Needles ; Syringes ; Needle-Exchange Programs

HIV/AIDS has become one of international public health problem. An effective method to spread HIV/AIDS is through shared needle and syringe among Injecting Drug Users (IDUs). Many studies have been undertaken to know the effect of Needle and Syringe Program (NSP) to reduce the risk behaviours of IDUs in sharing needle and syringe among IDUs. NSP has been implemented in Palembang since 2009. However, there is no previous research to examine IDUs behaviours in using non sterile injection and syringe in Palembang.Therefore, a research is needed to be undertaken to know the effect of NSP on IDUs’ behaviours in using sterile needle an syringe.To identify association between seeking behaviours of NSP on IDUs’ behaviours in using sterile needle and syringe.This was a case control study with respondents recruited using snowball and purposive technique. Simple and multiple logistic regression tests were performed using statistics program (Stata version 10) to identify main association between NSP access status and behaviours of using non-sterile needle and syringe. Some possible confounders were also explored. Odds ratio, 95 % Confidence interval and P value were reported.There were 121 IDUs, consisting of 41 IDUs in cases group (High risk group to use non sterile injection and syringe) and 80 IDUs in control group (low risk group to use non sterile injection and syringe). Mostly,respondents were male with senior high school education level and single status. Crude odds ratio indicated that IDUs accessing NPSs had an odds of 1.07 to share needle and syringe among IDUs compared to IDUS without accessing NSPs (OR=1.07, 95 % CI = 0.49-2.31), p=0.87). After OR was adjusted by knowledge about the spread and prevention of HIV/AIDS, IDUs’ Attitude towards Harm Reduction, education level, age, length of using Injectig, and income level, IDUs accessing NSPS tend to minimize their behaviours to share needle and syringe compared to IDUs in NSPs group by 29 % (odd ratio, 0.69, 95 % CI = 0.23-2.06, p=0.51). P value showed that there is weak evidence against the null hypotesis of no association between IDUs accessing NSPs and risk behavior of using non-sterile needle and syringe. Previous studies indicated that IDUS using NSPs tend to reduce the use of shared needle and syringe, and tend to wash their needle and syringe before another IDUs use them again (Gibson, 2001, Wodak A & Cooney A 2006). Therefore, NSP increase awareness of IDUs to prevent the spread of HIV/AIDS.Availability of NSP appeared to reduce the use of shared or non-sterile syringe or needle in this study, although the association was not significant. One of the reasons could be the free access of needle and syringe in pharmacy could be one confounding factors that contributed to this non significant association. Further research with bigger sample size and qualitative research to explore more in-depth information about IDUs’ behaviours in using non-sterile injection and syringe is recommended.
Drug Users ; Needles ; Syringes ; Needle-Exchange Programs ; Acquired Immunodeficiency Syndrome ; HIV

OBJECTIVETo measure related cost, effectiveness and benefit of needle and syringe exchange (NSP) in two provinces of Southwest China.

METHODSBetween September 2012 and February 2013, program files and questionnaires were used to collect the information about cost, effectiveness and benefit of NSP during three program years (July 2009 to June 2010, July 2010 to June 2011, July 2011 to June 2012 ) in 31 counties of two provinces of Southwest China. Unit cost indicators including cost of providing per syringe and cost of covering per IDU, number of new HIV infections avoided by providing needle and syringe exchange were used to evaluate the effectiveness of NSP, and the benefit indicators included the fees for ART, hospitalization cost and follow up of new HIV infection avoided by NSP. NEAR model was used to calculate the cases averted by NSP. Chi-square test was used to analyze the different percentage of allocation areas between two provinces.

RESULTSBetween July 2009 and June 2012, 25 374 041 yuan were totally used for NSP. In province A, the top investment area was management (1 848 485 yuan) while it was comprehensive intervention (5 452 355 yuan) in province B. The cost of providing per syringe was 3.67 yuan, and it decreased from 6.96 to 4.01 in province A and decreased from 3.38 to 2.17 in province B with the increasing needles distributed. The cost of covering per IDU was 712.71 yuan and the unit cost decreased from 882.85 to 574.95 in province A and decreased from 760.48 to 625.07 in province B with the growing number of IDUs intervened. A total of 1 307 new HIV infection were avoided by providing NSP, so 19 413.96 yuan would be used to avoid per IDU infecting HIV. A total of 367 507 488 yuan of HIV/AIDS related expenditure were avoided by NSP and the cost benefit ratio was 14.48.

CONCLUSIONNSP has a good cost-benefit ratio and should be promoted.

China ; Cost-Benefit Analysis ; Drug Users ; HIV Infections ; prevention & control ; Humans ; Needle-Exchange Programs ; economics ; Substance Abuse, Intravenous ; Surveys and Questionnaires ; Syringes

OBJECTIVETo evaluate the feasibility and effectiveness of needle and syringe exchange program among a community of injecting drug users (IDUs) on AIDS prevention.

METHODSA quasi-experiment design was used in a controlled community intervention study. Needle and syringe exchange program was implemented for 10 months in IDUs of an intervention community, including peer education and health education, provision of free needles and syringes, and collecting back of used needles and syringes by trained peer educators and local health workers, whereas no intervention measure in a control community was instituted. Interviews with IDUs were conducted before and after intervention with a snowballing strategy to evaluate its effectiveness.

RESULTSA total of 428 and 429 IDUs were interviewed with structured questionnaire before and after intervention in intervention and control communities, respectively. Results revealed that awareness of HIV-related knowledge increased from 29.4% to 58.7% in the intervention community. Multivariate logistic regression analysis showed that awareness of HIV-related knowledge was higher in those who had read health education materials (OR = 2.93, 95% CI 2.12 - 4.04). As compared with the baseline data, frequency of sharing needles and syringes in past 30 days in the intervention community decreased from 48.9% to 20.4% in before intervention community (chi(2) = 41.02, P = 0.001), whereas there was no significant change in the control community. The causes of sharing needles and syringes in the intervention community included 'disable to get needle and syringe during the night', 'lack of needle and syringe when injecting at friend's home', 'not daring to buy needle and syringe for fear of being arrested' and 'no money to buy needle and syringe', declined markedly.

CONCLUSIONSNeedle and syringe exchange program was feasible and effective in reducing their risky drug injecting behavior among IDUs in communities. Such strategy should be adopted in the country to reduce rapid spread of HIV.

Adult ; China ; epidemiology ; Female ; HIV Infections ; prevention & control ; transmission ; Health Education ; Humans ; Male ; Needle Sharing ; adverse effects ; statistics & numerical data ; Needle-Exchange Programs ; economics ; organization & administration ; Pilot Projects ; Program Evaluation ; Substance Abuse, Intravenous ; complications ; epidemiology