A syringe exchange programme in prison as prevention strategy against HIV infection and hepatitis B and C in Berlin, Germany

Abstract

SUMMARYIn two prisons in Berlin, Germany, provision of sterile injection equipment for injecting drug users (IDUs) started in 1998. To assess the programme's impact, the frequency of injecting drug use and syringe sharing, and the incidence of HIV, HBV, and HCV infection were determined in a follow-up study. Of all IDUs (n=174), 75 % continued to inject. After the project start the level of syringe sharing declined from 71% during a 4-month period of previous imprisonment to 11% during the first 4 months of follow-up, and to virtually zero thereafter. Baseline seroprevalences for HIV, HBV, and HCV were 18, 53, and 82 %. HIV and HCV seroprevalence at baseline was significantly associated with drug injection in prison prior to the project start. No HIV and HBV seroconversions, but four HCV seroconversions occurred. The provision of syringes for IDUs in appropriate prison settings may contribute to a substantial reduction of syringe sharing. However, the prevention of HCV infection requires additional strategies.

Hospital admission is a relevant source of hepatitis C virus acquisition in Spain

“…It is generally assumed that most new cases of hepatitis C acquired in recent years are related to needle sharing among intravenous drug users [1,16]. However, it is important to notice that the implementation of syringe exchange programs and methadone maintenance therapy among drug addicts has contributed to a reduction in HIV and HCV transmission [9][10][11][12][13]. Among other risk factors for HCV acquisition promiscuous sexual behavior and occupational contacts are well established [17].…”

“…First, blood transfusion has virtually disappeared as a mechanism of HCV transmission in developed countries. Second, since the implementation of syringe exchange programs and methadone maintenance therapy, there has been a reduction of HIV and HCV transmission among drug users [9][10][11][12][13]. Thus, the relative impact of nosocomial HCV transmission might be greater now than a few years ago.…”

Trends in HCV prevalence, risk factors and distribution of viral genotypes in injecting drug users: findings from two cross-sectional studies

“…On the other hand, IDUs reported a high frequency of needle-sharing while imprisoned, an important route of viral transmission in prison inmates [31]. Stark et al [32] studied the impact of a syringe exchange programme carried out in two prisons in Berlin. After 4 months, syringe sharing declined from 71 .…”

Seroepidemiology and Risk Factors Of Blood-Borne Virus Infections Among Drug Users in Uppsala County, Sweden

“…The seroprevalence rates for blood-borne viral infections in our population of IDUs are lower compared with IDUs attending general practitioners in Belgian [16], prisoners in a median security prison in Denmark [29], prisoners in the Republic of Ireland [17], and Germany [30], participants recruited by multisite sampling at different agencies for IDU in Georgia [18] or clients attending methadone treatment clinics in New Zealand [31] and Switzerland [32], but slightly higher compared with new drug injectors in New York [33], suggesting that our venues of contact reach IDUs at a relatively earlier stage of their drug-using career. The data underline the feasibility of our efforts to find ways of early interventions among new IDUs that combine mass screening for infection with blood-borne pathogens, information campaigns and HAV and HBV vaccination programmes, along with interventions targeted at high-risk subpopulations of new IDUs to prevent HAV, HBV and HCV epidemics as well as potential HIV epidemics.…”