Current State of Syringe Exchange in the Known Universe Don C. Des Jarlais, Vivian Guardino, Kamyar Arasteh, Courtney McKnight, Judith Milliken and David.

Slides:

Advertisements

Similar presentations

Developing a Gender Equity Action Plan Judith M. Sweet Former Senior Vice President for Championships and Education Services and Senior Woman Administrator.

Advertisements

Washtenaw County Office of The Sheriff Preliminary Proposal Jail Space Expansion.

Youth Mental Health April 9, Overview History Current Youth Mental Health Resources – Wraparound Orange Youth Mental Health Proposal Action item.

You Make a Difference 2013 Prevention Needs Assessment Survey Partners for Prevention Address: 460 North Main Street, Warsaw, NY Phone: (585) 786.

Nationals HIV/AIDS Strategy and how the mission of Women Accepting Responsibility, Inc. is helping to meet this goal. By She’kell Hutchinson Program Director,

Rapid Response to a Local Outbreak of Syphilis in Baltimore Joshua M. Michaud Epidemiologist Syphilis Elimination Project Johns Hopkins University School.

Don C. Des Jarlais, Vivian Guardino, Ann Nugent and Alisa Solberg The Dave Purchase Memorial 2012 National Survey of Syringe Exchange Programs: Summary.

Academic Advising Implementation Team PROGRESS REPORT April 29, 2009.

Killing the Pain: Prescription Drug Abuse and Other Risky Behaviors in Rural Appalachia Jennifer R. Havens, PhD, MPH Department of Behavioral Science Center.

Presentation ‘Developing positive working relationships between Health and Law Enforcement Agencies’

Public Funding of Syringe Exchange in the US: The Challenges of Failures and Successes and the New Heroin Injectors Don Des Jarlais 1, Heidi Bramson 1,

Emerging AHP Strategies for Recruitment Maria E. Alvarez, MPA CDC/NCHSTP/DHAP/PPB Public Health Advisor Duty Point: NYC

Ryan White CARE Act Dental Reimbursement Program (DRP) 2000 Data.

Overview of Syringe Exchange Programs New York City Police Academy November 24, 2004.

COMMUNITY PLANNING & S YRINGE A CCESS A DAM R EILLY P ROJECT D IRECTOR.

Afghanistan’s Present IDUs-HIV/AIDS Situation and future action plan Dr.Saifur-Rehman NACP Director April,11,2007 Islamic Republic of Afghanistan Ministry.

EXCELLENCE AND SUSTAINABILITY BUILDING COMMUNITY CONNECTIONS.

New York Harm Reduction Educators (NYHRE) UPRISE Peer Training Program Uniting Peers for the Rights of Injectors and Sex Workers Everywhere 9 th National.

How to survive in a non-supportive environment: Experience from Russia Ivan Varentsov (Andrey Rylkov Foundation) AIDS 2014, Melbourne.

HIV and drug prevention in Estonia Harm reduction services

Strategies for Incorporating OD Prevention Into Your Work Eliza Wheeler Drug Overdose Prevention & Education (DOPE) Project Harm Reduction Coalition

Population-based estimates of prevalence of HIV, HBV and HCV and HIV-related risk behaviors among male injecting drug users in Lagos, Nigeria Waimar Tun.

Abstract Liana Frey  Ann Gleason  Nikki Johnson  Jenna Laube  Crystal Schmitt  Kelsey Switters Women’s Studies  University of Wisconsin-Eau Claire.

Nursing Care Makes A Difference The Application of Omaha Documentation System on Clients with Mental Illness.

Larry Cuellar Adult Viral Hepatitis Prevention Coordinator Texas Department of State Health Services 2010 STREET OUTREACH WORKERS CONFERENCE June 21, 2010.

Integrated Health Home Services in an Opioid Treatment Program: A Model Yngvild Olsen, MD, MPH Institutes for Behavior Resources, Inc./REACH Health Services.

2011 National Survey of Syringe Exchange Programs: Summary of Results Don C. Des Jarlais, Vivian Guardino, Ann Nugent, Kamyar Arasteh, David Purchase This.

