It might sound counterintuitive: the idea that providing needles to IV drug users is a good public health strategy. But Prevention Point Philadelphia (PPP), a health services organization that runs one of the largest syringe exchange programs in the country, is proving that clean needles are a powerful tool in preventing HIV transmission. Now two researchers from Temple University’s College of Public Health are helping PPP improve its services by conducting an innovative analysis of 15 years of client data. Their findings — just published in AIDS and Behavior — may have big implications for the future of drug treatment policy in Philadelphia.
In their research, Social and Behavioral Sciences doctoral candidate Ms. Laurie Maurer and associate professor Dr. Sarah Bauerle Bass examined demographic data about the users of PPP’s syringe exchange program from 1999 to 2014. Their analysis helped the organization evaluate its services, including outreach programs and mobile exchange sites — locations around the city where IV drug users can receive clean needles. PPP wanted to know: who are the people using the syringe exchanges now, and are we meeting their needs well enough?
Ms. Maurer says the face of IV drug use has changed significantly: the average user in 2014 was nearly 15 years younger, and the percentage of Hispanics using the exchange increased by almost 20 percent. Users are also coming from different parts of the city, and Bass says this is partly due to gentrification. “There’s a mobile exchange site at Third Street and Girard Avenue, which used to be one of the prime areas for IV drug use. But now it’s one of the least-used sites, because Northern Liberties has grown and people are moving out of that area. It’s not the best use of resources anymore.”
Ultimately the trends they found will help PPP make its services more accessible to younger, more racially diverse IV drug users. “Prevention Point has had the same mobile sites for over a decade, because those were the ones approved by the city,” says Dr. Bass. “They’re hoping this will promote policy changes that allow them to provide services in areas that make more sense for people.”
According to Ms. Maurer and Dr. Bass, that argument is strengthened by the dramatic decrease of HIV infection among injection drug users over the past 25 years. “Incidence of HIV in Philadelphia went from around 25 percent of IV drug users to less than 5 percent now,” says Dr. Bass. “That’s a very clear picture of why needle exchange is an important tool for HIV prevention.”
Ms. Maurer says that despite their proven effectiveness, syringe exchanges still face an uphill battle in many communities — even with the rising rates of heroin use across the country. “Unfortunately there’s still a stigma surrounding syringe exchange,” she says. “A lot of people don’t understand the purpose of providing clean syringes for people to inject drugs. But it really can make a difference in reducing HIV.”