Evaluation Of The Provision Of Single Use Citric Acid Sachets To ...

2diagnosed cases of HIV infected injectors – the lowest annual number ever recorded (ISD,2001). This decline in cases has been accompanied by a rise in the average age at whichHIV is diagnosed and suggests that the few infections that are being reported werecontracted in the late 1980s or early 1990s. Recent HIV transm ission seems to be arelatively rare occurrence. Such reduction in incidence can be at least partly attributed tothe success of harm reduction interventions such as needle exchange and methadonemaintenance programmes (Hurley, 1997; Des Jarlais, et al, 1996).In contrast to the relatively low prevalence of HIV, the prevalence of Hepatitis C amongIDUs in Sco tla nd is ve ry high. By De cembe r 2001, the re we re 13,535 k no wn cases of HCVin Scotland (5019 in Greater Glasgow and 774 in Lanarkshire). Of these cases, 60% hadinjecting drug use as the probable route of transmission (SCIEH, 2002). Moreover, it islikely that a large number of IDUs are among the cases with an “unknown” cause oftransmission. Recent estimates suggest that as many as 10,000 IDUs in Scotland haveHC V and e ven this figure is likely to unde res tima te the true pre vale nce (Effe ctiveI nte rventions Unit, 2001). In Greate r Glasgo w, HC V is most pre vale nt, with e stima tes tha t64% of IDUs have the disease (Goldberg, et al 2001). While treatments for HCV arebecom ing more successful, prevention undoubtedly remains the key to halting theprogressio n o f this disease .He pa titis B is le ss pre vale nt among IDUs in Sco tla nd than Hepa titis C . In 2000, the re we re360 known cases of the virus. Of these, only 89 cases were attributed to injecting druguse, but it is likely tha t most case s had inje cting drug use as the pro bable ro ute o ftransmission (ISD, 2001).Harm Reduction: The Role of the Needle ExchangeReducing the prevalence of injecting drug use and the spread of associated blood-borneviruses in Scotland is a complex task. The best interventions are based on the principles ofharm reduction. Such interventions follow a set of practical strategies that aim to reducethe risks associated with injecting drug use and encourage safer use, which may or maynot lead to abstinence.One such harm reduction approach is to ensure that IDUs have access to clean needlesand syringes. Needle exchange programmes recognise that people who inject drugs are ata greater risk of contracting HIV, HBV and HCV and other health problems associated withsha ring needles and drug pa raphe rna lia . By pro viding clean equipment, info rmation andeducation on risk factors, and by making referrals to drug counselling services, their aim isto reduce the negative consequences associated with injecting drug use.First established in the UK in the mid 1980s, needle exchanges are an effective method ofdisease control. By reducing the length of time that each needle spends in the druginjecting population, they ensure that there is less chance of it being contaminated andsubsequently reused by another, potentially uninfected, IDU (Drucker, et al, 1998). Theirefficacy in reducing sharing behaviour has been well documented (Blumenthal, et al,2000). Other studies have reported that needle exchanges significantly increase single useof syringes and can reduce the number of injections per syringe by between 44% and85% (Heimer, et al, 1998; Kipke, et al, 1998).There is overwhelming evidence to suggest that needle exchanges decrease theprevalence of HIV among IDUs (Hurley, 1997, Des Jarlais, et al, 1996). In fact, all but twoo f the s tudies ca rrie d o ut to da te have co ncluded tha t needle ex changes reduce HI Vtransmission. Even the two Canadian studies, which concluded that needle exchange