1 Advancing Recovery: Baltimore Buprenorphine Initiative Tucson Presentation July 29, 2009 Baltimore Substance Abuse Systems.

Working with SEPs: How do we expand Hepatitis Services ? Narelle Ellendon, RN HCV Director Harm Reduction Coalition, NYC

Comprehensive HIV Prevention Strategies for Most at Risk Populations (MARPs) Anne Goldzier Thomas, Ph.D. US Department of Defense/PEPFAR Ethiopia National.

Universidad Central del Caribe Comorbidity and HIV Risk Behaviors among Hispanic Drug Users Residing in Puerto Rico Oral Presentation.

Mpumalanga Department of Health report on Comprehensive HIV and AIDS Grant 1.

2010 National Survey of Syringe Exchange Programs: Summary of Results Don C. Des Jarlais, Vivian Guardino, Ann Nugent, Kamyar Arasteh, David Purchase This.

A Profile of People Who Inject Drugs in London, Ontario Report on the Public Health Agency of Canada I-Track Survey, Phase 3 Canadian Public Health Association.

November 2012 Prepared for the Contra Costa Board of Supervisors by Contra Costa Health Department Needle Exchange Update.

HIV CARE UNDER THE AFFORDABLE CARE ACT: ADAP’S IN THE NEW ERA Richard Aleshire, MSW Program Manager, HIV Client Services Office of Infectious Disease Washington.

To Increase Investment in Syringe Exchange in the U.S. would be Cost-saving. Results from modeling hypothetical syringe coverage levels INTL AIDS CONF.

Reaching out to drug users and communities “ ” WDP Preventing HIV Yasmin Batliwala.

The United States is a drug culture. Americans use drugs on a regular basis to wake up in the morning (coffee and tea), get through the day (cigarettes),

CARIBBEAN BASIN AND HISPANIC ADDICTION TECHNOLOGY TRANSFER CENTER Effects of a Two-facet Intervention to Reduce HIV Risk Behaviors Among Hispanic Drug.

Drug Abuse Education Course Master Sgt. Doug Oswald Assistant Drug Demand Reduction Administrator.

Washtenaw County Office of The Sheriff Preliminary Proposal Jail Space Expansion.

 Policy initiatives Surveillance data use Leveraging SAMHSA HIV set- aside funds Healthcare reform planning  Condom distribution & syringe supply bank.

Washington D.C., USA, July 2012www.aids2012.org Alternatives to NSEPs: community-based initiatives Providing access to syringes in the politically.

HIV/AIDS, Housing and Risk Behaviors CT AIDS Resource Coalition and CIRA Community Research Partnership Program.

Effects of Pharmacy Syringe Access Among Young Heroin Injectors Results IDU needle sharing decreased after the enactment of the pharmacy access law in.

Jennifer R. Havens, PhD, MPH Associate Professor

Association for Women in Psychology Conference “A Model of Integrated Treatment for Women with Co-Occurring Disorders who are at High Risk for HIV” Presented.

Results from the STEAM Survey Elizabeth Barash, MPH.

| Web: The findings and conclusions in this report are those of the authors and do not necessarily represent the official.

Hepatitis Vaccination: Closing the Gaps in New York State Debra Blog, MD, MPH Immunization Program New York State Department of Health National Immunization.

Readiness To Change HIV/HCV Risk Behavior Among Young African American IDUs. Edward V Morse, PhD, Tulane University Health Sciences Center, Department.

Non-Medical Staff Knowledge, Beliefs and Practices about HIV and Hepatitis for Injection Drug Users Rowe, KA 1, Tesoriero, JM 1, Heavner, KK 1, Rothman,

The Reduction of Emergency Room Visits for Non- Emergent Health Concerns in Bakersfield, California Mariah Walton, MPH Public Health Advisor Office for.

A DAY IN THE LIFE OF BOOTS QUEEN STREET STATION Lynda Allan Store Manager.

HUMAN RIGHTS ISSUES RELATED TO THE EVALUATION OF AN ILLEGAL NEEDLE EXCHANGE PROGRAM Debra Harris, Ph.D., California State University, Fresno.

