Peer-Delivered Syringe Exchange: User-to-User community-based HIV prevention in New York City

Issues: HIV transmission among injection drug users and their sexual partners remains high. Syringe exchange is effective in reducing HIV infections, but disparities in transmission rates based on geography, age, race/ethnicity and gender remain due to persistent gaps in access to sterile injection equipment. Description: This presentation will provide an analysis of Peer-Delivered Syringe Exchange (PDSE), a program model in New York that trains injection drug users (IDUs) to conduct secondary syringe exchange with members of their social networks and other contacts. The analysis draws upon findings from multiple methods, including focus groups, qualitative interviews with IDUs conducting PDSE, health department officials, and other key stakeholders, and a quantitative survey of syringe exchange programs implementing PDSE. Lessons Learned: PDSE can expand syringe coverage to marginalized and high-risk IDUs who are unable or unwilling to access traditional syringe exchange services. PDSE also increases syringe exchange cultural competency and promotes healthier IDU communities though linkages to care and health promotion education. Drug-related stigma contributes to a lack of PDSE worker integration into syringe exchange programs, hindering overall program efficacy. Program eligibility criteria may pose a barrier to maximizing IDU participation in PDSE. Recommendations: Widespread implementation of PDSE and similar secondary syringe exchange models should be promoted to increase sterile syringe coverage, reduce HIV and hepatitis C transmission and promote healthier behaviors and norms among IDUs. Secondary syringe programs should provide adequate support, training and development opportunities to IDUs while minimizing barriers to broad participation.