving force of the global AIDS epidemic and is the primary mode of HIV transmission in many countries. In some cases, epidemics initially fueled by the sharing of contaminated injecting equipment are spreading through sexual transmission from IDUs to non-injecting populations, and through perinatal transmission to newborns. Reversing the rise of HIV infections among IDUs has thus become an urgent global public health challenge—one that remains largely unmet.

In response to this challenge, the Institute of Medicine convened a public workshop in Geneva in December 2005 to gather information from experts on IDU-driven HIV epidemics in the most affected regions of the world with an emphasis on countries throughout Eastern Europe, the Commonwealth of Independent States, and significant parts of Asia. Experts from other regions also provided information on their experiences in preventing HIV infection among IDUs. This report provides a summary of the workshop discussions.

Preventing HIV Infection among Injecting Drug Users in High Risk Countries describes the evidence on the intermediate outcomes of drug-related risk and sex-related risk prior to examining the impact on HIV transmission. This report focuses on programs that are designed to prevent the transmission of HIV among injecting drug users. These programs range from efforts to curtail non-medical drug use to those that encourage reduction in high-risk behavior among drug users. Although the report focuses on HIV prevention for IDUs in high-risk countries, the Committee considered evidence from countries around the world. The findings and recommendations of this report are also applicable to countries where injecting drug use is not the primary driver, but in which injection drug use is nevertheless associated with significant HIV transmission.

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