The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #70260

Thomas H. Riess, MPH¹, Moher Downing, MA², Karen Vernon¹, Courtney McKnight³, Don C. Des Jarlais, PhD³, and Brian R Edlin, MD². (1) Center for AIDS Prevention Studies, University of California, San Francisco, 74 New Montgomery Street, Suite 600, San Francisco, CA 94105, 415-597-9362, triess@psg.ucsf.edu, (2) Urban Health Study, Department of Family and Community Medicine, University of California, San Francisco, 3180 18th Street, Suite 302, San Francisco, CA 94110, (3) Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center, 1st Avenue and 16th Street, New York, NY 10003

Background: Syringe exchange programs (SEPs) have been shown to be highly effective in reducing HIV transmission among injecting drug users (IDUs). Despite this evidence, there is continuing opposition to implementation of SEPs in communities experiencing HIV epidemics among IDUs. Methods: Seventeen qualitative interviews were conducted with key informants in nine U.S. cities. Informants included AIDS prevention providers, political leaders, community activists, substance use and AIDS researchers, and health department directors. Cities were classified as to when they initiated SEPs as 1) early adopters, 2) middle adopters, and 3) late or never adopters. Results: Specific conditions were documented that facilitated or deterred the adoption of SEPs. Three implementation models were identified: 1) created by broad coalitions, 2) initiated from the top by government officials, and 3) set up by community activists. Coalition building and community consultation were key to the acceptance and sustainability of SEPs. Leadership from politicians, public health officials, and program directors provided authority, legitimacy and access to resources. Community activists took initiative and risks in the face of opposition but often lacked the resources to sustain their efforts. Successful implementers worked with or avoided the opposition rather than adopting adversarial positions, and sometimes utilized scientific research to garner support. Conclusion: Fear of SEP not being accepted by a community and lack of leadership are the biggest barriers to implementing SEPs. Understanding the conditions under which communities will accept SEPs can help in developing effective strategies to promote SEPs in areas where programs do not currently exist.

Learning Objectives:

At the conclusion of the session participants will be able to:
• List the three implementation models for syringe exchange programs.
• Recognize the need to understand community setting in establishing a syringe exchange program.
• Apply implentation models to an nascent syringe exchange program in order to increase its success.

Keywords: Needle Exchange Programs, Community Response

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.