Reducing HIV Transmission through Syringe Services Programs
Evidence Supporting Syringe Services Programs
- A population-based analysis in British Columbia demonstrated a province-wide decline in new HIV diagnoses of greater than 90%, largely attributed to the expansion of harm reduction programs coupled with enhanced antiretroviral therapy coverage among people who inject drugs (PWID) 1
- An ecological study in Vancouver showed that increased ART coverage combined with harm reduction services corresponded with approximately 50% reduction in new HIV diagnoses, including those among PWID 2
- Needle and syringe exchange programs link individuals to health care services and provide sterile injection equipment, reducing transmission risks associated with sharing syringes, needles, cookers, cottons, and water 1, 2
- Health outcomes among PWID living in New York City when syringe exchange was legal were substantially better than those among PWID in Newark, New Jersey when exchange was illegal—Newark had substantially higher prevalence rates of HIV, hepatitis C virus (HCV), and hepatitis B virus (HBV) infections and more frequent needle reuse and sharing 1, 2
Why Other Options Are Less Effective
- Access to low-cost intrauterine devices addresses unintended pregnancy prevention but does not directly impact the primary modes of HIV transmission in the United States (injection drug use, male-to-male sexual contact, and heterosexual transmission) 3
- While reproductive health services are important, they do not address the 28% of AIDS cases associated with injection drug use 3
- Federal funding for abstinence-only education has continued despite studies demonstrating that such programs are unsuccessful in delaying sexual activity and provide little sound information (and in some cases, misinformation) about reducing risky sexual activity that may lead to HIV infection 4
- Abstinence-only programs do not provide evidence-based information about contraception and condom use as part of comprehensive sex education 4
- This approach has been shown to be ineffective in changing behaviors that lead to HIV transmission 4
- While STDs have a synergistic effect on HIV infectivity and susceptibility, and treating STDs can reduce HIV transmission risk, this represents a more limited intervention compared to SSPs 5, 6
- A randomized controlled trial in Tanzania showed that treatment of symptomatic STDs reduced HIV incidence, but this was in a setting with early HIV epidemic (4% prevalence), whereas a similar trial in Uganda with mature epidemic (16% prevalence) showed no difference 6
- HSV suppressive therapy addresses only one cofactor for HIV transmission, whereas SSPs address the direct transmission route responsible for 28% of AIDS cases 3
Maximizing SSP Effectiveness
- The simultaneous scale-up of combining access to ART, opioid substitution therapy, and harm reduction services can greatly reduce HIV incidence among PWID, and is supported by WHO, UNODC, and UNAIDS technical guidelines 1, 2
- Treatment for opiate addiction with opioid substitution therapies (especially methadone) increases the likelihood that PWID will initiate ART and increases ART adherence 1, 2
- Opioid substitution therapies reduce HIV transmission by reducing illicit opioid use, sharing of injection equipment, numbers of sex partners, and exchange of sex for drugs or money 1, 2