The case of syringe distribution and exchange
Gerry V. Stimson and Martin C. Donoghoe
Drug injectors can and will change their behaviour to reduce their own risk of HIV infection and, to a lesser extent, the risk of transmitting the virus to others.
That remarkable conclusion can be drawn from an accumulating body of evidence from many countries. This evidence includes findings from evaluations of a wide variety of programmes that have been specifically designed to promote and facilitate behaviour change among people who inject drugs; from epidemiological and survey-based research of drug injectors in treatment, attending other helping agencies and in the community; and from qualitative or ethnographic social and behavioural studies. A major public health success story, which remains to be properly documented, will show that from 1985 onwards innovative health promotion projects have brought far-reaching changes in drug injectors’ behaviour (Stimson, 1995; Des Jarlais and Friedman, 1994). This is all the more extraordinary given that before the HIV/AIDS era, many people working with drug injectors would have been extremely pessimistic about the feasibility of encouraging such changes. We now know that harm minimisation can achieve its objectives and that health gains that fall short of abstinence from illicit and injecting drug use can be achieved and can have a cumulative impact on the spread of the HIV infection. The behaviour changes attained by drug injectors overshadow those in the general population. Drug injectors, in common with other marginalised and stigmatised groups, have taken the lead in demonstrating that people can respond to the threat of HIV infection.
RISK BEHAVIOUR AND HEALTH PROMOTION
A variety of innovative practices have been introduced to help prevent the spread of HIV among drug injectors through syringe sharing and, to a far lesser extent, from drug injectors to their injecting and non-injecting sexual partners. Interventions to prevent transmission of HIV among drug injectors have focused on drug use, drug injecting and syringe sharing. These include interventions that seek to reduce syringe sharing, such as syringe distribution