APPENDIX B Professional Association Positions on Needle Exchange and Bleach Distribution Programs

Chapter 4 summarized the panel's efforts to obtain views on needle exchange and bleach distribution programs from professional and trade associations that represent service providers. The panel contacted 25 such organizations; 13 responded, and 8 provided statements of their formal or informal positions. This appendix summarizes the responses by the panel to this request for information.

Alcohol and Drug Problems Association of North America (ADPANA)

No response was received.

American Academy of Health Care Providers in the Addictive Disorders (AAHCPAD)

No response was received.

The American Academy of Psychiatrists in Alcoholism & Addictions (aaPaa)

We are very pleased that the American Academy of Psychiatrists in Alcoholism & Addictions has been asked for their position on the issue of needle exchange programs. We believe that the expertise represented by our membership must be seriously considered in any study of drug use behaviors, research and treatment.



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Preventing HIV Transmission: The Role of Sterile Needles and Bleach APPENDIX B Professional Association Positions on Needle Exchange and Bleach Distribution Programs Chapter 4 summarized the panel's efforts to obtain views on needle exchange and bleach distribution programs from professional and trade associations that represent service providers. The panel contacted 25 such organizations; 13 responded, and 8 provided statements of their formal or informal positions. This appendix summarizes the responses by the panel to this request for information. Alcohol and Drug Problems Association of North America (ADPANA) No response was received. American Academy of Health Care Providers in the Addictive Disorders (AAHCPAD) No response was received. The American Academy of Psychiatrists in Alcoholism & Addictions (aaPaa) We are very pleased that the American Academy of Psychiatrists in Alcoholism & Addictions has been asked for their position on the issue of needle exchange programs. We believe that the expertise represented by our membership must be seriously considered in any study of drug use behaviors, research and treatment.

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Preventing HIV Transmission: The Role of Sterile Needles and Bleach Although aaPaa has no formal policy on needle exchange, we are currently reviewing the American Psychiatric Association's [APA's] policy [see below] which has been approved by the APA board. Our Public Policy Committee has not formally endorsed the APA policy but is very likely to recommend endorsement at our next board meeting. We feel that further study of needle programs is useful and may be an adjunct to other psychosocial approaches in addition to methadone in the treatment of injecting drug users. If you have questions or require additional information, please contact us. We would welcome the opportunity to meet with you to more fully inform you regarding the philosophy, goals and priorities of aaPaa. Thank you for the opportunity to express our views on this important issue. American Association of Public Health Physicians (AAPHP) No response was received. American College of Addiction Treatment Administrators (ACATA) ACATA deals almost exclusively in professional development and credentialing of administrators in the field. Consequently, it has not dealt with needle exchange and bleach distribution programs and does not have a position on this issue. American Medical Association (AMA) Whereas, AMA policy 20.977 recognizes the urgent need to decrease transmission of human immunodeficiency virus (HIV) and calls for ''pinpoint(ing) effective strategies (including needle exchange programs)" to reduce the spread of HIV infection among intravenous drug abusers; and Whereas, Negative consequences of needle exchange programs have not been detected, i.e., no increase in injection drug use or changing of drug use behavior from non-injection to injection; and Whereas, Syringe and needle exchange (SANE) programs reduce the rising incidence of HIV infection among intravenous drug users; and Whereas, Difficulty in obtaining sterile needles and syringes is significantly and independently associated with needle sharing; therefore be it RESOLVED, That the American Medical Association encourage needle exchange programs. American Medical Association House of Delegates Resolution 231 (I-94)

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Preventing HIV Transmission: The Role of Sterile Needles and Bleach American Psychiatric Association (APA) APA Policy on Clean Needle and Syringe Exchange: Addiction treatment on demand may be the most effective means of reducing HIV transmission among injecting drug users (IDUs). Treatment on demand, however, does not exist in most areas where injecting drug use is prevalent. In addition, a significant number of IDUs do not seek treatment. The APA recommends that clean needle and syringe exchange programs be developed and independently evaluated in terms of their efficacy in reducing HIV transmission and their impact on the prevalence of injecting drug use. The APA believes that those areas where treatment on demand is available are the most appropriate sites for evaluating this promising but unproven intervention. Further, the APA supports all efforts to increase addiction treatments to meet the need. American Psychological Association (APA) No response was received. American Public Health Association (APHA) Policy: In 1989, APHA passed a policy resolution, "Illicit Drug Use and HIV Infection," that addresses the issue. Our policy process requires that resolutions be based on scientific fact. Because of the lack of research findings on needle exchange at that time, the policy only goes so far as to call for the research and evaluation of needle exchange programs. The AIDS Working Group of APHA's Special Initiative on AIDS is drafting a new policy on needle exchange which will take into account current research and will be submitted for the 1994 policy resolution process. Commentary: Public health strategies such as needle exchange and bleach distribution are critical components necessary to fight the twin epidemics of substance abuse and HIV infection. In January 1990, APHA's Special Initiative on AIDS published a report on "Illicit Drug Use and HIV Infection." The reports in the AIDS series are sold to our members and the general public for a low price and are a good source of basic information on topics such as needle exchange. This particular report examines needle exchange and bleach distribution programs, and contains an appendix that describes programs that existed at that time. American Society of Addiction Medicine (ASAM) Background: Needle Exchange Programs are a crucial component of a spectrum of HIV prevention services to drug injectors which effectively

