Harm Reduction Action Center

Education on IDU-Specific Issues

The injection drug users (IDUs) community has one of the highest risks of HIV/HCV infection. However, the nature of the community - which is isolated, impoverished, stigmatized and transient - typically does not receive early and aggressive HIV/HCV education, testing or treatment.

The Value of Public Health Syringe Exchange Programs (SEPs)

The transmission of HIV among injection drug users and related populations of sex workers, youth, and other vulnerable populations, is greatly adding to the burden of disease in countries worldwide. Evidence from 20 years of research shows that SEPs prevent, control, and ultimately reduce the prevalence of HIV and other blood-borne infections among IDUs. These programs are now operating in 60 countries and in 36 states* in the United States; yet it is estimated that less than 2% of injection drug users are able to access sterile needles and syringes through SEPs.

*It is noted that Colorado signed in to law May of 2010 a legal syringe exchange program. Therefore it rests on the last 14 states to adopt this comprehensive public health intervention.

Protection of human rights is both universal and critical for the prevention of HIV as people are more vulnerable to infection when their economic, health, social or cultural rights are not respected. Equally, the punitive approach based on criminal justice measures, only drives underground those people who most in need of prevention and care services.

(Above information was presented to the World Health Organization, Joint United Nations Programme on AIDS, & United Nations Office on Drugs & Crime. More information can be found here and here.)

Safety and effectiveness of Syringe Exchange Programs (SEPs)

SEPs reduce HIV Transmission. Longitudinal studies tested injection drug users (IDUs) for HIV and compared those who used SEPs and those who did not. Some SEPs in the United States have operated since the late 1980’s. The data gathered permits researchers to evaluate it over a period of time. This additionally lends more information to gauge behavior change regarding drug use and HIV transmission. Furthermore, the basis of evaluation has now a greater accuracy by the administration of an HIV test, rather than relying on a self reported status. Concurrent with domestic findings, the World Health Organization reported in 2004 an “overwhelming” conclusion drawn from several global studies that SEPs reduce the spread of HIV.
SEPs reduce risky behaviors and injection drug use. SEP participants are less prone to share, lend, borrow, or reuse a dirty syringe when they have access (or, reliable source) to obtain a new and sterile syringe. Federal agencies for national health, such as CDC, SAMHSA, HRSA, & NIDA, conclude the use of clean and sterile syringes to prevent the spread of HIV and other blood-borne infectious diseases.
Syringe Exchange Programs (SEPs) do not promote substance abuse. Injection Drug Users (IDUs) who participate in SEPs do not have more positive urine test results or inject more frequently, than IDUs who do not use SEPs.
SEPs increase enrollment in drug treatment IDUs referred to treatment from SEPs are more likely to enter, stay, and remain in treatment. One study associated SEP participation with enrollment for methadone treatment among HIV-negative IDUs, another associated SEP use with entering a drug detoxification center, thus demonstrating an intervention for disease prevention also becoming a “bridge to drug treatment.” A third study found women were more prone to request methadone treatment, although men were more likely to enroll.

HHS Press Office (April 20, 1998). “Research shows needle exchange programs reduce HIV infections without increasing drug use.”

Hepatitis C (HCV) among Injection Drug Users

More than 76,000 Coloradans have been infected with the viral infection, Hepatitis C (HCV) with evidence that this number grossly underestimates the true disease burden in our State. Many with HCV will go on to have chronic life long infections that may require to chronic disease management or liver transplants. Though HCV is acquired in other ways outside of injection drug use, HCV is easily acquired by injecting drug users in sharing contaminated syringes or other injecting supplies (cotton, water and cooking devices). A non-published study among injection drug users in Denver found that 76% of those tested had been infected by HCV. HCV infection is further spread among other social networks such as populations in institutional facilities during “home-made tattooing practices”.

For more Hepatitis C information and resources please visit Hep-C Connection.

HIV among Injection Drug Users

As of September 30, 2008, according to the Colorado Department of Public Health and Environment (CDPHE), a total of 2,469 cases of HIV had been affected by injection drug use, accounting for 21% of all reported HIV cases in Colorado. Approximately 850 Colorado individuals are currently living with AIDS are attributed to injection drug use.

The overall poor health of an IDU exacerbates the impact of HIV/HCV disease on their quality of life and their ability to achieve any level of stability. This in turn, creates an enormous burden on their families. Women and MSM (men who have sex with men) are especially vulnerable sub-populations within the IDU population in Denver. They face unique exposures through combinations of unprotected sex and injection drug use that may put them at greater risk for HIV and HCV transmission.

Local Coverage of Syringe Exchange Issues in Denver