243040 Peer-Delivered Syringe Exchange: User-to-User community-based HIV prevention in New York City

Monday, October 31, 2011

Emily Winkelstein, MSW , Policy Department, Harm Reduction Coalition, New York, NY
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.

Learning Areas:
Diversity and culture
Implementation of health education strategies, interventions and programs
Planning of health education strategies, interventions, and programs

Learning Objectives:
1. Name 5 key barriers to injection drug user access to sterile injection equipment. 2. Describe how Peer-Delivered Syringe Exchange expands syringe access to marginalized and harder to reach injection drug users who are at high risk for HIV and hepatitis C. 3. Assess the effectiveness of Peer-Delivered Syringe Exchange implementation in New York. 4. Identify 2 models for expanding secondary syringe access based on an evaluation of Peer-Delivered Syringe Exchange.

Keywords: Drug Injectors, Peer Education

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have worked extensively in harm reduction for 15 years. I collaborate with researchers, public health officials, and harm reduction programs on issues related to syringe access and HIV/hepatitis C prevention. I have written training curricula for the New York State Department of Health on issues relating to public health and drug use. I conducted syringe exchange for over 5 years and authored a comprehensive manual on syringe exchange development and management. I was the Project Director for a research project working exclusively with injection drug users.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.