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Update:
Syringe Exchange Programs ---
United States, 2002
Syringe
exchange programs (SEPs) provide sterile syringes*
in exchange for used syringes to reduce transmission
of human immunodeficiency virus (HIV) and other
bloodborne infections associated with reuse of contaminated
syringes by injection-drug users (IDUs) (1). This
report summarizes a survey of SEP activities in
the United States for January--December 2002 and
compares the results with those of previous surveys.
The findings indicate that in 2002, for the first
time in 8 years, the number of SEPs, the number
of localities with SEPs, and public funding for
SEPs decreased nationwide; however, the number of
syringes exchanged and total budgets across all
programs continued to increase. SEPs can help prevent
bloodborne pathogen transmission by increasing access
to sterile syringes among IDUs and enabling safe
disposal of used syringes. Often, programs also
provide other public health services, such as HIV
testing, risk-reduction education, and referrals
for substance-abuse treatment.
In
December 2002, staff from Beth Israel Medical Center
(BIMC) in New York City and the North American Syringe
Exchange Network (NASEN) mailed surveys about syringes
exchanged and returned, services provided, and budgets
and funding to the directors of all 148 SEPs known
to NASEN (compared with 154 known SEPs for the 2000
survey, 131 for 1998, 113 for 1997, 101 for 1996,
and 68 for 1994--95) (2--5; BIMC, unpublished data,
2000). Data for 2002 were collected from SEP directors
during January--July 2003 through telephone interviews
with BIMC staff, Internet-based questionnaires,
or paper questionnaires returned by fax or mail.
With the exception of the Internet-based option,
the methods were similar to those used for previous
surveys (2--5).
Of
148 SEP directors contacted, 126 (85%) completed
the survey. These 126 SEPs reported operating in
102 cities in 31 states and the District of Columbia
(DC).¤ More than two-thirds (86) of SEPs were in
seven states: California (25), Washington (15),
New Mexico (14), New York (12), Wisconsin (eight),
Massachusetts (six), and Oregon (six).
SEP
size was classified by the number of syringes exchanged
(Table 1); 119 SEPs reported exchanging a total
of 24,878,033 syringes; seven SEPs did not track
the number of syringes exchanged. The 11 largest
programs¦ exchanged 49% of all syringes.
SEPs
provided other services in addition to syringe exchange.
One hundred ten (87%) SEPs provided male condoms,
96 (76%) female condoms, 111 (88%) alcohol pads,
and 86 (68%) bleach; 97 (77%) provided referrals
for substance-abuse treatment; 91 (72%) offered
voluntary on-site counseling and testing for HIV,
54 (43%) for hepatitis C, and 37 (29%) for hepatitis
B; 42 (33%) provided vaccination for hepatitis A
and 45 (36%) for hepatitis B; 39 (31%) offered sexually
transmitted disease (STD) screening; 29 (23%) provided
on-site medical care; and 28 (22%) provided tuberculosis
screening. Most programs provided risk-reduction
and risk-elimination education to IDUs. One hundred
fifteen (91%) programs provided education on hepatitis
A, B, and C; 114 (90%) on HIV/AIDS prevention; 111
(88%) on safer injection practices; 104 (83%) on
abscess prevention and care; 100 (79%) on vein care;
110 (87%) on STD prevention; 110 (87%) on male condom
use; and 94 (75%) on female condom use.
During
2002, a total of 126 SEPs maintained an average
of six exchange sites each (median: 3.0; range:
1--47). SEPs served clients for an average of 26
hours/week (median: 18 hours/week; range: 1--202
hours/week). Buildings (e.g., storefronts, clinics,
or health centers) were the most commonly reported
sites; 68 total SEPs (54%) operated 156 sites/week
for 1,334 hours/week). Forty-five (36%) programs
served clients through health vans or car stops
(203 sites/week for 616.5 hours/week), and 25 (20%)
operated other types of fixed sites, such as at
tables on streets, in private homes, or at shooting
galleries (i.e., locations where persons inject
drugs) (141 sites/week for 413.5 hours/week). Fifteen
(12%) programs used mobile workers on foot or bicycle
(81 sites/week for 202.0 hours/week). Of the 126
total SEPs in 2002, 69 (55%) had multiple types
of exchange sites, 36 (29%) were entirely building-based,
14 (11%) were vehicle-based, five (4%) used other
fixed sites, and two (2%) used mobile sites only.
Delivery of syringes and other risk-reduction supplies
to residences or meeting spots was reported by 62
(49%) SEPs. Secondary exchange (i.e., exchange of
syringes on behalf of other persons) was allowed
by 103 (82%) programs.
One
hundred ten of the 126 SEPs reported 2002 budget
information. The reported budgets totaled $13.0
million. Individual fixed budgets ranged from $0
(nine SEPs) to $1,035,831 (mean: $118,273; median:
$53,500) (Table 2). Thirty-one (28%) operated with
budgets of less than $25,000, 41 (37%) with budgets
of $25,000--$100,000, and 38 (35%) with budgets
exceeding $100,000. SEPs reported multiple sources
of financial support in 2002, including individual
contributors, foundations, and state and local governments.
In 2002, 58 (46%) of the 126 programs located in
15 states received public funding totaling approximately
$7.3 million from city, county, and state governments.**
In
2002, for the first time in 8 years, the number
of SEPs, the number of localities with SEPs, and
the amount of public funding for SEPs in the United
States decreased; however, the total number of syringes
exchanged and total budgets for all SEPs surveyed
continued to increase. During 2000--2002, the number
of SEPs known to NASEN decreased 3.8% (from 154
to 148), the number of states/territories with SEPs
decreased 8.6% (from 35 to 32), and public funding
of SEPs decreased 18% (from $8.9 million to $7.3
million). During the same period, the number of
syringes exchanged increased 10.2% (from 22.6 million
to 24.9 million) and total SEP budgets from public
and private funds increased 7.4% (from $12.1 to
$13.0 million). In addition, compared with data
from 1998 (5), the proportion of SEPs in 2002 considered
medium-sized (10,000--55,000 syringes exchanged)
or large (55,001--499,000 syringes exchanged) increased
19%, whereas the proportion of small SEPs (<10,000
syringes exchanged) decreased 33%.
Reported
by: CA McKnight, MPH, DC Des Jarlais, PhD,
T Perlis, PhD, K Eigo, Baron Edmond de Rothschild
Chemical Dependency Institute, Beth Israel Medical
Center, New York; M Krim, PhD, J Auerbach, PhD,
American Foundation for AIDS Research, New York,
New York. D Purchase, A Solberg, North American
Syringe Exchange Network, Tacoma, Washington. TS
Jones, RS Garfein, Div of HIV/AIDS Prevention, National
Center for HIV, STD, and TB Prevention, CDC.
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