Sherman Susan G, Patel Shivani A, Ramachandran Daesha V, Galai Noya, Chaulk Patrick, Serio-Chapman Chris, Gindi Renee M
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
Drug Alcohol Rev. 2015 Nov;34(6):637-44. doi: 10.1111/dar.12276. Epub 2015 Apr 28.
Syringe distribution policies continue to be debated in many jurisdictions throughout the USA. The Baltimore Needle and Syringe Exchange Program (NSP) operated under a 1-for-1 syringe exchange policy from its inception in 1994 through 1999, when it implemented a restrictive policy (2000-2004) that dictated less than 1-for-1 exchange for non-program syringes.
Data were derived from the Baltimore NSP, which prospectively collected data on all client visits. We examined the impact of this restrictive policy on program-level output measures (i.e. distributed : returned syringe ratio, client volume) before, during and after the restrictive exchange policy. Through multiple logistic regression, we examined correlates of less than 1-for-1 exchange ratios at the client level before and during the restrictive exchange policy periods.
During the restrictive policy period, the average annual program-level ratio of total syringes distributed : returned dropped from 0.99 to 0.88, with a low point of 0.85 in 2000. There were substantial decreases in the average number of syringes distributed, syringes returned, the total number of clients and new clients enrolling during the restrictive compared to the preceding period. During the restrictive period, 33 508 more syringes were returned to the needle exchange than were distributed. In the presence of other variables, correlates of less than 1-for-1 exchange ratio were being white, female and less than 30 years old.
With fewer clean syringes in circulation, restrictive policies could increase the risk of exposure to HIV among Injection Drug Users (IDUs) and the broader community. The study provides evidence to the potentially harmful effects of such policies.
在美国许多司法管辖区，注射器分发政策仍存在争议。巴尔的摩针头与注射器交换项目（NSP）自1994年成立至1999年一直实行1:1注射器交换政策，1999年至2004年实施了一项限制性政策，规定非项目注射器的交换比例低于1:1。
数据来源于巴尔的摩NSP，该项目前瞻性地收集了所有客户就诊的数据。我们研究了这项限制性政策在实施前、实施期间和实施后对项目层面产出指标（即分发的注射器与回收的注射器比例、客户数量）的影响。通过多元逻辑回归，我们研究了在限制性交换政策实施前和实施期间客户层面低于1:1交换比例的相关因素。
在限制性政策期间，项目层面分发的注射器与回收的注射器的年均比例从0.99降至0.88，2000年降至最低点0.85。与前一时期相比，限制性政策实施期间分发的注射器平均数量、回收的注射器数量、客户总数和新登记客户数量均大幅下降。在限制性政策期间，返还给针头交换项目的注射器比分发的多33508支。在存在其他变量的情况下，低于1:1交换比例的相关因素包括白人、女性和年龄小于30岁。
随着流通中的清洁注射器减少，限制性政策可能会增加注射吸毒者（IDU）和更广泛社区感染艾滋病毒的风险。该研究为这类政策的潜在有害影响提供了证据。
