The Health Benefits of Secondary Syringe Exchange

Abstract

From a process evaluation, participants in San Francisco's syringe exchange program (SEP) are described. Three groups, primary, secondary, and nonexchangers, were interviewed for a total of 244 study participants recruited from eight needle exchange sessions. Fifty percent of all primary exchangers exchanged for one or more injecting drug user(s) (IDUs). Three general routes of syringe distribution were identified between primary and secondary exchangers: between close friends and lovers; for people who lived in close proximity to them; and with customers who bought drugs from them. Focusing on why some go to SEPs and why some rely on others to go for them, findings are summarized primarily as the barriers for not attending SEPs, including exposure, legal status, illness, drug lifestyle, and conflicts with service provision. The secondary exchangers had similar risk reduction profiles to the SEP users that overall were better than the nonexchangers. For example, they shared syringes and cookers significantly fewer times than nonexchangers. The results demonstrate that these client-provided exchanges enable the SEP to overcome injection drug users' obstacles to program attendance, thereby reaching even hard to access members of IDU populations. We found the effects of these client-provided services to be positive for the larger IDU population.

Doing Syringe Exchange: Organizational Transformation and Volunteer Commitment

“…Data collection included participant observation, indepth life history interviews, and a closed-ended quantitative instrument. Data collection was completed in 1995 with a total of 244 exchange participants (clients of the syringe-exchange program) recruited from eight syringeexchange sites, many of whom exchanged needles for other users unable or unwilling to visit the exchange (Kelley, Murphy, & Lune, 2001;Murphy, Kelley, & Lune, 2004). Data collection also included interviews with 56 volunteer service providers, which represented the total population of providers involved at the eight data collection sites during the time of our study.…”

Social Network-Related Risk Factors for Bloodborne Virus Infections Among Injection Drug Users Receiving Syringes through Secondary Exchange

“…Most research confirms that SSE occurs more frequently within established injecting networks, such as among close friends, sexual partners, and family members. 10,13 Furthermore, IDUs with larger injecting networks, those living in close proximity to each other, and those who exchange drugs have also been found to participate in SSE. 13,31 An Australian study showed the importance of one's personal network as a source of injecting equipment, both used and clean.…”

“…7 The high volume of syringes distributed through SSE reflects findings from other jurisdictions where SSE providers have been reported to distribute up to 60% of syringes exchanged at SEPs, although these individuals represented less than 10% of the clientele. 8,13 Traditional SEP and pharmacy-based syringe distribution strategies have several limitations. The use of SEPs may be restricted by limited hours of operation, distribution policies, geographic distance to the SEP, fear of stigmatization, as well as fear of police harassment.…”

“…The use of SEPs may be restricted by limited hours of operation, distribution policies, geographic distance to the SEP, fear of stigmatization, as well as fear of police harassment. 8,9,10,[13][14][15] Pharmacies, on the other hand, may refuse to provide syringes without a prescription, do not typically accept used syringes in exchange for new ones, nor do they offer the social and medical services available at SEPs. In addition, SEPs and pharmacies may serve a selective subpopulation of IDUs.…”

“…10 Other reported benefits of secondary exchange have included reductions in syringe sharing, less reuse of personal syringes, less filter and container sharing, more consistent condom use, and greater uptake of drug treatment. [11][12][13] However, critics of SSE contend that IDUs who do not personally attend a SEP to obtain their own injecting equipment are not exposed to other important prevention services that may be offered, such as HIV or HCV testing and counseling, behavioral interventions, as well as referrals to drug abuse treatment programs and relevant social services. 8 In addition, SSE recipients appear to live within social contexts that can increase the health risks associated with drug using.…”