Needle Exchange Programs
ktrairatana | March 3, 2011 at 04:57 pmby
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Needle Exchange Programs Decrease the Epidemics of HIV/AIDS Injecting Drug Users
Vancouver, British Columbia, the third metropolitan of Canada, has a higher rate of drugs and substance use. Vancouver’s Downtown Eastside has been a center of injecting drug users (IDUs) of the community (Schechter et al., 1999). Needle Exchange Programs (NEPs), one of a strategy to prevent sexually transmitted infections (STIs), was first started in the mid-1980’s in Europe and spread to all over the world rapidly; and Vancouver formally has been started NEPs in 1989 (Kaiser Foundation, 2003). Many people agree with NEPs that decrease the risk of spread of STIs, while some of them disagree with the programs can help STIs solution. The NEPs, a controversial and political concern, is the prevention strategy of Public Health Care (PHC) system to decrease STIs, especially human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) in community, Vancouver.
There are many addictive drugs and many ways to consume those drugs into the body. People take both legal and illegal drugs for several reasons. All drug users prefer to use the addictive drugs because they feel a sense of detachment. The drug users prefer to administer the drugs by injection because of rapidity of their actions and preferences of each group depending upon the types of drugs, for instance, heroin, cocaine, and amphetamine and individual practice. Majority of drug users generally share devices for drug consumption. Injecting devices are one alternative for them to share in their activities because the appropriate or sterile solvents, syringes and needles or even alcohol swabs are not available and affordable for them in term of financial difficulty, readiness for preparation, emergent physical and psychological requirement or requirement, ignorance of harmfulness, and misconceptual norms and beliefs in some communities, counting people who had miserable history when they were children, for instance sexual and physical abuse, mental illness, homeless, street youth and inmate in correctional facilities (Public Health Agency of Canada, 2003). In many reasons of sharing injecting drug devices, the IDUs overlook the consequences, transmitted diseases, after sharing those devices. Hence, NEPs is an alternative for them to use new injecting devices individually and get away from transmitted diseases and any risk factors of other diseases.
NEPs is to provide clean needles and syringes for IDUs based on the viewpoint of harm reduction, by which the public health policies were created to reduce the harmful consequences related to drug use and other risk activities. PHC, nonprofit organization, and community support reports that hypodermic needles remain more than 20 blood-borne diseases, especially HIV/AIDS, hepatitis B and C (CBC News, 2004). Drug users using injecting apparatus are more concerned about their health and risks for sharing the injecting equipments to others although they are clean from STIs or other diseases. Regarding the human rights and PHC policies, the IDUs have the rights as same as other people that they have the opportunity to choose their preferred pathways of lifestyles. They also have access to receive the health care services anytime they want related to personal preferences. Moreover, NEPs is one program of healthcare services where they can access this service. The important thing for this program not only controls the transmitted diseases among drug users with injecting devices, but also prevents the transmitted diseases to other drug users without infecting devices and others who do not the drug users in the community.
The approach of the drug prevention and NEPs is based on the four pillars: prevention is education on substances and awareness, treatment is interventions and support programs, enforcement is redeployment of officers, and harm reduction is practical approach of decreasing negative consequences of drugs use in communities (Elliott et al, 2002). The harm reduction concept and intervention is to provide sterile needles and syringes for IDUs, including the injecting rooms, information about injecting procedure, drug intoxication and drug overdose, drug overdoses, and etc. for the safety of drug users and community (Wood et al, 2001). The harm reduction is mentioned in the study that revealed that approximately 25-35% of high HIV/AIDS prevalence rates among IDUs in Vancouver. It has been related to financial difficulty and poverty in the downtown eastside of the city (Public Health Agency of Canada, 2003). It also reflected the increasing rate of adult HIV positive/AIDS cases of IDUs from 4% to 30% between 1992 and 1998 (Public Health Agency of Canada, 2003). This means that IDUs have difficulties to have sterile needles and syringes available for their injecting drug activities. The better way is that they go to facilities and use the injecting drug supplies and other services from NEPs for their activities. The study also supports that NEPs significantly decrease HIV/AIDS risk behaviors, transmission of blood borne infections, and mortality rate in the community and surrounding areas (Wood et al, 2001).
