Friday, March 28, 2008

International Harm Reduction Association Website

One of the most useful resources for up-to-date information about Harm Reduction is the International Harm Reduction Association (IHRA) website, at:

Frequently, information I share with you on this BLOG comes from that site.

For those of you who prefer not to rely on me to vet info that makes it to you, you can sign up to receive your own regular updates from IHRA by visiting the site.

Hope this helps.

Monday, March 24, 2008

More evidence that needle distribution reduces transmission of blood borne viruses

Please find below an abstract from a paper offering more evidence of the efficacy of needle distribution to reduce the spread of HIV and other blood-borne viruses.


J Urban Health. 2008 Mar 14 [Epub ahead of print]

Greater Drug Injecting Risk for HIV, HBV, and HCV Infection in a City Where Syringe Exchange and Pharmacy Syringe Distribution are Illegal.

Neaigus A, Zhao M, Gyarmathy VA, Cisek L, Friedman SR, Baxter RC.

Institute for International Research on Youth at Risk, National Development and Research Institutes, 71 West 23rd Street, 8th Floor, New York, NY, 10010, USA,


Comparing drug-injecting risk between cities that differ in the legality of sterile syringe distribution for injection drug use provides a natural experiment to assess the efficacy of legalizing sterile syringe distribution as a structural intervention to prevent human immunodeficiency virus (HIV) and other parenterally transmitted infections among injection drug users (IDUs).

This study compares the parenteral risk for HIV and hepatitis B (HBV) and C (HCV) infection among IDUs in Newark, NJ, USA, where syringe distribution programs were illegal during the period when data were collected, and New York City (NYC) where they were legal. IDUs were non-treatment recruited, 2004-2006, sero-tested, and interviewed about syringe sources and injecting risk behaviors (prior 30 days). In multivariate logistic regression, adjusted odds ratios (AOR) and 95% confidence intervals (95% CI) for city differences are estimated controlling for potential city confounders.

IDUs in Newark (n = 214) vs. NYC (n = 312) were more likely to test sero-positive for HIV (26% vs. 5%; AOR = 3.2; 95% CI = 1.6, 6.1), antibody to the HBV core antigen (70% vs. 27%; AOR = 4.4; 95% CI = 2.8, 6.9), and antibody to HCV (82% vs. 53%; AOR = 3.0; 95% CI = 1.8, 4.9), were less likely to obtain syringes from syringe exchange programs or pharmacies (AOR = 0.004; 95% CI = 0.001, 0.01), and were more likely to obtain syringes from street sellers (AOR = 74.0; 95% CI = 29.9, 183.2), to inject with another IDU's used syringe (AOR = 2.3; 95% CI = 1.1, 5.0), to reuse syringes (AOR = 2.99; 95% CI = 1.63, 5.50), and to not always inject once only with a new, sterile syringe that had been sealed in a wrapper (AOR = 5.4; 95% CI = 2.9, 10.3).

In localities where sterile syringe distribution is illegal, IDUs are more likely to obtain syringes from unsafe sources and to engage in injecting risk behaviors. Legalizing and rapidly implementing sterile syringe distribution programs are critical for reducing parenterally transmitted HIV, HBV, and HCV among IDUs.

Tuesday, March 18, 2008

How to Manage a Needle and Syringe Program

Please find below a weblink to a very useful resource, published by WHO and written by IDU expert Dave Burrows (and others), on how to establish and manage a Needle and Syringe Program serving IDUs.


Guide to Starting and Managing Needle and Syringe Programmes by Dave Burrows, Nick Walsh, James Boothroyd et al. World Health Organization, Department of HIV/AIDS, 2007 64 pp. 812 kB

The transmission of HIV among injecting drug users and related populations of sex workers, youth and other vulnerable people is greatly adding to the burden of disease in countries worldwide. This guide is designed to assist in expanding the response to HIV among injecting drug users globally. The end of this guide provides a list of useful web sites, publications and networks, followed by annexes and notes.

Friday, March 14, 2008

Using pharmacies to deliver products to IDUs

Please find below an article explaining how California is about to mobilize pharmacies to deliver urgently-needed HIV prevention products like sterile syringes to IDUs.

PSI is already using this model in Kyrgyzstan. It has proven to be an extremely effective way of reaching young IDUs, who are embarresed to go to traditional Needle Exchange Points (NEPs).


Harm Reduction Through a Pharmacy Near You

Wednesday, March 12, 2008

DPA Southern California recently brought together more than 60 pharmacists and healthcare professionals to learn about how harm reduction principles and over-the-counter sales of syringes at pharmacies can reduce the spread of HIV, hepatitis C and other blood-borne diseases. With an estimated 84,000 people in Los Angeles County still sharing drug injection equipment, the need for this event was evident and urgent.
The conference, the 2008 Los Angeles Pharmacists’ Summit on Viral Diseases and Their Prevention, was organized by DPA’s Southern California Harm Reduction Coordinator Meghan Ralston, co-sponsored and hosted by the University of Southern California (USC) School of Pharmacy, and supported through a grant from the California Endowment.
Sales of syringes to adults without a prescription have been legal throughout the county since last year via a program called the Disease Prevention Demonstration Project. The Pharmacists’ Summit was designed to educate pharmacists and generate interest in the program, with the goal of encouraging enrollment.
“The County’s best and most recent estimate is that there are around 1,600 people in the county who are HIV positive because they shared syringes and were exposed to the virus. With an additional estimated 1,700 people here currently living with AIDS because of sharing syringes, and over 80,000 still sharing their equipment, it was clear that we needed to do even more to drive home the point that pharmacy sale of syringes needs to happen now, at every pharmacy in the county,” said Ralston.
Physician Laveeza Bhatti, HIV researcher Dr. Stan Louie, pharmacist and Clean Needles Now board president Terry Hair, and Ralston presented information at the half-day event on Sunday, February 24. The USC School of Pharmacy was delighted with attendees’ interest in the subject matter, and pleased that so many people turned out for the event on a rainy Sunday morning. Due to the strong success of the summit, DPA has been invited to work with USC again to create a similar event in the future.
“Syringe exchanges do great work and are essential in disease prevention, but unfortunately their hours and locations are really limited in L.A.,” said Ralston. “The Disease Prevention Demonstration Project will go a long way to helping to get sterile syringes to the people who need them. So far it’s been a huge success, with about 270 pharmacies now authorized to participate--but L.A. is huge and we still have a long way to go. The summit definitely brought us one step closer to our goal.”

Friday, March 7, 2008

Evidence of impact on smoking cessation

Following on last week's BLOG about smoking, I attach below a link to an intervention from "Behavior Works" the former PSI US Programs based in Portland, Oregon. This intervention has some initial data linking their program with reduced rates of smoking.

Thanks to David Olson for forwarding this to me.

Sunday, March 2, 2008

What about smoking?

Today's BLOG is not directly IDU-related, but is related to the topic of drug-related disease.

In most PSI countries, smoking-related illnesses account for a substantial portion of overall death and disability. And in many PSI countries, unfortunately, the problem is only getting worse.

To date, PSI has yet to delve into this field. The WHO has released a report on the "global tobacco epidemic." The link is below. I always thought that there is something PSI could be doing on this issue. The potential DALYs to be gained are enormous. It is not yet clear what that might be. I share this question with you for our common consideration.