Effectiveness of needle and syringe programmes for preventing HIV transmission

MacDonald, Margaret; Law, Matthew; Kaldor, John; Hales, Jim; J. Dore, Gregory

doi:10.1016/S0955-3959(03)00133-6

Next »International Journal of Drug Policy
Volume 14, Issue 5 , Pages 353-357, December 2003

Effectiveness of needle and syringe programmes for preventing HIV transmission

Margaret MacDonald
- National Centre in HIV Epidemiology and Clinical Research, University of NSW Level 2, 376 Victoria Street, Darlinghurst, NSW 2010, Australia
- Corresponding author. Fax: +61-2-9332-1837.
Matthew Law
- National Centre in HIV Epidemiology and Clinical Research, University of NSW Level 2, 376 Victoria Street, Darlinghurst, NSW 2010, Australia
John Kaldor
- National Centre in HIV Epidemiology and Clinical Research, University of NSW Level 2, 376 Victoria Street, Darlinghurst, NSW 2010, Australia
Jim Hales
- Health Outcomes International Pty. Ltd., P.O. Box 1038, Kent Town, SA 5071, Australia
- Fax: +61-8-8363-9011.
Gregory J. Dore
- National Centre in HIV Epidemiology and Clinical Research, University of NSW Level 2, 376 Victoria Street, Darlinghurst, NSW 2010, Australia

Received 1 December 2002; received in revised form 15 March 2003; accepted 2 July 2003.

Abstract

Objective: To examine the effectiveness of needle and syringe programmes (NSPs) in preventing HIV transmission among injecting drug users (IDUs).

Methods: An ecological study design was used to determine change in HIV prevalence among injecting drug users between cities with and without NSPs. Several data sources, such as electronic journal databases, surveillance reports, websites, and index review of relevant journals, were used to identify studies of HIV seroprevalence among IDUs, and presence of NSPs. The rate of change in HIV prevalence was estimated by regression analysis.

Results: There were 778 years of data from 99 cities globally included in the analysis. HIV prevalence decreased by 18.6% per annum in cities that introduce NSPs, and increased by 8.1% in cities that had never introduced NSPs (mean difference −24.7% [95% CI: −43.8, 0.5%], P=0.06). The mean difference was –33% when comparison was weighted to one over the variance of the regression estimator (29% decrease in cities with NSPs and 5% increase in cities without NSPs, P<0.001). When analysis was restricted to cities with first HIV seroprevalence less than 10%, the average annual change in seroprevalence was 18% lower in cities with NSPs (P=0.03).

Conclusions: Despite the inherent limitations within an ecological study design, the study provides additional evidence that NSPs reduce transmission of HIV infection. The rapid spread of HIV among IDU populations and increasing rates of injecting in many countries calls for scaling up of NSPs as well as other harm reduction strategies.

Keywords: Syringe exchange programmes, HIV prevention, Australia