Quelling the controversy over needle exchange and high HIV rates
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* Heather Kent

Controversy has surrounded needle-exchange programs for injection drug users in Vancouver's Downtown Eastside neighbourhood since recent studies showed high rates of HIV infection among drug users participating in the programs. This question was recently revisited by Dr. Martin Schechter and his colleagues in a study designed to find out whether the programs contribute to HIV transmission by promoting needle sharing and other high-risk behaviours, or simply attract participants who are already involved in high-risk activities (AIDS 1999;13:F45-51).

A total of 694 intravenous drug users who were HIV-negative when they were recruited and had injected illegal drugs within the previous month participated in the project. The researchers set up a storefront office in the Downtown Eastside, where 80% of the subjects came for at least one follow-up visit. The researchers found no evidence that needle-exchange programs resulted in drug users forming new needle-sharing partnerships. Only 1 of 498 subjects said he or she had met new needle-sharing partners through the needle-exchange programs. The increased infection rate among people using the program was consistent with their pre-existing higher-risk profile. The researchers also point out that Vancouver's Downtown Eastside was "a haven for intravenous drug users long before needle exchange." As well, needle-exchange programs are just one of a range of services needed for HIV prevention, such as methadone maintenance and adequate housing.

The study's findings follow on those of a previous study (AIDS 1997;11:F59-65), which found that of 1000 injection drug users, those who had participated in the needle-exchange programs had significantly higher rates of HIV infection than those who did not attend the exchange. Those results were interpreted in the US to mean that the programs promote increased HIV infection rates. The US government still refuses to fund needle-exchange programs.-[copyright sign] Heather Kent, Vancouver Figure 1

![Figure1](http://www.cmaj.ca/https://www.cmaj.ca/content/cmaj/161/1/16.2/F1.medium.gif)

[Figure1](http://www.cmaj.ca/content/161/1/16.2/F1)

Figure 1.