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Preventing HIV Transmission: The Role of Sterile Needles and Bleach reduce the transmission of the Human Immunodeficiency Virus. The preferred options within the spectrum are abstaining from the injection of drugs and engagement within the drug treatment system. Other public health interventions which will reduce the transmission of blood borne pathogens include: teaching injection equipment sterilization techniques, teaching safer injecting practices, safer sex education and counseling, the provision of HIV literature and the distribution of risk-reducing materials including condoms, dental dams, and bleach kits. International and U.S. evaluation studies of needle exchange, as an additional method of risk reduction, have not shown an increase in drug use, an increase in injection as a route of drug administration, nor have they shown an increase in contaminated injection equipment in the community. These studies consistently show decrease in equipment sharing, strongly suggesting a decrease in incidence of new infections of blood borne pathogens such as HIV or Hepatitis B. The programs also serve as a point of contact between heretofore alienated drug dependent persons and service providers who can help them improve their health. In fact, the most requested service by needle exchange clients throughout the world is placement in drug treatment programs. ASAM Position: For these reasons, ASAM recommends that: Needle/distribution exchange programs be instituted in all communities with injection drug users. Drug paraphernalia laws be amended to eliminate those statutes outlawing the possession of syringes or needles. Proper federal agencies be encouraged to sponsor needle exchange programs on a Federal level. (Adopted by ASAM Board of Directors, October 2, 1994.) Association of Black Psychologists (ABP) No response was received. Association of Medical Education and Research in Substance Abuse (AMERSA) The panel received a call on March 16, 1994, to indicate that its query would be an item for the association's board to discuss at its meeting at the end of April 1994. It was indicated that a statement, if any, would be forwarded for our information in May 1994. No statement was received. Black Psychiatrists of America (BPA) No response was received.

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Preventing HIV Transmission: The Role of Sterile Needles and Bleach Chemical Dependency Treatment Programs Association (CDTPA) The panel was informed that this association no longer exists. Drug and Alcohol Nursing Association (DANA) No response was received. National Association of Addiction Treatment Providers (NAATP) NAATP does not have positions on either of these matters. National Association of Alcoholism and Drug Abuse Counselors (NAADAC) No response was received. National Association of Psychiatric Health Systems (NAPHS) Informal Position: Although NAPHS does not have a formal position on these issues, its view is that the clear nexus between HIV-infected needles and transmission of the virus is so powerful that we can ill afford to ignore any opportunity to intervene in the prevention of the infection. National Association of Social Workers (NASW) AIDS/HIV Statement—Recommendation: HIV and AIDS prevention and treatment efforts must incorporate substance abuse issues into their models. By impairing judgment, alcohol and other drug use leads to increased participation in high-risk activities and contributes to the increase in HIV infection. The sharing of any kind of injection equipment will contribute to the spread of the virus. Additionally, although the percentage of cases resulting from men having sex with men is decreasing, the rate of infection resulting from substance use is increasing, that is, the person with AIDS was an injection drug user or had sex with an injection drug user. HIV/AIDS prevention and education must therefore include needle exchange programs as well as substance abuse prevention efforts that are explicit, relevant, and culturally sensitive. There also needs to be an increase in drug treatment slots, particularly for parents. All human services and educational institutions, including correctional facilities, have the responsibility to carry out maximum HIV prevention activities, including education and needle exchange and condom accessibility programs, as appropriate. Agencies should be encouraged to … Provide information on prevention and other issues. All agencies have a responsibility to educate clients

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Preventing HIV Transmission: The Role of Sterile Needles and Bleach about risk reduction behaviors, including safer sexual practices, not sharing needles or other injection equipment, proper needle-cleaning techniques, needle exchange programs, tuberculosis prevention, and life skills such as sexual negotiation and assertive communication. National Association of State Alcohol and Drug Abuse Directors (NASADAD) The NASADAD Board of Directors formally passed the following resolution on September 18, 1991: The NASADAD Board of Directors supports the recommendations of the National Commission on AIDS regarding the Twin Epidemics of Substance Use and HIV. Additional alcohol and other drug abuse prevention and treatment services, increased HIV prevention activities, and expanded research and epidemiologic studies are urgently needed to prevent further HIV transmission among highly vulnerable and at-risk populations. NASADAD recommends support for bleach and/or needle distribution programs in areas and geographic regions where appropriate. However, the decision to conduct bleach and/or needle distribution programs should remain at the discretion of States and Territories and/or local communities (where legally permissible). National Association of Substance Abuse Trainers and Educators (NASATE) No response was received. National Consortium of Chemical Dependency Nurses, Inc. (NCCDN) The NCCDN has no official position on the issues of needle exchange and bleach distribution. This type of program is quite controversial among treatment professionals and the Board of Directors has chosen to not officially speak to these techniques. National Nurses Society on Addiction (NNSA) No response was received. Social Work Administrators in Health Care (SWAHC) No response was received. Therapeutic Communities of America (TCA) No response was received.