November 26, 2019
Needle and syringe programs: HIV prevention
Human Immunodeficiency Virus (HIV) has killed at least 32 million people globally since 1981 and is still one of the most serious contemporary challenges to public health.1 Since the 1980s, it has prompted a swathe of policies and programs to reduce transmission and provide treatment and care for people affected by HIV. Many of these measures are collectively referred to as ‘harm reduction’, including needle and syringe programs (NSPs).
NSPs provide people who inject drugs with hypodermic needles and other paraphernalia for free, or at a low cost. Australia has one of the lowest rates of HIV transmission via injecting drug use because of the availability of NSPs.2
What is HIV/AIDS?
AIDS stands for acquired immune deficiency syndrome. It is a condition caused by an infection of Human Immunodeficiency Virus (HIV) – a virus that, if left untreated, increases a person’s risk of developing opportunistic infections and cancers, and can cause death. HIV is carried by bodily fluids like blood, semen and breast milk.
As such, it can be transmitted through unprotected vaginal or anal sex, shared injecting equipment, breastfeeding, pregnancy and childbirth, and less commonly through blood transfusions or in healthcare settings. Saliva does not carry HIV, so it can not be transmitted by sharing drinks or kissing. HIV transmission via sex can be prevented by using condoms or Pre-Exposure Prophylaxis (PrEP).
Among people who inject drugs, one of the most effective and well-known harm reduction measures to prevent the transmission of HIV and other blood-borne viruses is the needle and syringe program.
What is harm reduction?
Harm reduction is one of the key pillars of Australia’s national strategy for minimising the harms associated with alcohol and other drug use. It means reducing negative or unintended effects of substance use for individuals, their loved ones and the community in general. This includes addressing the health, economic and social consequences of drug use and dependence.3
What are Needle and Syringe Programs (NSPs)?
NSPs are a harm reduction initiative. They provide unused needles and syringes to people who inject drugs in order to reduce the transmission of blood-borne viruses such as HIV, hepatitis B and C.4
NSPs can be delivered through:
- permanent sites
- secure dispensing units, such as monitored vending machines
- mobile services
- community health organisations such as cohealth, EACH and the North Richmond Community Health service.
NSPs are one of the most successful and cost-effective ways to reduce HIV transmission among people who inject drugs; and have been implemented in diverse settings, from developed cities to resource-poor and remote areas in south-east Asia.5
The origin of Needle and Syringe Programs (NSPs)
Modern NSPs originated in Edinburgh, Scotland, when there was an outbreak of hepatitis B and C among people injecting heroin between 1982 and 1984.6-8
After several failed attempts to introduce an NSP trial in Australia, Dr Alex Wodak established an illegal pilot needle and syringe program in November 1986, based in the Alcohol and Drug Service at St. Vincent’s Hospital, Darlinghurst.
His actions were spurred by the crisis of HIV/AIDS; and made possible by the support of some staff, activists, people who used drugs, the Sisters of Charity that ran the hospital, and the NSW Police, who refrained from arresting staff or people using the service.9
The following year, NSPs were adopted as part of the New South Wales government policy to reduce the risk of blood-borne virus transmission.
As a result of Australia’s needle and syringe programs, the proportion of new HIV diagnoses attributable to injecting drug use is one per cent of total HIV diagnoses.10 In contrast, globally:
“every four minutes, one person who injects drugs becomes infected with HIV and 50% (6.1 million) of people who inject drugs are living with hepatitis C.”11
NSPs have played a crucial role in HIV prevention and surveillance.12 According to the World Health Organization, providing needles and syringes to people who inject drugs has decreased HIV transmission by 18.6% annually.13
World AIDS Day
In 2016, there were an estimated 3,509 NSPs in Australia.14 For a full list of NSPs in Victoria, see the Victorian Government website.
- UNAIDS. Global HIV & AIDS statistics - 2019 fact sheet: UNAIDS; 2019 [cited 2019 18 November].
- Aspinall EJ, Nambiar D, Goldberg DJ, Hickman M, Weir A, Van Velzen E, et al. Are needle and syringe programmes associated with a reduction in HIV transmission among people who inject drugs: a systematic review and meta-analysis. Int J Epidemiol. 2014;43(1):235-48.
- Commonwealth of Australia (Department of Health). National Drug Strategy 2017-2026. Canberra; 2017.
- Abdul-Quader AS, Feelemyer J, Modi S, Stein ES, Briceno A, Semaan S, et al. Effectiveness of structural-level needle/syringe programs to reduce HCV and HIV infection among people who inject drugs: a systematic review. AIDS and behavior. 2013;17(9):2878-92.
- Wodak A, Cooney A. Effectiveness of sterile needle and syringe programming in reducing HIV/AIDS among injecting drug users. Geneva: World Health Organization; 2004.
- Robertson JR, Bucknall AB, Welsby PD, Roberts JJ, Inglis JM, Peutherer JF, et al. Epidemic of AIDS related virus (HTLV-III/LAV) infection among intravenous drug abusers. British medical journal (Clinical research ed). 1986;292(6519):527-9.
- Brettle R, Bisset K, Burns S, Davidson J, Davidson S, Gray J, et al. Human immunodeficiency virus and drug misuse: the Edinburgh experience. British medical journal (Clinical research ed). 1987;295(6595):421-4.
- Power R, Hartnoll R, Daviaud E. Drug Injecting, AIDS, and Risk Behaviour: potential for change and intervention strategies. British Journal of Addiction. 1988;83(6):649-54.
- Vumbaca G. Celebrating 20 years of needle and syringe programs. Of Substance: The National Magazine on Alcohol, Tobacco and Other Drugs. 2007;5(1):6.
- Kirby Institute. HIV in Australia: annual surveillance short report. Sydney; 2018.
- UNAIDS Joint United Nations Programme on HIV/AIDS. Harm Reduction Saves Lives. Geneva; 2017.
- Topp L, Day CA, Iversen J, Wand H, Maher L, NSPs CoA. Fifteen years of HIV surveillance among people who inject drugs: the Australian Needle and Syringe Program Survey 1995–2009. Aids. 2011;25(6):835-42.
- World Health Organization. Policy brief: provision of sterile injecting equipment to reduce HIV transmission. Geneva; 2004.
- Iversen J, Linsen S, Kwon J, Maher L. Needle Syringe Program National Minimum Data Collection: National Data Report 2016. Sydney: Kirby Institute; 2017.