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1.
J Ethn Subst Abuse ; 19(3): 403-416, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-30431407

RESUMO

We aim to compare the values and challenges of peer outreach workers (POWs) with a history of drug use with non-POWs (NPOWs) in a needle and syringe exchange program (NSEP) in Yunnan, China. Data were abstracted from two independent surveys of 98 outreach workers and 33 program managers in 2014. POWs were more likely than NPOWs to conduct active outreach and to report ease in exchanging needles. Commonly cited concerns from POWs were low wages and frustration with client follow-up. Managers expressed the most concern on high turnover rates and low education levels. POWs seem to be more effective than NPOWs in conducting outreach, though POWs face unique challenges. We call for a recognition of the challenges and needs for more sensitive support for POWs.


Assuntos
Atitude do Pessoal de Saúde , Agentes Comunitários de Saúde , Infecções por HIV/prevenção & controle , Redução do Dano , Promoção da Saúde , Programas de Troca de Agulhas , Grupo Associado , Avaliação de Processos em Cuidados de Saúde , Abuso de Substâncias por Via Intravenosa , Adulto , China , Pesquisas sobre Atenção à Saúde , Promoção da Saúde/organização & administração , Promoção da Saúde/normas , Humanos , Programas de Troca de Agulhas/organização & administração , Programas de Troca de Agulhas/normas , Reorganização de Recursos Humanos , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde
2.
Health Promot Pract ; 19(5): 741-746, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29884081

RESUMO

Needle and syringe programs (NSPs) are key public health and HIV prevention programs. We sought to compare over time the quality of relationships between NSPs and police, and implementation of best practices. We conducted cross-sectional surveys in 2008 ( n = 32) and 2015 ( n = 28) with NSP managers in Ontario, Canada. Participants were recruited via e-mail to complete an online survey. Over the period studied, self-reported quality of NSP-police relationships did not change-roughly two thirds of NSP managers reported a positive/mostly positive relationship. In 2015, higher proportions of programs offered training to police about the following: the purpose and goals of NSPs (48% vs. 41% in 2008), NSP effectiveness (55% vs. 34%), the health and social concerns of people who use drugs (52% vs. 40%), and needlestick injury prevention (44% vs. 31%). Few managers reported formal conflict resolution procedures with the police (22% in 2015, 9% in 2008). Our findings show that NSP-police relationships did not deteriorate during a time when such programs fell into disfavor with the federal government. More research is needed to understand if and when formal versus informal agreements with police serve the needs of NSPs.


Assuntos
Capacitação em Serviço/organização & administração , Programas de Troca de Agulhas/organização & administração , Polícia/educação , Polícia/psicologia , Adulto , Estudos Transversais , Infecções por HIV/prevenção & controle , Redução do Dano , Humanos , Masculino , Programas de Troca de Agulhas/normas , Ontário , Autorrelato
3.
BMC Public Health ; 11: 250, 2011 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-21507267

RESUMO

BACKGROUND: As a harm reduction strategy in response to HIV epidemics needle and syringes programs (NSPs) were initiated throughout China in 2002. The effectiveness of NSPs in reducing the spread of infection in such an established epidemic is unknown. In this study we use data from Yunnan province, the province most affected by HIV in China, to (1) estimate the population benefits in terms of infections prevented due to the programs; (2) calculate the cost-effectiveness of NSPs. METHODS: We developed a mathematical transmission model, informed by detailed behavioral and program data, which accurately reflected the unique HIV epidemiology among Yunnan injecting drug users (IDUs) in the presence of NSPs. We then used the model to estimate the likely epidemiological and clinical outcomes without NSPs and conducted a health economics analysis to determine the cost-effectiveness of the program. RESULTS: It is estimated that NSPs in Yunnan have averted approximately 16-20% (5,200-7,500 infections) of the expected HIV cases since 2002 and led to gains of 1,300-1,900 DALYs. The total $1.04 million spending on NSPs from 2002 to 2008 has resulted in an estimated cost-saving over this period of $1.38-$1.97 million due to the prevention of HIV and the associated costs of care and management. CONCLUSION: NSPs are not only cost-effective but cost-saving in Yunnan. Significant scale-up of NSPs interventions across China and removal of the societal and political barriers that compromise the effects of NSPs should be a health priority of the Chinese government.


