Hankins C A
Infectious Disease Unit, Montreal Regional Public Health Department, Quebec, Canada.
Subst Use Misuse. 1998 Apr;33(5):1129-46. doi: 10.3109/10826089809062211.
This article provides a historical perspective on the development of syringe exchange in Canada, the Canadian legal and policy context, evaluation and monitoring strategies, and current challenges facing HIV prevention efforts among injecting drug users. Despite the fact that it is legal to sell, exchange, or provide an IDU with a syringe and there are no laws in Canada requiring a physician's prescription to justify possession of a syringe, policy development and programming have not been adequate to hold HIV at bay in several cities across the country. Although there have been concerted efforts by syringe and needle exchange programs to increase the supply of injecting equipment, HIV prevalence continues to rise, provoking a rethinking of the role of syringe exchange. In a coordinated strategy for HIV prevention among drug users in Canada, needle and syringe exchange is not itself in question; however, ghettoization and needle quota systems may have had an adverse impact on prevention programming. A national action plan has been developed which aims to decentralize both methadone maintenance and syringe and needle exchange programs, increase access to detoxification and treatment modalities, and advocate for changes in the criminal justice system and law enforcement practices.
本文从历史角度审视了加拿大注射器交换项目的发展、加拿大的法律和政策背景、评估与监测策略，以及注射吸毒者中艾滋病预防工作目前面临的挑战。尽管在加拿大，向注射吸毒者出售、交换或提供注射器是合法的，且没有法律要求凭医生处方才能持有注射器，但政策制定和项目实施在全国多个城市仍不足以控制艾滋病。尽管注射器和针头交换项目齐心协力增加注射设备的供应，但艾滋病感染率仍在上升，这促使人们重新思考注射器交换的作用。在加拿大针对吸毒者的艾滋病预防协调战略中，针头和注射器交换本身并无问题；然而，集中化和针头配额制度可能对预防项目产生了不利影响。现已制定一项国家行动计划，旨在将美沙酮维持治疗以及注射器和针头交换项目去中心化，增加戒毒和治疗方式的可及性，并倡导刑事司法系统和执法实践的变革。
