Study Finds Effectiveness of Needle Exchange Increases With Rapidity of Needle Turn-In
In a study published in the American Journal of Public Health, researchers found that the apparent effectiveness of New Haven, Connecticut's Department of Health needle exchange program was due to the shortened length of time that the needles were in the hands of the public (Edward H. Kaplan, Ph.D., Kaveh Khoshnood, MPH, and Robert Heimer, Ph.D., "A Decline in HIV-Infected Needles Returned to New Haven's Needle Exchange Program: Client Shift or Needle Exchange? American Journal of Public Health, Dec. 1994, p. 1991-1994).
The study's lead author is responsible for compiling program evaluation information for the New Haven needle exchange. His team at Yale University tracks participants in the program and tests returned needles for the presence of HIV.
The proportion of HIV-infected needles to the total number returned to the program has fallen dramatically since the program's inception on Nov. 13, 1990. Critics of the program say that the decrease is due to a shift in client base and does not represent any decrease in the spread of HIV among injection drug users.
The researchers argue that the program is effective in cutting the amount of time that the needles are out in the injection drug using public, decreasing the likelihood that users will share the needles with one another. Accordingly, users have less of a chance of being infected if they are not sharing needles as frequently.
In the study, the researchers looked at whether client shifting or turn-around time of the needles might be responsible for the decrease in HIV-infected needles returned to New Haven's program. They looked at a number of variables over time and found only one change -- the percentage of whites using the program had increased over time. However, non-whites using the program were no more likely to be HIV-infected than whites. What did change was the time that the needles were out in the public before they were returned to the program. The duration of circulation time seemed to predict the number of HIV-infected needles returned. Increases in the duration the needles were in the public corresponded with increases in the level of HIV-infected needles.
The authors conclude that the data support the theory that decreased circulation time, and not a change in the client base, is responsible for decreasing HIV-infection among injection-drug using individuals.