Assuntos
Programas de Troca de Agulhas/economia , Avaliação de Programas e Projetos de Saúde/métodos , China/epidemiologia , Análise Custo-Benefício , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Humanos , Modelos Estatísticos , Programas de Troca de Agulhas/normas , Abuso de Substâncias por Via Intravenosa
4.
J Infect Dev Ctries ; 15(10): 1497-1506, 2021 10 31.
Artigo em Inglês | MEDLINE | ID: mdl-34780373

RESUMO

INTRODUCTION: This paper examines the correlates of needle and syringe sharing among People Who Inject Drugs in Dhaka city, Bangladesh, which is currently experiencing a steep increase in HIV prevalence despite the ongoing presence of Needle Exchange Programs. METHODOLOGY: This was a retrospective chart review with cross-sectional design that extracted data from 783 male People Who Inject Drugs enrolled into five Opioid Substitution Treatment clinics in Dhaka city between April 2010 and January 2016. Data were retrieved from the program's electronic database. Needle and syringe sharing constituted the borrowing or lending of needles and syringes from others within the past month preceding data collection. RESULTS: Buprenorphine was the preferred injection drug and 44.6% shared needles and syringes within the past month. Multivariate analysis indicated that People Who Inject Drugs who were homeless (OR = 8.1, 95% CI = 1.4-44.9, p < 0.05), living with friends (OR = 6.8, 95% CI = 2.5-18.2, p < 0.001), injecting 2-3 times/day (OR = 4.8, 95% CI = 1.2-19.7, p < 0.05), injecting more than three times/day (OR = 4.8, 95% CI = 1.1-20.0, p < 0.05), not using condom with non-commercial female sex partners (OR = 3.3, 95% CI = 1.8-6.0, p < 0.05), bought sex from female sex workers (OR = 2.9, 95% CI = 1.0-8.3, p < 0.05), and did non-suicidal self-injury (OR = 1.8, 95% CI = 1.0-3.0, p < 0.05) were more likely to share needles and syringes. CONCLUSIONS: This study demonstrates that operating a standalone harm reduction approach that just provides sterile needles and syringes may not adequately curb needle and syringe sharing among People Who Inject Drugs.


Assuntos
Uso Comum de Agulhas e Seringas/estatística & dados numéricos , Programas de Troca de Agulhas/normas , Abuso de Substâncias por Via Intravenosa/epidemiologia , Adulto , Bangladesh/epidemiologia , Estudos Transversais , Bases de Dados Factuais , Infecções por HIV/prevenção & controle , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Abuso de Substâncias por Via Intravenosa/psicologia , Sexo sem Proteção/estatística & dados numéricos
5.
Subst Abuse Treat Prev Policy ; 15(1): 79, 2020 10 14.
Artigo em Inglês | MEDLINE | ID: mdl-33054832

