Needle exchange programs and drug use
CMAJ 1998;158:171
Re: "Needle exchange programs: an economic evaluation of a local experience" (CMAJ 1997;157[3]:255-62 [full text / résumé]), by Michelle Gold and associates
In response to: W.D. Gutowski
Dr. Gutowski raises the question of the role of homosexual activity in spreading HIV among injection drug users (IDUs). Although data from Toronto suggest a much higher prevalence of HIV infection among male IDUs who also report having sex with other men,1 this represents a small percentage of the overall population of IDUs. It is clear that in Canada and elsewhere the majority of HIV infections among IDUs are occurring in heterosexual users who are infected after sharing needles and other drug paraphernalia, or through heterosexual contact with partners infected by this means. The relatively low estimates of incidence cited in our study are in keeping with infection rates occurring in the latter population.
We interpret Gutowski's primary concern to be the concept of needle exchange and its role in the harm-
reduction approach to injection drug use. Research has indicated that needle exchange does not encourage injection drug use or lead users to believe that they are being encouraged to continue their drug use.2 Qualitative evidence from an early evaluation of British needle exchange programs showed that they provided a means for IDUs to discuss their concerns about drug use and treatment options in a user-friendly, nonjudgemental environment; this may be especially beneficial for those not yet ready to approach a treatment program directly, because it will encourage them to take this step.
An economic evaluation like ours must rely on estimates of HIV incidence among IDUs and the impact of needle exchange programs on these users. Unfortunately, there is no definitive way of knowing how many cases might have been prevented except by failing to prevent them. The paper demonstrates that the costs of that approach are high and are likely to more than outweigh the costs of even moderately successful prevention strategies. The goal of harm reduction is not to encourage injection drug use; it is to respect the users and offer them a chance to avoid life-threatening diseases while determining how best to cope with their drug-use issues.
Michelle Gold, MSW
Department of Clinical Epidemiology
and Biostatistics
McMaster University
Hamilton, Ont.
Amiram Gafni, PhD
Department of Clinical Epidemiology
and Biostatistics
Centre for Health Economics
and Policy Analysis
McMaster University
Hamilton, Ont.
Penny Nelligan, RN, BScN
HamiltonWentworth Regional Public
Health Department
McMaster University and
University of Guelph
Peggy Millson, MD, MHSc
HIV Social, Behavioural and
Epidemiological Research Unit
Department of Public Health Sciences
Faculty of Medicine
University of Toronto
Toronto, Ont.
References
- Millson P, Myers T, Rankin J, Major C, Fearon M, Rigby J. Drug injecting and risk of HIV infection in Toronto. Toronto: Department of Public Health Sciences, Faculty of Medicine, University of Toronto; 1995. Final report of NHRDP grant 6606-4694-AIDS.
- Normand J, Vlahov D, Moses LE, editors. Preventing HIV transmission: the role of sterile needles and bleach. Washington: National Research Council/Institute of Medicine; 1995.
 |
Send a letter to the editor responding to this letter
Envoyez une lettre à la rédaction au sujet de cette lettre |
Letters