Review
The effectiveness and safety of syringe vending machines as a component of needle syringe programmes in community settings

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Abstract

Syringe vending machines (SVMs) have been introduced in Europe and Australasia as part of the effort to increase the availability of sterile needles and syringes to injecting drug users (IDUs). This qualitative review of 14 published and grey literature studies examines whether community-based SVMs as a component of a comprehensive needle syringe programme (NSP) assist to reduce the spread of HIV and other blood-borne viruses amongst IDUs. The available evidence suggests that SVMs increase access to sterile injecting equipment, reduce needle and syringe sharing, and are likely to be cost efficient. SVMs also complement other modes of NSP delivery as they are used by IDUs who are less likely to attend staffed NSPs or pharmacies. If installed and properly maintained in a well-chosen location and with the local community well prepared, SVMs can enhance the temporal and geographical availability of sterile injecting equipment.

Introduction

Sharing contaminated injecting equipment remains the most common mode of HIV and hepatitis transmission amongst injecting drug users (IDUs). Most sterile injecting equipment is accessed by IDUs via needle and syringe programmes (NSPs), primarily via staffed outlets and pharmacies. Barriers to use of these staffed services however include concerns about anonymity and confidentiality, the need to travel long distances to access services, and limited opening times (Baxter, 2005, Sharp et al., 1991; Treloar & Cao, 2005). The provision of staffed services can also be logistically difficult and expensive during evenings and weekends. As part of the effort to diversify NSP delivery options, syringe vending machines (SVMs) have been introduced by some NSPs in an attempt to provide more anonymous access to and increased temporal and geographical availability of sterile injecting equipment.

SMVs are also known as ‘syringe dispensing machines’, ‘syringe automat’, ‘slot machines’, ‘syringe machines’, ‘FITPACK® vending machines’ (in Australia), ‘electronic dispenser’ (in New Zealand) and ‘distribox®’ (in France). They operate analogously to coin operated cigarette vending machines; most accept coins or used syringes and then mechanically provide sterile syringes in exchange. Some machines require no payment or exchange of equipment. Many SVMs also dispense health advice pamphlets, condoms and other minor health supplies together with the sterile needles and syringes (Loxley et al., 1991). SVMs appear to have been first used in Copenhagen, Denmark, in 1987 (Trond H. Diseth, personal communication) and have since been introduced in Norway, Germany, the Netherlands, Switzerland, Italy, Austria, Australia, France and New Zealand (Islam, Conigrave, & Stern, in press; Programmes for Needle and Syringe Provision, 2005).

This review examines whether community-based SVMs, as a component of a comprehensive NSP: (i) increase access to sterile injecting equipment; (ii) impact on syringe sharing, disposal and community levels of drug use; and (iii) offer potential for cost savings.

Section snippets

Methods

Journal papers and conference abstracts describing or evaluating the sale or dispensing of sterile needles and syringes through SVMs were identified using a comprehensive search of electronic databases including Medline, Medscape, Current Contents, HealthSTAR, CAB Abstracts and CINAHL. Search terms included: ‘syringe vending machine’, ‘automatic syringe machine’, ‘vending machines for IDUs’, ‘syringe exchange machine’, ‘syringe dispenser for IDUs’ and ‘electronic dispenser’. As relatively few

Increased access to sterile injecting equipment

All 14 studies included in this review found SVMs increased IDUs’ access to sterile injecting equipment (Table 1).

Enhanced temporal availability was identified as a key way in which SVMs increase sterile equipment access, particularly amongst IDUs with more chaotic lifestyles who are less likely to save sterile equipment to use when staffed outlets are closed (Diseth, 1989, Klaassen, 1989). For example, after the introduction of SVMs in Berlin in the early 1990s, SMVs became the NSP outlet with

Discussion

Injecting drug use is a highly stigmatised behaviour. As a result, a segment of IDUs prefer to stay out of view and so also may stay outside the reach of staffed NSP services (Baxter, 2005; Treloar & Cao, 2005). Other IDUs may find that staffed NSP services are offered in locations and at times not compatible with their lifestyle (Strike, Challacombe, Myers, & Millson, 2002). These IDUs can have poor access to sterile injecting equipment even in the context of extensive intervention efforts.

Conclusion

In spite of the relatively small number of published evaluations of SVMs, a consistent finding is that if installed properly in a well-chosen location with the local community well prepared, SVMs appear to enhance the availability of sterile injecting equipment by providing increased temporal and geographical availability. SVMs appear to offer a comparatively inexpensive mode of NSP, but efforts need to be made to ensure that they function reliably and are sufficiently sturdy to withstand

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