RESUMO

BACKGROUND: Supervised injection facilities have been set-up in many countries to curb the health risks associated with unsafe injection practices. These facilities have, however, been met with vocal opposition, notably in France. As harm reduction policies can only succeed to the extent that people agree with them, this study mapped French people's opinions regarding the setting-up of these facilities. METHOD: A sample of 318 adults--among them health professionals--were presented with 48 vignettes depicting plans to create a supervised injection facility in their town. Each vignette contained three pieces of information: (a) the type of substance that would be injected in the facility (amphetamines only, amphetamines and cocaine only, or amphetamines, cocaine and heroin), (b) the type of staff who would be working in the facility (physicians and nurses, specially trained former drug users, specially trained current drug users, or trained volunteers recruited by the municipality), and (c) the staff members' mission (to be present and observe only, technical counselling about safe injection, counselling about safe injection and hygiene, or counselling and encouragement to follow a detoxification program). RESULTS: Through cluster analysis, three qualitatively different positions were found: Not very acceptable (20%), Depends on staff and mission (49%), and Always acceptable (31%). These positions were associated with demographic characteristics--namely gender, age and political orientation. CONCLUSION: French people's positions regarding supervised injection facilities were extremely diverse. One type of facility would, however, be accepted by a large majority of people: supervised injection facilities run by health professionals whose mission would be, in addition to technical and hygienic counselling, to encourage patrons to enter detoxification or rehabilitation programs.


Assuntos
Programas de Troca de Agulhas/organização & administração , Opinião Pública , Abuso de Substâncias por Via Intravenosa/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Usuários de Drogas , Feminino , França , Redução do Dano , Humanos , Masculino , Pessoa de Meia-Idade , Programas de Troca de Agulhas/normas , Política , Fatores Sexuais , Fatores Socioeconômicos , Adulto Jovem
7.
Drug Alcohol Depend ; 195: 40-44, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30580202

RESUMO

BACKGROUND: People who inject image and performance enhancing drugs (IPEDs) are often the largest group using needle and syringe programmes (NSPs) in the UK. NSP providers report these clients repeatedly collecting large amounts of equipment for others. The extent of secondary distribution of injecting equipment is unknown. METHODS: Data from national surveillance of people injecting IPEDs were used. Participants completed a questionnaire and provided a dried-blood spot sample. Data from two biennial surveys was combined; repeat participants were excluded. Self-reported data was used to explore the extent of secondary distribution. RESULTS: Of the participants, 87% (467) reported NSP use; median age was 31 years; 98% were male. A third (34%, 157) reported collecting equipment for others. Of those collecting for others, 154 reported how many people they had collected for: 55% had collected for one person, 27% for 2-9 people, 5% for 10-19 and 13% for 20 or more (no difference by psychoactive drug use). Those vaccinated for hepatitis B were more likely (22% [15/68] vs 6% [5/86], p = 0.003), and those reporting redness/swelling at an injection site were less likely to collect equipment for at least 20 others (8% [8/106] vs 25% [12/48], p = 0.003). Overall, 154 people collected equipment for 639-1569 people injecting IPEDs. CONCLUSIONS: Secondary distribution of injecting equipment is common among those injecting IPEDs and using NSPs. Whilst not allowing for rotational collection within groups, our analysis suggests that many of those injecting IPEDs are not in direct contact with NSPs. Innovation approaches for harm reduction interventions are needed.


Assuntos
Imagem Corporal , Programas de Troca de Agulhas/métodos , Substâncias para Melhoria do Desempenho/administração & dosagem , Abuso de Substâncias por Via Intravenosa/epidemiologia , Seringas , Adulto , Imagem Corporal/psicologia , Estudos Transversais , Inglaterra/epidemiologia , Feminino , Redução do Dano , Hepatite B/epidemiologia , Hepatite B/prevenção & controle , Hepatite B/psicologia , Humanos , Masculino , Programas de Troca de Agulhas/normas , Substâncias para Melhoria do Desempenho/efeitos adversos , Abuso de Substâncias por Via Intravenosa/psicologia , Abuso de Substâncias por Via Intravenosa/terapia , Inquéritos e Questionários , Seringas/normas , País de Gales/epidemiologia
8.
Can J Public Health ; 99(6): 446-50, 2008.
Artigo em Inglês | MEDLINE | ID: mdl-19149383

