In Sub-Saharan Africa the HIV epidemic has largely been spread through sexual intercourse, a complicated and messy behavior that has proven highly stubborn to intervention. Outside of Africa, the HIV epidemic, however, has also been spread through other means, including the re-use of contaminated needles. An excellent must-read piece in today’s NYTimes explains:

“In Russia, 83 percent of infections in which the origin is known come from needle sharing. In Ukraine, the figure is 64 percent; Kazakhstan, 74 percent; Malaysia, 72 percent; Vietnam, 52 percent; China, 44 percent. Shared needles are also the primary transmission route for H.I.V. in parts of Asia. In the United States, needle-sharing directly accounts for more than 25 percent of AIDS cases.”

Of course, as epidemic go, even if sexual behavior is primary means of transmission, the spread of the virus is amplified through other transmission channels, such as injection drug users, who subsequently spread the virus to their sexual partners.

The good news is that there is actually an intervention available to help curb the transmission of the virus (and other viruses) that has been shown to be highly effective, low-cost, and easily adopted by targeted populations: clean needle exchange programs. Free clean needles are made available for free to drug users in exchange for their old infected ones, removing the dirty needles from the streets and greatly reducing the likelihood that drug users will spread the virus to one another.

“Needle exchange is AIDS prevention that works. While no one wants to have to put on a condom, every drug user prefers injecting with a clean needle. In 2003, an academic review of 99 cities around the world found that cities with needle exchange saw their H.I.V. rates among injecting drug users drop 19 percent a year; cities without needle exchange had an 8 percent increase per year. Contrary to popular fears, needle exchange has not led to more drug use or higher crime rates. Studies have also found that drug addicts participating in needle exchanges are more likely to enter rehabilitation programs. Using needle exchange as part of a comprehensive attack on H.I.V. is endorsed by virtually every relevant United Nations and United States-government agency.”

The bad news, however, is that many policy makers and politicians refuse to support such programs on the basis that supporting these programs would be the equivalent to supporting drug related behaviors and directing public subsidies to a particularly undesirable part of the populace. The US government has banned the use of federal funds to support such programs since George Bush Sr.’s time in office, and despite claims to support such programs by both Bill Clinton and Barack Obama, the ban remains in effect.

Targeting high risk groups is likely the key to effective HIV prevention – that is a lesson that has emerged from past research efforts. It is time that public health policies begin to reflect this reality. Presumably saving lives is always good politics.

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3 Responses to “Ignoring the most successful HIV prevention strategy”

  1. Brendan says:

    There have been epic battles over Vancouver's Insite over the past couple years (http://supervisedinjection.vch.ca/). Thankfully there has been enough public pressure to keep it open, even in the face of old school politics.
    B

  2. Electronic Medical Records says:

    There is a lot of awareness spread on this measure though the disease keeps spreading some through unsafe sexual means or through needle sharing…sad but there is more and more of this disease every day.

  3. Anonymous says:

    On an amusing note, there was a guy sitting on the median begging a couple years ago who was obviously an H addict. His sign said, "Anything helps!" so one afternoon I drove by and handed him a shopping bag filled with syringes with needles on them. I'll never forget his expression when he looked in the bag. Priceless!

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