By ETHAN ALTHOFER
NEEDLE and Syringe Exchange Programs have prevented more than 32,000 cases of HIV and almost 100,000 cases of hepatitis, according to a report released by the Department of Health and Ageing.
What is a Needle and Syringe Exchange Program (NSP)?
The NSP is a controversial social policy based on the theory that injecting drug users should have access to sterile equipment, which prevents the transmission of HIV and hepatitis C infections. Targeting blood-borne viruses through the NSP is a government initiative aiming to reduce the nation’s health bill. Injecting drugs users are able swap their used equipment for sterile equipment, free of charge at NSP stations. These programs also provide education and information on reducing drug use, drug treatment, medical care and legal and social services. With more than 3000 needle exchange sites set up across Australia, including syringe vending machines and mobile services, availability and access to the program is slowly increasing.
How long has the program been running?
The first exchange program began in 1986 at St Vincent’s Hospital in Sydney. The program was instigated by the director of the drug and alcohol services at St Vincent’s, Dr Alex Wodak. At the time, Dr Wodak observed how rates of confirmed HIV cases were dramatically increasing amongst injecting drug users. As expected, however, there was overwhelming initial reluctance for leaders to take the step to support Dr Wodak’s cause. Though, with the aid of the NSW Police who decided to not take any action against the users or staff of the exchange and those concerned about public health, the program was given a “trial ” status by the NSW government and permitted to operate legally. By 1987, the NSW government endorsed NSPs through policy and the other states and territories were quick to follow.
Why do they have this program?
The report commissioned by the Federal government and authored by University of New South Wales (UNSW) National Centre in HIV Epidemiology and Clinical Research (NCHECR) says because it works. The report details how the program has prevented a little more than 32,000 new HIV infections and almost 100,000 cases of hepatitis C. According to the Department of Health and Ageing, the level of HIV infection among injecting drug users in Australia has remained around 1%, compared to levels of up to 50 per cent in other countries . The Department of Health and Ageing says that along with the savings to national health, this program has been one of the major public health success stories implemented by the government.
How much is this costing taxpayers?
As with all programs, they come at a cost. The Government has funded $234 million over the past decade sustaining the program. Though the report, titled Return on investment 2: evaluating the cost-effectiveness of needle and syringe programs in Australia 2009, has found the amount saved by taxpayers from this program far exceeds the cost. Researchers from UNSW, who authored the report, found that for every $1 spent on the programs, taxpayers are $4 better off. The expected saving from these programs to the nation’s health bill over this period is estimated to be $1.3 billion. Since 2000, more than 30 million needles and syringes have been distributed through the programs in Australia every year.
Is there opposition to the program?
Of course there is. The Federal government recognises that there is opposition to the program and that this report will not please everyone. Dr Wodak also believes that support is not high for the program, though its success should not be underestimated. Support from the public is estimated to be at 60%, which is much higher than when the project first started 23 years ago. The Christian Democratic Party opposes all NSPs and wants all needle exchange facilities to be abandoned. They suggest these programs have added to the number of addicts and facilitated the spread of blood-borne viruses. However, the Department of Health and Ageing refers to strong evidence from a World Health Organisation review, which concluded that NSPs do not encourage more frequent use of drugs, or increase the recruitment of new injecting drug users. The Australian National Council on Drugs (ANCD) also strongly supports NSPs. ANCD says that they recognise the results of the program and continue to endorse the Australian Government’s commitment to the strategy along with supportive services.
Wouldn’t it be better to stop people using drugs, rather than give them needles and syringes?
Despite public education about the negative short and long-term effects of drug use, people still inject drugs. This is the problem with awareness and education in that there is always a certain failure rate. As one of the major problems of injecting drug users is the transfer of blood-borne diseases, NSPs are one of the main strategies we have to prevent the spread of infection among users. NSPs also provide support services and information on reducing drug use, medical care, legal and social services and provides support to families of drug users.
Should the program be expanded?
At this stage, the government has no plans to expand NSPs. However, in light of this report, we will have to wait to see if this decision changes. With such proven success, the call to expand NSPs is important according to advocacy group, Hepatitis Australia. Hepatitis Australia believes that current demand is not being met by supply which they say is failing Australians. Backing the expansion call, Associate Professor David Wilson of the NCHECR who led the report, says it is vital that the government increases its investment in the program. The report concluded that an increase in investment of 50% by the government would further reduce new HIV cases by 37% and hepatitis C cases by 23% over the next 10 years.