RESUMO

OBJECTIVES: The British Columbia Centre for Disease Control (BCCDC) tracks the distribution of all harm reduction products subsidized by the BC government, including needles and syringes, sterile water vials, alcohol swabs, condoms, and lubricant. This study measures the distribution of harm reduction products in BC, identifies regional variation in distribution, and estimates the supply/demand ratio for needle and syringe units. METHODS: Using three years of administrative data (2004-2006) from the BCCDC, the quantity of harm reduction products distributed was calculated by Health Service Delivery Area (HSDA). Regional hepatitis C virus (HCV) case report rates were calculated to reflect potential variation in IDU populations at the HSDA-level and the number of needle and syringe units distributed per reported case of HCV was calculated and ranked by HSDA. To compare the demand for sterile injecting equipment to the distribution, the number of illicit drug injections per year was approximated using established estimates of IDU populations in BC and Vancouver. RESULTS: Marked regional variation exists in the rates of harm reduction product distribution per 100,000 residents aged 15-64. The average number of needle and syringe units distributed annually in BC from 2004-2006 was 5,382,933. The estimated number of injections per year in BC is 24,951,144, suggesting the province distributed 21.5% of the units required to cover all illicit drug injections in the province. DISCUSSION: Harm reduction product distribution is not equitable between BC HSDAs. The current level of distribution of sterile injecting equipment is inadequate to provide a clean needle for every injection.


Assuntos
Redução do Dano , Hepatite C/epidemiologia , Programas de Troca de Agulhas/normas , Agulhas/provisão & distribuição , Administração em Saúde Pública , Centros de Tratamento de Abuso de Substâncias/normas , Abuso de Substâncias por Via Intravenosa/epidemiologia , Seringas/provisão & distribuição , Adolescente , Adulto , Colúmbia Britânica/epidemiologia , Hepatite C/etiologia , Hepatite C/prevenção & controle , Humanos , Drogas Ilícitas , Pessoa de Meia-Idade , Programas de Troca de Agulhas/estatística & dados numéricos , Avaliação das Necessidades , Avaliação de Programas e Projetos de Saúde , Regionalização da Saúde , Centros de Tratamento de Abuso de Substâncias/estatística & dados numéricos , Abuso de Substâncias por Via Intravenosa/complicações , Abuso de Substâncias por Via Intravenosa/virologia , População Urbana , Adulto Jovem
9.
Drug Alcohol Rev ; 37(5): 653-657, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29851167

RESUMO

INTRODUCTION AND AIMS: Services provided by needle and syringe programs (NSP) within Australia are easily accessible by international standards. However, important variation in NSP policy remains across Australian jurisdictions. The potential impacts of these variations on program operation for clients have not been systematically analysed in Australia. In this paper we conduct a preliminary examination to compare individual-level syringe coverage between and within Australian capital cities. DESIGN AND METHODS: Participants were 2498 people who inject drugs (PWID) recruited from all Australian capital cities as part of the annual Illicit Drug Reporting System PWID survey over the period 2014-2016. Insufficient coverage was defined when <100% of a participant's injecting episodes were 'covered' by sterile needles and syringes. We report the percentage of insufficient coverage for each capital city for each year, and present descriptive statistics for coverage parameters, and an alternative measure for insufficient coverage, as Supporting Information. RESULTS: Differences in behaviours that have the potential to impact syringe coverage were highly variable over time and place leading to variations in levels of insufficient coverage between and within all cities. Overall, insufficient coverage was most evident in larger cities where insufficient coverage varied between 19% and 23% (Sydney) over time, compared to smaller cities with variation from 9% to 12% (Adelaide). DISCUSSION AND CONCLUSIONS: We found no consistent pattern of differences in individual-level needle and syringe coverage between and within Australian capital cities. Further work is needed to fully evaluate whether policy variation between Australian jurisdictions impacts on NSP coverage.