Nowadays, the harm reduction expands its services not only to substance addiction, including NEPs, but also poverty, inadequate education, unemployment, and family dysfunction, which are negative consequences in community (Elliott et al, 2002). Hence, addictive people in the community, especially the Downtown Eastside of Vancouver absolutely agree with the program to assist them in their safely addictive practice and support them in counseling and information difficulties of their activities. Many people without addictive condition also agree with this program that can partially maintain the community clean and sober. They certainly trust the program that can control a number of prevalence of IDUs in specific locations, injecting users’ behaviors and lifestyles, and development and prognosis of STIs, especially HIV/AIDS, Hepatitis B and C and its outbreak in community. The program also has credible record and information of precise injecting users and increasing accuracy of communicable disease control. The study has shown that the IDUs who have been used the services of NEPs promotes a declining frequency of injection drug use; and it reflect the limitation of amount of IDUs and risks of HIV/AIDS, Hepatitis B and C prevalence (Kerr et al, 2010). The program forms closely like drug and substance abuse treatment or counseling program that the IDUs can continue to receive treatment. Therefore, many people feel more comfortable to have NEPs, at least the progression of prevalence IDUs and STIs is limited and increasing safety precaution to other people in the community.
In contrast, the survey had been shown that in Vancouver, the NEPs in 1990 distributed 343,995 needles (on average 942 needles per day), and by 2000 has increased to 3,449,539 needles (on average 9,451 needles per days) (Kaiser Foundation, 2003). From the survey, we recognize that there was rapidly increasing a numbers of needles during ten years, which signifies that there are increasing the number of IDUs and the frequency of drug use per day per capita. Many people argue that PHC has to spend the budget for this program, which is a very high cost and waste. IDUs decide to intentionally consume illegal drugs and substances. This means that they well realize predictably several negative consequences that will occur to them and the community. Although they have right to choose their preferences, they generate the problematic sequences back to themselves and others in the community. Many people question that it is appropriate for the PHC to facilitate all supplies for them to continue drug or substance use. It is quite controversy. The location of main NEPs service is at the eastside downtown of Vancouver, where it is extended, crowned, and mixed up with community positive consequence services and other private services, for instance, schools and colleges, libraries, hospitals, churches, theatres, and attractive points of tourists, and etc. Especially schools and colleges, NEPs supports public attention to the negative motion of IUDs who perform the negative role model to new generation. It is an inappropriate life pattern for students and adolescences to follow in the future. The service can bother or make difficulties to neighborhood and other services. NEPs is an offering service to IDUs, not a commitment for them to use the service every time they want to process their negative practice. It is very difficult to control their practice because they can lose contact any time they want. They can disperse throughout other communities and spread out diseases without caution. If they move to other communities or places, the service does not have case referrals to the new other services to take care of them further. It is a critical point for the new communities to cautiously watch out.
The Federal Minister of Health needs to pay attention in transmitted diseases epidemics and responds for the community. It provides the budget for the project programs and researches in this matter. Many studies support that harm reduction, focusing on NEPs, providing access to sterile needles and syringes to IDUs, has been succeeded from time to time. It is extremely and progressively effective in reducing HIV/AIDS and Hepatitis B and C transmission among IDUs and reflecting to other people in the community also. Although, the program seems to promote IDUs increasing drug use, it can control the diseases among this group and not disseminate those diseases to other groups in the community in the long run. This program is one of prevention strategy, which is not only more practical at the Eastside Downtown of Vancouver, Canada, but also more efficient in nationwide and worldwide.
CBC News Online. (2004). Point for point: Canada’s needle exchange programs, Retrieved on January 12, 2011 from http://www.cbc.ca/news/background/drugs/needleexchange.html
Elliott, R., Malkin, I., and Gold, J. (2002). Establishing safe injection facilities in Canada: Legal and ethical issues. Retrieved on January 12, 2011 from http://www.aidslaw.ca/publications/interfaces/downloadFile.php?ref=776
Kaiser Foundation. BC partners for mental health and addiction information. (2003). Needle exchange programs. Retrieved on January 12, 2011 from http://www.upnbc.org/needleexchange.pdf
Kerr, T., Small, W., Buchner, C., Zhang, R., Li, K., Montaner, J. & Wood, E. (2010). Syringe sharing and HIV incidence among injection drug users and increased access to sterile syringes. Retrieved on January 12, 2001 from http://www.bccdc.ca/NR/rdonlyres/25519E09-2221-4918-A19A-2264DE2AB7B1/0/Kerr2010syringesharing.pdf
Public Health Agency of Canada. (2003). Harm reduction and injection drug use: An international comparative study of contextual factors influencing the development and implementation of relevant policies and program. Retrieved on January 12, 2001 from http://www.phac-aspc.gc.ca/hepc/pubs/hridu-rmudi/index-eng.php
Schechter, M. T., Strathdee, A. S., Cornelisse, P. G.A., Currie, S., Patrick, D. M., Rekart, M., & O’Shaughnessy, M. V. (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.
Wood, E., Tyndall, M. W., Spittal, P. M., Li, K., Kerr, T., Hogg, R. S., Montaner, J. S.G., O’Shaughessy, M. V., Schechter, M. T. (2001). Unsafe injection practices in a cohort of injection drug users in Vancouver: Could safer injecting rooms help? Canadian Medical Association or Its Licensers. 165 (4), 405-409.