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End of needle exchange
heightens risk, study says
January 25, 1999

When public opposition forced the closure of the Windham needle-exchange program two years ago, local officials vowed the program's termination would rid the city of its drug scene. They were wrong.

So found a team of social scientists at UConn who have completed the first empirical study that demonstrated - through interviews with needle-exchange clients, surveys of public drug-using sites and ethnographic interviews - how a community's demonstrably effective HIV-prevention efforts can be quickly eroded by the abrupt end of a key harm-reduction service.

Controversy has frequently surrounded the establishment of needle exchange programs, pitting scientific findings that show such programs reduce the spread of AIDS against widespread public concern that such services make matters worse. In Windham's case, closure of the needle-exchange program followed 10 months of tumultuous public debate, with opponents blaming the program for the community's ongoing drug scene.

"In fact, Windham now faces even more problems," says Robert S. Broadhead, a professor of sociology and lead author of the study. "With closure of the exchange and the campaign against it, Windham has seriously crippled its ability to protect the community against HIV and other drug-related diseases."

Broadhead and the other members of the UConn study team, Douglas D. Heckathorn, also a professor of sociology, and Yael Van Hulst, a graduate student, will release the results of the study at a colloquium sponsored by the Yale AIDS Program on January 28. The study will also be published in the February 1999 issue of Social Problems, the journal of the Society for the Study of Social Problems.

The primary goal of needle-exchange programs is to reduce HIV transmission associated with drug injection, by providing sterile syringes in exchange for used, potentially contaminated syringes. Data from the Centers for Disease Control and Prevention show that more than one-third (36 percent) of AIDS cases in the United States are directly or indirectly associated with injecting drug use. In Windham, 43 percent of AIDS cases are associated with drug injection.

Despite the public opposition displayed in Windham and a current ban on the use of federal funds for syringe-exchange programs, the number of such programs is growing nationwide. According to a paper in this month's American Journal of Public Health, 87 programs were operating in 71 cities in 28 states in 1996. By comparison, in 1994, just 60 syringe-exchange programs were reported operating in 46 cities and in 21 states.

There already exists a wealth of scientific findings showing that needle-exchange programs reduce unsafe injection practices. Yet the abrupt termination of the Windham needle-exchange offered an opportunity to re- examine this type of program as public health policy, from the perspective of what consequences the closure might pose for the community's public health.

For three years prior to the Windham needle exchange's closure, the Eastern Connecticut Health Outreach (ECHO) project, directed by the UConn research team, interviewed more than 300 Windham drug injectors and provided HIV-test counseling and education/preventio n services. In March 1997, the needle-exchange program, which operated independently of the ECHO project, was closed. Over the next 11 months, the ECHO project re-interviewed 111 former respondents who remained in the area and continued as active drug users, focusing on any changes in their risk behaviors. Of these, 78 were re-interviewed three months later. Among their findings:

  • Before closure, 14 percent of Windham's drug injectors reported that their primary source of syringes was from unsafe sources, such as family or friends. At the post-closure initial interview, the number reporting obtaining syringes from unsafe sources increased to 36 percent, and to 51 percent at the post-closure follow-up interview. More alarming, before closure only 4 percent of respondents obtained their syringes from street dealers - the least safe source. After closure the rate increased to 38 percent.

  • Before closure of the exchange, respondents reported re-using a syringe 3.52 times on average before disposal. After closure, this increased to 7.68 times, a 118 percent increase. This finding is significant because the amount of time a dirty syringe remains in circulation increases the probability it will become infected by re-use.

Surveys of public outdoor areas frequented by Windham's drug injectors, as well as the town's own monthly "recovery log" of syringes found by the police department, the department of public works, and an AIDS prevention outreach worker, found that the closure of the needle exchange had no effect on the number of discarded syringes and other drug-related debris found in the community.

"Science constantly butts up against persons or groups with agendas that science cannot control," says Broadhead. "But communities ignore solid evidence at their peril. We certainly see that in Windham."

David Bauman