Assuntos
Política de Saúde , Programas de Troca de Agulhas/normas , Abuso de Substâncias por Via Intravenosa/epidemiologia , Abuso de Substâncias por Via Intravenosa/terapia , Austrália/epidemiologia , Estudos Transversais , Política de Saúde/economia , Política de Saúde/tendências , Humanos , Programas de Troca de Agulhas/economia , Programas de Troca de Agulhas/tendências , Tratamento de Substituição de Opiáceos/economia , Tratamento de Substituição de Opiáceos/normas , Tratamento de Substituição de Opiáceos/tendências , Abuso de Substâncias por Via Intravenosa/economia
10.
Cad Saude Publica ; 23(9): 2134-44, 2007 Sep.
Artigo em Português | MEDLINE | ID: mdl-17700948

RESUMO

This paper assesses how decentralization of resources and initiatives by the Brazilian National SDT/AIDS Program has impacted the transfer of funds for programs to prevent HIV/AIDS among injecting drug users in Rio de Janeiro, Brazil (1999-2006). The effects of the decentralization policy on Rio de Janeiro's Syringe Exchange Programs (SEPs) are assessed in detail. Decentralization effectively took place in Rio de Janeiro in 2006, with the virtual elimination of any direct transfer from the Federal government. The elimination of direct transfers forced SEPs to seek alternative funding sources. The structure of local SEPs appears to be weak and has been further undermined by current funding constraints. Of 22 SEPs operating in 2002, only two are still operational in 2006, basically funded by the State Health Secretariat and one municipal government. The current discontinuity of SEP operations may favor the resurgence of AIDS in the IDU population. A more uniform, regulated decentralization process is thus needed.


Assuntos
Infecções por HIV/prevenção & controle , Redução do Dano , Alocação de Recursos para a Atenção à Saúde/economia , Programas Nacionais de Saúde/normas , Avaliação de Programas e Projetos de Saúde , Política Pública , Síndrome da Imunodeficiência Adquirida/economia , Síndrome da Imunodeficiência Adquirida/prevenção & controle , Brasil , Atenção à Saúde/normas , Financiamento Governamental , Infecções por HIV/economia , Alocação de Recursos para a Atenção à Saúde/normas , Reforma dos Serviços de Saúde , Implementação de Plano de Saúde , Humanos , Programas de Troca de Agulhas/economia , Programas de Troca de Agulhas/normas , Formulação de Políticas , Abuso de Substâncias por Via Intravenosa/prevenção & controle
11.
Cad Saude Publica ; 22(4): 761-70, 2006 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-16612430

RESUMO

The present study aims to evaluate the current operation of Brazilian syringe exchange programs (SEP). After consulting national and regional networks of people working in projects/programs aiming to reduce drug-related harm, we identified 134 potential participant programs. Unfortunately, only 45 SEPs answered a survey, even after repeated attempts. The survey addressed: coverage, funding, procurement of basic supplies, managerial capacity, and the local political environment. Findings were triangulated with in-depth interviews with key informants. The main findings included: satisfactory adherence to the initiatives and adequate documentation, but deficiencies in terms of coverage and monitoring, and uneven procurement of resources. Program personnel work mostly on a provisional basis, despite the efforts of local coordinators. Most programs are funded by the National STDs/AIDS Program. A comprehensive agenda aiming to improve current operations should include: concerted efforts to improve local and regional databanks, incentives/sanctions toward full accountability of initiatives carried by the programs, and a genuine culture of monitoring and evaluation.


Assuntos
Infecções por HIV/prevenção & controle , Redução do Dano , Programas de Troca de Agulhas/organização & administração , Política Pública , Abuso de Substâncias por Via Intravenosa , Brasil , Estudos Transversais , Humanos , Entrevistas como Assunto , Programas de Troca de Agulhas/normas , Programas de Troca de Agulhas/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde
12.
Cad Saude Publica ; 22(4): 871-9, 2006 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-16612440

RESUMO

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.