Best Practices and Harm Reduction Needle Exchange Program of Asheville (NEPA) Michael Harney Prevention Educator Western North Carolina AIDS Project.

Building a needle exchange in the desert COMMUNITY, LEGAL, AND OPERATIONAL ASPECTS OF THE ORANGE COUNTY NEEDLE EXCHANGE PROGRAM (OCNEP) KYLE BARBOUR, OCNEP.

Name(s) Here Job Title(s) Here.

Syringe Exchange Programs in NC

Emerging AHP Strategies for Recruitment

Riga city Council Welfare department HIV prevention

Effective HIV & SRH Responses Among Sex Workers and other Key Populations Module 1: National Data.

Needle Exchange Update

Syringe Exchange Programs in NC

Sherry Deren, Sung-Yeon Kang, Milton Mino & Honoria Guarino

Rowe, KA1, Tesoriero, JM1, Davis, SJ1, Heavner, KK1, Rothman, J2,

Needle exchange program

Human Dignity and Harm Reduction

March 8, 2006 New ACIP Hepatitis B Recommendations

Presentation transcript:

Current State of Syringe Exchange in the Known Universe Don C. Des Jarlais, Vivian Guardino, Kamyar Arasteh, Courtney McKnight, Judith Milliken and David Purchase This work was funded by amfAR, The Foundation for AIDS Research, with support from the Elton John AIDS Foundation and the Irene Diamond Foundation-Tides Foundation. NASEC 2010, Austin, TX November 17, 2010

Three Eras of Syringe Exchange in the US Homeric age: heroes, demigods, villains and wars The Greek city-state era and the ideal of the rational The Roman empire era: central administration and resources

Homeric Age: mid to late 1980s Heroes, demigods, villains and wars Activist initiated exchanges Some support from local and state governments Intense opposition from some political/community leaders Court cases “Public health necessity”

Homeric Age Strom Thurmond Catch 22 on federal funding International and US research and practical experience indicating programs effective

Greek City-state Era. The ideal of the rational: mid 1990s to mid 2000s Growth of SEPs in many different areas, but without national plan Programs evolved with minimum bureaucratic regulation, maximum input from front line staff and participants Occasional compromises with receipt of state/local funding, often “workarounds”

Characteristics of SEP’s Participating in BIMC/NASEN Surveys United States, Numbers of SEPs known to NASEN SEPs Participating in survey (%) 60 (88%) 87 (86% 100 (88% 110 (84%) 127 (82%) 126 (85% 109 (63%) 118 (71%) 150 (80%) 131 (70%) 123 (67%) 149 (74%) Cities with SEP’s participating States with SEP’s participating * Syringes exchanged (millions) Total of SEP budgets ($, millions) Total of SEP budgets in 2009-adjusted $ (millions) Public funding as % of total SEP budgets 62% 67%69%74%67%76%74%79%73%79%80% * This category includes the District of Columbia and/or Puerto Rico.

National Survey of Syringe Exchange Programs Methodology 2008 Survey 184 SEPs contacted in first quarter SEPs (67%) submitted completed surveys by early summer Survey 201 SEPs contacted in first quarter SEPs (74%) submitted completed surveys by early summer.

SEP Budget Dollars Total $$$$21,307,337$21,686,788 City Gov $ $5,041,332 $5,381,142 County Gov $ $2,402,678 $2,261,688 State Gov $ $9,417,053 $9,768,293 Foundation $ $3,440,558 $3,233,266 Individual Donations $458,685 $536,333 Out-of-pocket $ $57,911 $41,959 NASEN $ $ 65,170 $45,609 CBO Donation $ $19,000 $2,059 Corporate Donation $ $85,832 $38,084 Other $ $319,118 $378,355

Budget Status 2009 vs n = 149

SEPs That Participated in 2008 & 2009 Surveys Total Budget $$ 2008 $19,427,228 (as reported by 103 SEPs) 2009 $18,001,377 (as reported by 100 SEPs)

