Needle Exchange and Drug Treatment More Effective HIV Prevention
By Yale School of Medicine
Dec 18, 2006, 07:00

(HealthNewsDigest.com).. New Haven, Conn.- For injection drug users, the
most productive and cost-effective approach to managing the spread of HIV is
expanding syringe exchange and drug treatment, as well as promoting
antiretroviral treatment for those already infected with HIV, according to a
new study by researchers at Yale School of Medicine.

Published in the January issue of American Journal of Public Health, the
authors, led by Yale Public Health professor Robert Heimer, found that the
Centers for Disease Control and Prevention's (CDC) new approach of promoting
HIV testing, "Advancing HIV Prevention," may not be best for injection drug
users.

Heimer, professor in the Department of Epidemiology and Public Health at
Yale School of Medicine, said the CDC policy is based on the presumption
that the HIV epidemic can be curtailed in great part by promoting HIV
testing and that more resources should go to expanded testing of high-risk
populations. However, the results reported in this study revealed that
testing was already widespread for urban injectors.

Heimer and co-authors analyzed interviews conducted with 1,543 injection
drug users in five cities, including New Haven and Hartford, CT,
Springfield, MA, Chicago, IL, and Oakland, CA. Access to sterile syringes
through syringe exchanges or at pharmacies with a prescription was not
available in all cities. Injection drug users who participated in the study
were asked if they had been tested for HIV and if they had ever been told
they were HIV positive. From this, the research team estimated what
percentage had never been tested and what percentage did not know their
status.

Ninety-three percent of injectors had been tested, and of those currently in
need of testing, 90 percent were tested in the past three years and 70
percent within the past year. Less than three percent were infected with HIV
without their knowledge. Women and syringe-exchange participants were more
likely to have been tested at least once, and in the recent past. The team
estimated the number of undetected infections among urban injection drug
users in the United States to be fewer than 40,000.

"Our results highlight the need for shifting prevention dollars for urban
injection drug users," said Heimer, who is also an associate professor of
pharmacology at Yale. "It is more important to expend scant resources on
effective primary and secondary preventive programs including access to
clean syringes and helping users get into treatment for their addiction."

Heimer emphasized needle exchange programs, substitution therapy like
methadone and buprenorphine, and engaging those injection drug users already
infected with HIV in supportive anti-retroviral therapy. He said these
approaches have been shown to decrease the incidence of new infections at
rates sufficient to save money.

"When it comes to urban injection drug users, money will be wasted on
low-impact, low-yield counseling and testing programs," said Heimer.
"Prevention programs should not be compelled to generalize and accept a
single approach to preventing disease transmission. Injection drug users
should not be lumped in with other high risk groups. Instead, tailored
programs designed with their unique needs in mind will yield better
outcomes."

Since the study was conducted, Heimer and his colleagues have been working
to immunize injection drug users against hepatitis B, as well as developing
other interventions designed to reduce HIV infections in drug using
populations.

Other authors on the study were Lauretta Grau, Erin Curtin, Kaveh Khoshnood
and Merrill Singer.

Citation: American Journal of Public Health, Vol. 97, No. 1 (January 2007)