Assuntos
Infecções por HIV/prevenção & controle , Redução do Dano , Programas de Troca de Agulhas , Defesa do Paciente , Bangladesh , Brasil , China , Feminino , Infecções por HIV/transmissão , Humanos , Masculino , Programas de Troca de Agulhas/legislação & jurisprudência , Programas de Troca de Agulhas/organização & administração , Programas de Troca de Agulhas/normas , Avaliação de Programas e Projetos de Saúde , República de Belarus , Federação Russa , Abuso de Substâncias por Via Intravenosa/complicações , Ucrânia
13.
Georgian Med News ; (140): 62-5, 2006 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-17179591

RESUMO

IDUs are under the high risk of HIV and other blood born diseases. In Georgia injecting drug use is associated with two third of registered HIV/AIDS cases. Majority of them are also infected with B and C Hepatitis. One of the main components of HIV/AIDS prevention among drug users is considered to be harm reduction programs, among them syringe exchange program. We conducted observational cohort study and performed interviewing participants of syringe exchange program using structured questionnaire. The interviewing was conducted at intake, after 3 months and at the end of the program. During interviewing we used risk assessment questionnaire which we have little adapted (Risk Assessment Battery, Navaline, et al, 1994). The data were statistically analysed using SPPS-11, 5 program. The aim of the study was to assess the efficacy of outreach and needle exchange programs in terms of reduction of HIV risk behavior of injection drug users in Tbilisi. The results of the study show visible reduction in injection risk behavior for clients being in the program for at least three months. There was not seen any significant change in the level of sexual risk behavior, which might suggest the need for targeting this behavior during the further interventions. The results of the study suggest a visible potential benefit to drug users and communities that could be gained through the wide scale implementation of harm reduction programs in Georgia.


Assuntos
Síndrome da Imunodeficiência Adquirida/prevenção & controle , Transmissão de Doença Infecciosa/prevenção & controle , Programas de Troca de Agulhas/normas , Síndrome da Imunodeficiência Adquirida/epidemiologia , Síndrome da Imunodeficiência Adquirida/transmissão , Feminino , Seguimentos , República da Geórgia/epidemiologia , Humanos , Masculino , Prevalência , Inquéritos e Questionários
14.
R I Med J (2013) ; 99(11): 21-24, 2016 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-27801915

RESUMO

From its beginning, HIV has primarily affected marginalized populations, such as injection drug users, gay, bisexual and other men who have sex with men (GBMSM), and minority racial and ethnic groups. HIV is a disease that, from the start, has been strongly influenced by issues related to social justice and health equity due to its intersection with behaviors among at-risk populations. While some of the risks associated with HIV have been successfully mitigated through social justice initiatives related to needle exchange programs and routine HIV testing of pregnant women, Rhode Island remains confronted with the health equity challenges of preventing HIV transmission and ensuring access to HIV care/treatment, especially for Black/African Americans, Hispanics, and GBMSM. [Full article available at http://rimed.org/rimedicaljournal-2016-11.asp].


Assuntos
Infecções por HIV/etnologia , Equidade em Saúde/normas , Programas de Troca de Agulhas/normas , Justiça Social , Feminino , Infecções por HIV/prevenção & controle , Humanos , Masculino , Grupos Minoritários , Rhode Island , Fatores de Risco , Abuso de Substâncias por Via Intravenosa
15.
J Subst Abuse Treat ; 48(1): 112-6, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25205666

RESUMO

Poor access to buprenorphine maintenance treatment (BMT) may contribute to illicit buprenorphine use. This study investigated illicit buprenorphine use and barriers to BMT among syringe exchange participants. Computer-based interviews conducted at a New York City harm reduction agency determined: prior buprenorphine use; barriers to BMT; and interest in BMT. Of 102 opioid users, 57 had used illicit buprenorphine and 32 had used prescribed buprenorphine. When illicit buprenorphine users were compared to non-users: barriers to BMT ("did not know where to get treatment") were more common (64 vs. 36%, p<0.01); mean levels of interest in BMT were greater (3.37 ± 1.29 vs. 2.80 ± 1.34, p=0.03); and more participants reported themselves likely to initiate treatment (82 vs. 50%, p<0.01). Illicit buprenorphine users were interested in BMT but did not know where to go for treatment. Addressing barriers to BMT could reduce illicit buprenorphine use.