Types of Areas SEPs Are Located in United States, 2009 n = 149

Gender Distribution Frequency of SEP Participants in 2009 <25%<50%<75%75% or more Didn’t Answer Male 2 (1.34%) 12 (8.05%) 113 (75.84%) 21 (14.09%) 1 (0.67%) Female 22 (14.77) 112 (75.17%) 13 (8.72%) 1 (0.67%) 1 (0.67%) Transgender 145 (97.32%) 1 (0.67%) 1 (0.67%) 1 (0.67%) 1 (0.67%)

Ethnic Distribution Frequency of SEP Participants in 2009 <25%<50%<75%75% or more Didn’t Answer African American 103 (69.13%) 28 (18.79%) 5 (3.36%) 10 (6.71%) 3 (2.01%) Asian Pacific Islander 144 (96.64) 1 (0.67%) 01 (0.67%) 3 (2.01%) Caucasian 25 (16.78%) 22 (14.77%) 47 (31.54%) 52 (34.90%) 3 (2.01%) Latino/a 114 (76.51%) 21 (14.09%) 6 (4.03%) 4 (2.68%) 4 (2.68%) Native American 145 (97.32%) 1 (0.67%) 003 (2.01%)

% of Injected Substances and Substance Combinations < 25%< 50%< 75%> 75% ‘08‘09‘08‘09‘08‘09‘08‘09 Heroin by itself 14%12%30%27%30%28%26%32% Heroin & Cocaine 75%77%16%15%6%4%2%1% Heroin mixed with another drug (not cocaine) 93%89%3% --3% Cocaine by itself (including Crack) 82%77%15%17%2%3%1% Cocaine mixed with another drug (not heroin) 96%94%--2%1% 2%1% Methamphetamine (crystal meth/ice/crank) 63%68%24%22%8%7%4%1% Other Amphetamines (uppers/Dexedrine) 98%94%--3%--1% -- Other Opiates (OxyContin, Percodan, Vicodin, etc.) 80%75%13%16%2%4%3% Steroids 97%96%-- 1%2%-- HIV meds and/or insulin 96%97%1% -- 2%-- Downers (benzodiazepines, tranquilizers) 96%91%1%4%2%1% Silicone 98%96%-- 1% -- Any other substances 97%95%-- 1%

Type of Heroin Used in 2009 As Reported by SEPs

Type of Exchange Conducted by SEPs in 2009 VariationNo. (%) Allowed receipt of more syringes than brought in 126 (84.56%) Used Start-up Packs91 (61.07%) Used A Minimum48 (32.21%) Used A Distribution Model 83 (55.70%) Had a Limit on Syringes Exchanged 34 (22.82%)

Weekly Exchange Regular, Scheduled Times & Places 2008 Total of 3,625 hours per week averaging hours per SEP (n = 123) 2009 Total of 4,063 hours per week averaging hours per SEP (n = 146)

Number of Syringes Distributed by Syringe Exchange Programs (SEPs), by Program Size: 2008 & 2009 SEP Size (Syringes Distributed) No. of SEPs 2008 Total syringes exchanged 2008 No. of SEPs 2009 Total syringes exchanged 2009 Small (< 10,000) 2067,593 (0.2%) 2594,611 (0.3%) Medium (10,000-55,000) 33982,317 (3.4%) 391,129,493 (3.4%) Large (55, ,999) 549,894,182 (34.1%) 7013,011,703 (39.3%) Very Large (  500,000) 1518,113,914 (62.3%) 1418,879,383 (57.0%) Total122*29,058,006148*33,115,190 * In 2008 & 2009 one program responding to the survey did not track the number of syringes exchanged.

