Objective: To assess the impact of syringe exchange programs (SEPs) on HIV risk and transmission. Methods: Beginning in 1996, 683 SEP users and 221 drug injectors from an area of Chicago with no SEP (‘controls’) were interviewed and tested for HIV. Follow-up data collection was scheduled at 1-year intervals. Analysis: Baseline comparisons in injection risk and HIV serostatus were made between those who lived in an area with SEP and obtained over half their syringes from an SEP in the previous 6 months (‘consistent SEP users’) and controls who used no SEP. In the longitudinal analysis, comparisons were made between all SEP users, consistent SEP users and controls. Analytic methods include McNemar’s chi-square tests, multiple logistic regression and survival analysis. Results: The sample is 45% African-American, 20% Latino, 34% White, 28% are women, and median age is 42 years. Compared to SEP nonusers, consistent SEP users were significantly less likely at baseline to have engaged in recent multiperson use of syringes, cookers, cotton filters and water, or to use a syringe for more than one injection. At follow-up, all groups reported sizable and statistically significant reductions in injection risk, but SEP participants compared to SEP nonusers reported lower risk levels. HIV incidence was notably low for all groups despite a background HIV prevalence among SEP users (18%) over twice that of the SEP nonusers (7%). Conclusion: Participation in an SEP is associated with declines in injection risk practices and low levels of seroincident HIV infection.
Learning Objectives: At the presentation’s conclusion, participants should be better equipped to discuss the impact of syringe exchange programs on HIV risk and to assess certain methodological difficulties in evaluating SEPs that may lead to an underestimation of the impact of SEP on risk reduction.
Keywords: Needle Exchange, HIV Interventions
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: Campaign for a Drug-Free Westside (CDFW), Chicago Health Outreach (CHO), Community Outreach Intervention Projects (COIP)
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: COIP, which I direct, is one of the contractors funded by the City to provide SEP. Much of this funding is subcontracted to CDFW & CHO and none supports my salary.