Overview of Harm Reduction and Sterile Syringe Access Anna Benyo Syringe Access Policy Coordinator Harm Reduction Coalition New Jersey Syringe Access Informational Forum February 28 th 2007

Topics for Today  Overview of Harm Reduction Principles and practice  National scope of sterile syringe access Opportunities and challenges  Harm Reduction Coalition Resources for providers and communities

Working Definition of Harm Reduction Harm Reduction: A set of practical, public health strategies designed to reduce the negative consequences of drug use and promote healthy individuals and communities.

Key Principles of Harm Reduction  Designs & promotes public health interventions that minimize the harmful affects of drug use.  Understands drug use as a complex, multi- faceted issue that encompasses behaviors from severe abuse to total abstinence.  Meets people where they are in the course of their drug use

Key Principles (continued)  Ensures that people who use drugs have a real voice in the creation of programs.  Affirms people who use drugs are the primary primary agents of change.  Empowers communities to share information and support each other

Social and Environmental Factors  Harm reduction recognizes that the realities of poverty, class, racism, social isolation, past trauma, sex-based discrimination and other social inequalities affect vulnerability to, and capacity for, effectively dealing with drug-related harm.  It does not attempt to minimize the real dangers associated with licit and illicit drug use, and how those issues impact our lives.

Harm Reduction Practice Calls For  Non-judgmental, non-coercive provision of services  Low-threshold program models  Resources to people who use drugs

Harm Reduction & Sterile Syringe Access: history and timeline  First started in Holland in response to hepatitis B outbreak in the 1980s  First legal program in United States started in Tacoma, Washington in 1988  Rooted in activism and advocacy

Goals of Harm Reduction  Prevent disease Sterile syringe access to prevent HIV and hepatitis  Reduce mortality Overdose prevention with training and naloxone distribution; link to medical care and social services  Treatment for drug dependence Buprenorphine or Methadone Maintenance  Empower communities and reduce stigma Community organizing and engagement

Efficacy and Outcomes  Syringe access programs are the most effective, evidence-based HIV prevention tool for people who use drugs  Seven federally funded research studies found that syringe exchange programs are a valuable resource  In cities across the nation, people who inject drugs have reversed the course of the AIDS epidemic by using sterile syringes and harm reduction practices.

Key points in research: syringe exchange does not…  Syringe exchange does not encourage drug use  Syringe exchange does not increase crime rates  Syringe exchange does not increase needlestick injuries in the community

Syringe Exchange Does….  Syringe exchange reduces HIV infection.  Syringe exchange reduces risk for hepatitis C infection.  Syringe exchange programs link participants to drug treatment, medical care, housing, and other other social services.

Injection Drug Use: national scope  Estimates of current injection drug users in the United States range from 354,000 to over 1.3 million.  Injection drug use occurs in every socioeconomic and racial/ethnic group and in urban, suburban, and rural areas.  The majority of injection drug users are men, but between ¼ and 1/3 of injection drug users are women.

The NEED for Syringe Access & Harm Reduction  Over 8,000 people are newly infected with HIV every year due to syringe sharing.  Over 15,000 people are newly infected with hepatitis C every year due to syringe and equipment sharing.  Overdose is the nation’s 2 nd leading cause of accidental deaths.

Demographics  African Americans account for over 50% of all AIDS cases attributed to injection drug use, while Latinos account for nearly 25%.  Among women, an estimated 61% of AIDS cases are due to injection drug use or the result of sexual contact with someone who contracted HIV through injection drug use.  Younger injection drug users generally become infected with hepatitis C within two years.

Sterile Syringe Access Programs  Nearly 200 syringe exchange programs currently operate in 38 states, Puerto Rico, Washington DC.  Access includes: syringe exchange programs, over- the-counter pharmacy sales, syringe prescriptions, and secondary exchange (distribution informally through peer networks)  Endorsed by American Medical Association, American Public Health Association, US Conference of Mayors, among many other legal, medical, and policy institutions

Syringe exchange program models  Storefront  Street-based (fixed sites; roving sites through mobile vans and/or walking teams)  Peer and secondary exchange through networks  Underground, unauthorized programs (operating under the radar)

Opportunities and Challenges: the good news and bad news GOOD: New Jersey authorized sterile syringe access! Improved access to syringe and harm reduction methods will benefit individual and communities. BAD: Federal ban on syringe exchange funding. There is no federal funding or national policy for syringe exchange.

Harm Reduction Coalition (HRC) Education, Training, Technical Assistance, and Capacity Building -Harm reduction methods and practice -HIV prevention in communities of color -Sterile syringe access expansion -Hepatitis C prevention and awareness -Overdose prevention and response Pilot innovative program models - Buprenorphine treatment Advocacy, community organizing and policy - national, regional and local levels

HRC’s Resources National Sterile Syringe Access: technical assistance to expand syringe access, provide best practices, program models, advocacy, and training Overdose: train service providers, drug users, and their friends/family members how to prevent and respond to overdoses Hepatitis C: provide expert training about hepatitis prevention, treatment, and care issues specifically designed for active drug users Buprenorphine: low-threshold pilot intervention to increase access to opiate substitution therapies HIV: training and capacity building to programs working primarily with the African-American Community (CDC DEBIs)

Contact Information For training information: Rebecca Stryjewski ext 18 For questions about citations or syringe access: Anna Benyo Syringe Access Policy Coordinator ext 49 Thanks to Drug Policy Alliance New Jersey, Roseanne Scotti, and Meagan Johnson