TY - JOUR
T1 - Needle-exchange participation, effectiveness, and policy
T2 - Syringe relay, gender, and the paradox of public health
AU - Valente, T.
AU - Foreman, R.
AU - Junge, B.
AU - Vlahov, D.
N1 - Funding Information:
This research was supported by the National Institute on Drug Abuse (DA09225 and DA10172). We thank Ronald Brookmeyer, Jacquie Astemborski, Peter Beilen-son, and an anonymous reviewer for advice and Melissa Marx, Elise Riley, Steve Huettner, Michele Brown, and the staff at the NEP who have worked diligently to reduce HIV infection in this population.
PY - 2001
Y1 - 2001
N2 - Needle-exchange programs (NEPs) have been politically controversial, and most studies have focused on evaluating their effectiveness on human immunodeficiency virus (HIV) transmission rates with little emphasis on the process of how they are used. This article shows that the way intravenous drug users use NEPs may influence their effectiveness. Using data from Baltimore's NEP, participants (N = 2,574) were classified as low, medium, and high users based on the volume, frequency, and duration of contact with the NEP. Higher NEP use was associated with shorter syringe circulation times and less syringe relay, returning syringes to the NEP originally acquired by someone else. For a subsample that was HIV tested (N = 262), syringe relay among women was associated with HIV seroconversion (at a 95% confidence interval). We conclude that exclusive use of the NEP (no relay) provides greater HIV protection than NEP use involving syringe relay. The paradox is that public health goals will not be achieved by prohibiting syringe relay activities and promoting exclusive use. NEPs should broaden their education efforts to have participants understand the value of repeated visits to the NEP.
AB - Needle-exchange programs (NEPs) have been politically controversial, and most studies have focused on evaluating their effectiveness on human immunodeficiency virus (HIV) transmission rates with little emphasis on the process of how they are used. This article shows that the way intravenous drug users use NEPs may influence their effectiveness. Using data from Baltimore's NEP, participants (N = 2,574) were classified as low, medium, and high users based on the volume, frequency, and duration of contact with the NEP. Higher NEP use was associated with shorter syringe circulation times and less syringe relay, returning syringes to the NEP originally acquired by someone else. For a subsample that was HIV tested (N = 262), syringe relay among women was associated with HIV seroconversion (at a 95% confidence interval). We conclude that exclusive use of the NEP (no relay) provides greater HIV protection than NEP use involving syringe relay. The paradox is that public health goals will not be achieved by prohibiting syringe relay activities and promoting exclusive use. NEPs should broaden their education efforts to have participants understand the value of repeated visits to the NEP.
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U2 - 10.1093/jurban/78.2.340
DO - 10.1093/jurban/78.2.340
M3 - Article
C2 - 11419584
AN - SCOPUS:0034970014
VL - 78
SP - 340
EP - 349
JO - Bulletin of the New York Academy of Medicine
JF - Bulletin of the New York Academy of Medicine
SN - 1099-3460
IS - 2
ER -