No expansion of needle and syringe programmes despite effectiveness

Despite reports of expanding rates of injecting drug use in a new list of countries around the world, no new countries have established needle and syringe programmes in the last three years. This was one of the headline findings of an exhaustive review of the state of harm reduction services around the world conducted by international NGO Harm Reduction International, presented at the 25th International Harm Reduction Conference (HR17) in Montréal last week.

This is the first time that there has been no increase since monitoring coverage of harm reduction services started in 2008. Of the 90 countries that report provision of needle and syringe programmes, only 17 countries are expanding these services, whilst 20 countries report a decrease of needle and syringe programmes.

Needle and syringe programmes are one of the most effective HIV prevention interventions available for people who inject drugs. Access to needle and syringe programmes is attributed to substantial reductions in the sharing of injecting equipment – a high-risk practice that drives HIV and hepatitis C transmission across the world. Needle and syringe programmes are the first intervention on the World Health Organization’s list of essential services for HIV and hepatitis C prevention and care for people who inject drugs.

The evidence for the effectiveness of needle and syringe programming is very strong. It is one of the most effective HIV prevention interventions available to HIV programmers, though it is often fraught with controversy. The distribution of clean injecting equipment often causes controversy because policy makers, neighbours, local officials and other stakeholders fear that it will lead to increases in drug use.