1. 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

2. 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

3. 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.

4. 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

5. 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

6. 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.

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

8. 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

9. 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

10. 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.

11. 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

12. 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.

13. 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.

14. 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.

15. 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.

16. 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

17. 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)

18. 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.

19. 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

20. 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)

21. Contact Information For training information: Rebecca Stryjewski 212.213.6376 ext 18 stryjewski@harmreduction.org For questions about citations or syringe access: Anna Benyo Syringe Access Policy Coordinator 212.213.6376 ext 49 benyo@harmreduction.org Thanks to Drug Policy Alliance New Jersey, Roseanne Scotti, and Meagan Johnson