Advocacy and coverage of needle exchange programs: results of a comparative study of harm reduction programs in Brazil, Bangladesh, Belarus, Ukraine, Russian Federation, and China

Abstract

To prevent or mitigate an AIDS epidemic among injecting drug users (IDUs), effective activities need to be implemented on a large enough scale to reach and assist sufficient numbers of drug users and thereby change their risk behaviors related to drug use and sex. Recent work by UNAIDS on "high coverage sites", adopting the above strategies, has shown that one of the key elements in achieving high coverage is ongoing and sophisticated advocacy. High coverage harm reduction sites were studied through literature search and site visits, including key informant interviews, review of service statistics, and data analysis, in order to document the steps that led to scaling up, the way coverage was defined in these sites, and the lessons learned from their efforts. Syringe-exchange programs can achieve high coverage of IDUs. Monitoring to determine regular reach (those who are in regular contact with harm reduction services) should be added to uniform data collection carried out by harm reduction programs. Advocacy is crucial to achieving high coverage.

Syringe Coverage in an Australian Setting: Does a High Level of Syringe Coverage Moderate Syringe Sharing Behaviour?

“…There is evidence to show that in contexts where people have reduced syringe availability there is a higher prevalence of receptive syringe sharing and blood borne viruses [7][8][9][10]. This is found to be true at the macro level where countries with less availability have higher HIV prevalence [11] and at a micro level where needle and syringe programs with highly restrictive dispensation policies have clientele who report more risky behaviours than programs with less restrictive dispensation policies [12,13]. The concept of syringe coverage has been useful for estimating the impact of syringe availability on syringe sharing behaviour.…”

“…At the population level, syringe coverage is calculated by approximating the proportion of the local population of PWID that has had at least one contact with a local syringe distribution program [11,16] or at least one contact with a syringe program within a given time period [11,20,21]. At the individual level, syringe coverage can be measured using a person's reported reuse of new syringes [13], or the ratio of syringes obtained for personal use to their total number of injections [7,9,12].…”

The art and the science of scaling‐up needle and syringe programmes

“…Unfortunately, the opposition to NSPs has little to do with science, and this appears true no matter where in the world we look [6][7][8]. What advocacy for NSPs entails has been defined clearly by Burrows [9] and others [10]. It includes strategies for overcoming fears and developing relationships with local community members, religious and community leaders, the media, government representatives-in ministries of health, justice, prisons-and, very importantly, with law enforcement officers.…”

“…A study conducted in the Russian Federation found that a history of having been arrested or detained was associated with increased syringe-sharing [11]. The most successful NSPs establish partnerships with law enforcement in planning and implementing programmes [9]. Experience has shown that persistent, nonconfrontational approaches are the most successful [8,9].…”

“…The most successful NSPs establish partnerships with law enforcement in planning and implementing programmes [9]. Experience has shown that persistent, nonconfrontational approaches are the most successful [8,9]. This applies to all the relationships that NSP programme staff must foster.…”