Returned/Collected Syringes

Disposal Methods of Collected Used Syringes in 2009

Syringes Exchanged By 106 Programs That Participated in Both 2008 & 2009 Surveys 2008 (n = 106) 26,834,186 syringes distributed 24,409,879 syringes collected 2009 (n = 105) 29,257,618 syringes distributed 27,731,430 syringes collected

SEP Usage of Unique Identifiers for Tracking Individuals in 2009

Secondary (Satellite) Exchange & Methods of Encouragement Used by SEPs in 2009 Secondary ExchangeNo. (%) SEPs allowing secondary exchange135 (90.60%) SEPs encouraging secondary exchange119 (79.87%) Methods of Encouragement Talked about it108 (72.48%) Had no limit on syringes exchanged 96 (64.43%) Gave extra supplies110 (73.83%) Provided sharps containers103 (69.13%) Enrolled people receiving syringes from secondary exchange 34 (22.82%) Peer education 79 (53.02%) Gift certificates/Other incentives 20 (13.42%)

Risk Reduction Education Provided by SEPs in 2008 & No. (%) 2009 No. (%) Condom Use 120 (97.56%) 146 (97.99%) Hepatitis (A,B,C) Prevention 119 (96.75%) 142 (95.30%) OD Prevention with Narcan 62 (50.41%) 76 (51.01%) OD Prevention without Narcan 59 (47.97%) 78 (52.35%) Safer Crack Use 65 (52.85%) 81 (54.36%) STD and HIV Prevention (other than condom use) 118 (95.93%) 138 (92.62%) Dental Dam/Female Condom Use 91 (73.98%) 105 (70.47%) Use of Bleach 85 (69.11%) 97 (65.10%) Safer Injection Techniques 116 (94.31%) 140 (93.96%) Abscess/Wound and/or Vein Care 113 (91.87%) 134 (89.93%)

Weekly On-Site Medical Services SEPs reported providing on-site medical care totaling 1,516 hours per week SEPs reported providing on-site medical care totaling 1,360 hours per week

Supplies Provided by SEPs 2008 No. (%) 2009 No. (%) Containers for carrying syringes 102 (83%)135 (91%) Cookers119 (97%)144 (97%) Crack Kits 47 (38%) 61 (41%) Cotton120 (98%)146 (98%) Alcohol Pads123 (100%)148 (99%) Bleach69 (56%)83 (56%)

Supplies Provided by SEPs 2008 No. (%) 2009 No. (%) Water bottles94 (76%)116 (78%) Ties111 (90%)135 (91%) Antibiotic Ointment 97 (79%) 117 (79%) Wound Kits 63 (51%)86 (58%) Band-aids105 (85%)124 (83%) Suboxone11 (9%)10 (7%) Buprenorphine7 (6%)10 (7%) Narcan54 (44%)66(44%)

Supplies Provided by SEPs 2008 No. (%) 2009 No. (%) Condoms121 (98%)148 (99%) Female Condoms97 (79%)129 (87%) Dental Dams 88 (72%) 99 (66%) Lubricant112 (91%)143 (96%)

Supplies Provided by SEPs 2008 No. (%) 2009 No. (%) Hygiene Items104 (85%)124 (83%) Clothes79 (64%)88 (59%) Food84 (68%)103 (69%) Gift Certificates / Vouchers / Travel 46 (37%) 54 (36%) Other 24 (20%) 28 (19%)

Selected On-Site Services Provided by SEPs 2008 No. (%) 2009 No. (%) HIV Counseling & Testing 107 (87%)129 (87%) Hepatitis C Counseling & Testing 80 (65%)93 (62%) Hepatitis B Counseling & Testing 30 (24%) 29 (19%) Hepatitis A Counseling & Testing 22 (18%)22 (15%) Hepatitis B Vaccination60 (49%)57 (38%) Hepatitis A Vaccination58 (47%)56 (38%)

Selected On-Site Services Provided by SEPs 2008 No. (%) 2009 No. (%) STD Screening67 (55%)69 (46%) Tuberculosis Screening 38 (31%)38 (26%) Substance Abuse Treatment Referrals 110 (89%) 128 (86%)

Additional Program Characteristics 2008 No. (%) 2009 No. (%) Did not operate for two months or more 2 (1.63%)13 (8.72%) Any full-time (paid) staff 86 (69.92%) 97 (65.10%) Operated by city, county or state health department 35 (28.46%) 35 (23.49%) 501-C3 Status 96 (78.05%) 117 (78.52%)

