Reaching the Unreached: Targeting Hidden IDU Populations with Clean Needles via Known User Groups

Abstract

Needle exchange is a practical and important part of the Dutch prevention strategy to check the spread of HIV among injecting drug users (IDUs). However, needle-exchange programs are often tied to drug treatment programs that only reach a limited number of IDUs. To overcome this limitation, alternative designs are considered and initiated. This article describes a community-based approach to needle exchange that is built on empowerment of, and intense participation by, known IDUs to target unknown IDUs for delivery of clean needles. The needle-exchange patterns of the IDUs participating in this collective scheme are compared to those of other users who exchanged needles on an individual basis. It was found that this approach extended the reach of the program to a great degree and that it was well received in the IDU community. However, the results were negatively influenced by police activities aimed at closing down places where drugs were used and sold. It is concluded that engaging IDUs in peer-group-directed prevention efforts is both feasible and promising.

A Description of a Peer-Run Supervised Injection Site for Injection Drug Users

“…Previous studies have indicated that IDU-driven interventions can be effective in increasing the reach and effectiveness of harm reduction interventions [35][36][37] and are more effective in the coverage they provide than traditional service provider interventions. 38,39 Furthermore, IDU accessing syringe exchanges have reported that they are more comfortable receiving this type of service from their peers than from professional providers.…”

An External Evaluation of a Peer-Run "Unsanctioned" Syringe Exchange Program

“…While it is likely that the extended hours played a major role in reaching the highest risk IDUs, previous studies have shown that user-run services may greatly extend the reach of traditional service provider/client models of service delivery. 14,35 The use of public spaces for drug use is responsible for public nuisance, unsafe disposal of syringes and has been cited among the greatest concerns of residents and businesspersons in neighborhoods where public drug use is common. 16,20,34,36 While the provision of syringes from an outdoor table may play a beneficial public health role, interventions aimed at balancing public order and public health are clearly needed in these circumstances.…”

“…9 As a result of the existing barriers to sterile syringe acquisition, several studies have demonstrated that IDUs will often obtain syringes from secondary sources, including their peers. [13][14][15] In fact, in some settings, organizations of drug users have mobilized themselves in an effort to prevent the ongoing spread of HIV and overdoses among their peers. 14,[16][17][18] The activities of these organizations range from education and advocacy to syringe exchange.…”

“…[13][14][15] In fact, in some settings, organizations of drug users have mobilized themselves in an effort to prevent the ongoing spread of HIV and overdoses among their peers. 14,[16][17][18] The activities of these organizations range from education and advocacy to syringe exchange. Although their impact has rarely been quantified, drug user organizations are believed to have major potential to improve the health of these users' peers.…”

Methods for accessing young people from marginalised groups : researcher and practitioner perspectives

“…For example, one AIDS prevention project in Rotterdam, Netherlands provided outreach and information to active drug users who were not in treatment through a needle exchange program (Grund et al, 1992). Another project, the five-city AIDS Community Demonstration Projects for HIV prevention was first established in clinical settings to serve those who believed themselves in need of HIV prevention services (O'Reilly and Higgins: 1991).…”