Assuntos
Buprenorfina/uso terapêutico , Acessibilidade aos Serviços de Saúde/normas , Antagonistas de Entorpecentes/uso terapêutico , Programas de Troca de Agulhas/normas , Tratamento de Substituição de Opiáceos/normas , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Abuso de Substâncias por Via Intravenosa/tratamento farmacológico , Adulto , Feminino , Redução do Dano , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque
16.
Addiction ; 98(2): 153-8, 2003 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-12534419

RESUMO

Journal publications and conference presentations on prison-based syringe exchange (PSE) programmes were identified by a comprehensive search of electronic databases. Experts involved with development and evaluation of current PSE programmes or policy were contacted for reports, documents and unpublished material. Spanish information on PSE was translated for this review. We identified 14 papers specifically on PSE programmes in Switzerland (six papers), Germany (four) and Spain (four). The first PSE programme started in 1992 in Switzerland. As of December 2000, seven PSEs were operating in Switzerland, seven in Germany and five in Spain. There have been six evaluations of prison syringe exchange programmes and all have been favourable. Reports of drug use decreased or remained stable over time. Reports of syringe sharing declined dramatically. No new cases of HIV, hepatitis B or hepatitis C transmission were reported. The evaluations found no reports of serious unintended negative events, such as initiation of injection or of the use of needles as weapons. Staff attitudes were generally positive but response rates to these surveys varied. Overall, this review indicated that prison syringe exchange programmes are feasible and do provide benefit in the reduction of risk behaviour and the transmission of blood-borne infection without any unintended negative consequences.


Assuntos
Programas de Troca de Agulhas/organização & administração , Prisões , Abuso de Substâncias por Via Intravenosa/prevenção & controle , Alemanha , Infecções por HIV/prevenção & controle , Hepatite B/prevenção & controle , Hepatite C/prevenção & controle , Humanos , Programas de Troca de Agulhas/normas , Programas de Troca de Agulhas/estatística & dados numéricos , Espanha , Suíça
17.
AIDS Educ Prev ; 14(2): 126-37, 2002 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-12000231

RESUMO

The consistency among needle exchange practices, HIV prevention, harm reduction goals, and potential program effectiveness are analyzed. Using a modified ethnographic approach, qualitative interviews were conducted with staff (n = 59) of needle exchange programs (NEPs; n = 15). Interviews addressed operational policies; funding and challenges. An iterative, inductive analytic process was used. Differences in exchange practices are traced to differences in how workers define needles as objects of "risk" and/or "prevention." The weight accorded to each definition has implications for service delivery. Among NEPs that ascribe a "risk" meaning, workers enforce a strict one-for-one exchange, encourage clients to take fewer needles, and penalize clients. Programs that focus on the "prevention" meaning of needles work towards improving access, problem solving about proper disposal and do not penalize clients. Operational policies that restrict access to sterile equipment or discourage attendance need to be reconsidered if HIV prevention goals are to be realized.


Assuntos
Infecções por HIV/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Programas de Troca de Agulhas/normas , Assunção de Riscos , Canadá , Feminino , Infecções por HIV/transmissão , Pesquisa sobre Serviços de Saúde , Humanos , Entrevistas como Assunto , Masculino , Programas de Troca de Agulhas/organização & administração , Programas de Troca de Agulhas/estatística & dados numéricos , Agulhas/provisão & distribuição , Agulhas/virologia , Ontário , Política Organizacional , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Fatores Socioeconômicos , Abuso de Substâncias por Via Intravenosa/virologia
18.
Health Policy ; 45(3): 209-20, 1998 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-10338952