Additional Program Characteristics 2008 No. %) 2009 No. (%) Operated a Delivery Service 51 (41.46%)78 (52.35%) Had Referral Tracking System 65 (52.85%) 68 (45.64%) Was involved in formal external evaluation 24 (19.51%)28 (18.79%)

Problems SEPs Encountered in 2008 & 2009 Problems2008 No. (%)2009 No. (%) Operations disrupted by government or law enforcement official 20 (16.26%) 18 (12.08%) Lack of resources/Lack of funding83 (67.48%)103 (69.13%) Staff shortage63 (51.22%) 77 (51.68%) Staff burnout38 (30.89%) 44 (29.53%) Lack of political support21 (17.07%) 29 (19.46%) Lack of community support25 (20.33%) 28 (18.79%) Lack of outreach28 (22.76%) 31 (20.81%) Legal status 9 (7.32%) 12 (8.05%) Police harassment of participants (at/near site) 27 (21.95%) 30 (20.13%) Police harassment of staff / program10 (8.13%) 8 (5.37%) Reaching or recruiting participants 31 (25.20%) 38 (25.50%) Retaining participants12 (9.76%) 20 (13.42%) Any type of problem due to gentrification? 15 (12.20%) 15 (10.07%) Other 18 (14.63%) 15 (10.07%)

Quality of Relationship Between SEPs and Police as Reported by SEPs in 2008 & 2009 Quality of Relationship 2008 No. (%) 2009 No. (%) Very Good 24 ( 19.51%) 33 (22.15%) Somewhat good 37 (30.08%) 45 (30.20%) Neutral 45 ( 36.59%) 45 (30.20%) Somewhat poor 5 (4.07%) 7 (4.70%) Very poor 2 (1.63%) 4 (2.68%) Non-existent 10 (8.13%) 12 (8.05%)

Quality of Relationship Between SEPs and Local Health Officials in 2008 & 2009 Quality of Relationship 2008 No. (%) 2009 No. (%) Very Good 71 ( 57.72%) 103 (69.13%) Somewhat good 32 (26.02%) 28 (18.79%) Neutral 11 ( 8.94%) 8 (5.37%) Somewhat poor 1 (0.81%) 2 (1.34%) Very poor 2 (1.63%) 2 (1.34%) Non-existent 6 (4.88%) 4 (2.68%)

Strategies SEPs Used in 2009 to Gain Law Enforcement Support Strategy# of SEP’s% None % Meetings % Trainings % Invitation to exchange % Street demonstrations 64.02% Coalition work w/other public health activists % Officer Liasons % Didn’t have capacity/resources for strategy % Other %

Any favorable or unfavorable media attention in 2009 –YES 42 programs (28.19%) –NO 106 programs (71.14%)

The Roman Empire Era: 2010 onward Need for a national plan Need for national resources Will rationality and best practices be retained?

Federal Funding SEPs …YesNoDon’t Know Didn’t Answer Believe Eligible 65 (43.62%) 16 (10.74%) 68 (45.64%) 0 Have or expect to apply 73 (48.99%) 28 (18.79%) 47 (31.54%) 1 (0.67%) Expect to receive funds 34 (22.82%) 15 (10.07%) 78 (52.35%) 22 (14.77%)

If Federal Funding Received Programs Anticipate … Maintaining Present Services Expanding Present Services Adding New Services Don’t Know Didn’t Answer 27 (18.12%) 58 (38.93%) 23 (15.44%) 10 (6.71%) 31 (20.81%)

Three Eras of Syringe Exchange in the US Homeric age: heroes, demigods, villains and wars The Greek city-state era and the ideal of the rational The Roman empire era: central administration and resources

Other Parts of Known Universe Canada: expansion of syringe access in Vancouver and Montreal led to decreased HIV incidence China: Scaling up, but not sure how to measure effectiveness Russia: scaling down Estonia: scaled up, preliminary evidence of decreased HIV incidence

Thank You!  Special Thanks to Alisa Solberg and Kay Borba for their help in reaching out to SEPs  Many Thanks to EVERYONE who contributed to a survey submission. KEEP THEM COMING!