Syringe Exchange Programs --- United States, 2008

Syringe Exchange Programs --- United States, 2008
Weekly
November 19, 2010 / 59(45);1488-1491

Persons who inject drugs should use a new, sterile needle and syringe for each injection (1). Syringe exchange programs (SEPs) provide free sterile syringes and collect used syringes from injection-drug users (IDUs) to reduce transmission of bloodborne pathogens, including human immunodeficiency virus (HIV), hepatitis B virus, and hepatitis C virus (HCV). As of March 2009, a total of 184 SEPs were known to be operating in 36 states, the District of Columbia (DC), and Puerto Rico (North American Syringe Exchange Network [NASEN], unpublished data, 2009). Of these, 123 (67%) SEP directors participated in a mail/telephone survey conducted by NASEN and Beth Israel Medical Center (New York, New York) that covered program operations for the calendar year 2008. To characterize SEPs in the United States, this report summarizes the findings from that survey and compares them with previous SEP survey results from the period 1994--2007 (2--3). In 2008, the 123 SEPs reported exchanging 29.1 million syringes and had budgets totaling $21.3 million, of which 79% came from state and local governments. Most of the SEPs reported offering preventive health and clinical services in addition to basic syringe exchange: 87% offered HIV counseling and testing, 65% offered hepatitis C counseling and testing, 55% offered sexually transmitted disease screening, and 31% offered tuberculosis screening; 89% provided referrals to substance abuse treatment. Providing comprehensive prevention services and referrals to IDUs, such as those offered by many SEPs, can help reduce the spread of bloodborne infections and should increase access to health care and substance abuse treatment, thus serving as an effective public health approach for this population.

In March 2009, staff members from Beth Israel Medical Center and NASEN mailed surveys to directors of all 184 SEPs registered with NASEN at that time. The surveys included closed-ended questions regarding the number of syringes* exchanged, the types of services provided, budgets, and funding sources during 2008. Follow-up telephone interviews were conducted with the program directors by research staff members to clarify unclear or missing responses received on hard copy surveys. To protect participant confidentiality, many SEPs do not collect client-level data (e.g., number of persons who exchanged syringes or used other services); thus, the survey did not ask for such information. The data collection and analysis methods for this report are similar to those used in previous SEP surveys (2--3). The analyses for this report are limited to frequencies. To assess changes in funding over time, budgets from previous years were adjusted to 2008 dollars.

Data were compiled to show the numbers of programs known to NASEN, numbers of programs completing the surveys, syringes exchanged, and budget information for the surveys conducted from 1994--1995 through 2008 (Table 1). Rapid growth occurred in the number of SEPs in the United States in the 1990s and early 2000s, followed by more incremental growth through 2008. The 123 SEPs participating in the 2008 survey reported operating in 98 cities† in 29 states and in DC.§ A total of 120 SEPs reported budget information for 2008. The reported 2008 budgets for these 120 SEPs totaled $21.3 million; individual program budgets ranged from $300 to $2.3 million, with a median of $63,258.¶ Approximately one third (32%) of SEPs operated with a budget of <$25,000, 34% with $25,000--$100,000, and 37% with >$100,000. SEPs reported multiple sources of financial support in 2008, including private (individuals and foundations) and public (state and local government); 71% of the 120 SEPs that provided budget information received public funding, totaling nearly $16.8 million. The proportion of the SEP budgets coming from public sources increased from 62% during 1994--1995 to 79% in 2008 (Table 1).

SEPs were categorized as small, medium, large, or very large based on the number of syringes exchanged during 2008 (Table 2); SEPs reported exchanging a total of 29 million syringes in 2008. The 15 largest programs exchanged approximately 18 million syringes (62% of all syringes exchanged).

In 2008, many SEPs operated multiple sites, including fixed sites and mobile units. The total number of hours that clients were served by SEPs was summed for all sites operated by each program. The total number of scheduled hours per week ranged from <1 to 168 (mean: 29 hours per week; median: 24 hours per week). Delivery of syringes and other risk-reduction supplies to residences or meeting spots was reported by 41% of SEPs. A total of 111 (90%) SEPs allowed persons to exchange syringes on behalf of other persons (i.e., secondary exchange).

In addition to exchanging syringes, SEPs provided various supplies, services, and referrals in 2008; the percentage of programs providing each type of service was similar for the period 2005--2008 (Table 3). In 2008, all SEPs provided alcohol pads, and nearly all (98%) provided male condoms. Most (89%) provided referrals to substance abuse treatment. Other services also offered by SEPs included counseling and testing for HIV (87%) and HCV (65%), and screening for sexually transmitted diseases (55%) and tuberculosis (31%). Vaccinations for hepatitis A and B were provided by nearly half the programs (47% and 49%, respectively).
Reported by

V Guardino, DC Des Jarlais, PhD, K Arasteh, PhD, Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center; R Johnston, PhD, amfAR (Foundation for AIDS Research), New York, New York. D Purchase, A Solberg, North American Syringe Exchange Network, Tacoma, Washington. A Lansky, D Lentine, Div of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC.

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Syringe Exchange Programs --- United States, 2008
Syringe Exchange Programs --- United States, 2008