RESUMO

This study evaluated the effectiveness of the first needle exchange program (NEP) established in Puerto Rico. The data for this study were collected during the first months of the NEP from July 1995 to March 1996 in 13 communities of the San Juan metropolitan area. Subjects were the participants of two modalities of the NEP: a mobile team and a community-based drug treatment program. During the 3-week evaluation period, 2401 injection drug users (IDUs) were recruited, resulting in a total of 19,195 exchange contacts and 146,323 syringes exchanged. No significant change in drug injection was observed. However, the program was effective in reducing sharing of syringes and cookers. The study suggests that the NEP did help in reducing needle sharing in Puerto Rico. However, the HIV seropositivity in returned syringes suggests the need to continue aggressive prevention programs to arrest the epidemic among IDUs. However, factors related to the socio-cultural environment as well as cultural norms and traditions need to be considered when planning and expanding NEPs.


Assuntos
Infecções por HIV/prevenção & controle , Programas de Troca de Agulhas/normas , Abuso de Substâncias por Via Intravenosa , Infecções por HIV/transmissão , Pesquisa sobre Serviços de Saúde , Humanos , Programas de Troca de Agulhas/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde , Avaliação de Programas e Projetos de Saúde , Porto Rico , Seringas
19.
Can J Public Health ; 91(2): 129-32, 2000.
Artigo em Inglês | MEDLINE | ID: mdl-10832179

RESUMO

OBJECTIVES: To determine the demographic characteristics, risk behaviours and prevalence of HIV-1 among injection drug users (IDU) attending Calgary's needle exchange program (NEP). METHODS: A survey was conducted from June through September 1998 among IDU attending Calgary's NEP. Demographic and behaviour characteristics were determined by personal interview and saliva was tested for HIV antibody. RESULTS: There were 278 participants providing 272 saliva specimens. Nine were positive for HIV-1 (3.3%, 95% C.I. 1.6-6.4%). Sexual and injecting practices, cities where drugs had been used, incarceration, addiction treatment and demographic characteristics were described, and a subanalysis for women, youth and Aboriginals was carried out. CONCLUSIONS: HIV prevalence remains low among NEP attenders in Calgary, although high-risk behaviours are common. Women, youth and Aboriginals have unique risk behaviour profiles. Many IDU want to participate in addiction treatment, and strategies should be made to provide accessible, appropriate treatment services.


Assuntos
Infecções por HIV/epidemiologia , Programas de Troca de Agulhas , Adolescente , Adulto , Alberta/epidemiologia , Feminino , Infecções por HIV/transmissão , Soroprevalência de HIV , Humanos , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde , Programas de Troca de Agulhas/normas , Assunção de Riscos , Comportamento Sexual , Abuso de Substâncias por Via Intravenosa/epidemiologia
20.
AIDS Alert ; 10(12): 147-9, 1995 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-11362931

RESUMO

AIDS: A Congressional panel endorsed the implementation of needle exchange programs (NEPs) that provide access to clean needles and syringes to injection drug users. However, experts are recommending that NEP advocates proceed without Federal funds or approval. It is unlikely that Congress will lift current NEP bans because the programs send mixed messages about drug use. Congressional panel chair Lincoln Moses, professor of statistics at Stanford University, reports that NEPs reduce the spread of HIV and do not increase injection drug use. In fact, these programs often result in increased referrals to substance abuse treatment programs. Many of the NEPs in the U.S. currently operate illegally under state paraphernalia and prescription laws. The panel recommends repealing these laws and lifting the ban on Federal NEP funding. A plan for the disposal of used needles needs to be designed.^ieng


Assuntos
Infecções por HIV/prevenção & controle , Programas de Troca de Agulhas/normas , Planejamento em Saúde Comunitária/organização & administração , Feminino , Financiamento Governamental , Infecções por HIV/transmissão , Humanos , Masculino , Programas de Troca de Agulhas/legislação & jurisprudência , Política , Estados Unidos
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