In Hawaii, Number of Needles Exchanged Through Program Increases, HIV Cases DecreaseHawaii's needle-exchange program gave out a record 347,793 syringes last year -- a 58% increase over 2000 -- while the number of HIV cases in the state dropped, indicating that the program is having an impact, the Honolulu Advertiser reports. Although the high exchange rate reflects a large amount of IV drug use in Hawaii, the number of AIDS cases attributable to injection drug use remains unexpectedly low. Only five of the state's 57 AIDS cases reported in 2001 were linked to IV drug use. "Based on their drug injection frequencies, these participants would be at very high risk for HIV infection if they didn't have a legal source of sterile injection equipment and other services," Dr. Don Des Jarlais, a research director at the Chemical Dependency Institute at New York's Beth Israel Medical Center who recently completed an evaluation of Hawaii's exchange program, said, adding that IV drug users typically inject three times a day. He also noted that the 12-year-old program, which had a budget of $360,000 last year, is saving the state "thousands of dollars in medical expenses" each year. "If the program prevents five HIV infections ... per year, it produced a cost savings to the state," he explained, noting that the state spends about $102,000 per year for every HIV-positive person.
Department of Health Director Bruce Anderson said he was "pleased" with the study's findings but warned that the program, which was the first of its kind established in the United States, still faces "a number of challenges," including finding a permanent home. The exchange, which is run by Community Health Outreach Work, currently operates from six mobile vans on four islands and the Kalihi-Palama Clinic in Oahu. "It's important to find a place and establish a clinic where IV drug users are comfortable seeking services that may provide more focused services around their needs, and that would include not only providing sterile needles, but other support services," including HIV counseling, hepatitis B vaccination and drug counseling and treatment, Anderson explained (Lum, Honolulu Advertiser, 2/15).
A Model Program
Des Jarlais, who also coordinates a 14-nation survey of HIV and drug use for the World Health Organization, said Hawaii's program could serve as a model for other states and Asian nations hit hard by IV drug use. Needle-exchange programs in Asia "potentially would be effective but they're already quite late," he said, adding, "Worldwide, the problem of HIV among drug injectors is approaching catastrophe." Between 50% and 70% of Asian IV drug users already have HIV, compared to only 1% or 2% of Hawaii's IV drug-using population, he noted (Altonn, Honolulu Star-Bulletin, 2/14).