June 2001

National survey shows increase in syringe exchange programs

ATLANTA — According to a survey fielded by the American Foundation for AIDS Research (AMFAR) and published in a recent issue of the Morbidity and Mortality Weekly Report, the number of syringe exchange programs (SEPs) in the United States nearly doubled between 1994 and 1998. The AMFAR-funded study is the only annual survey of SEPs nationwide and provides evidence that a comprehensive approach to HIV prevention should include making sterile syringes available to injection drug users.

Injection drug use is a major cause of HIV transmission, accounting for more than one-third of all adult AIDS cases in the United States. The U.S. Surgeon General recently determined that there is conclusive scientific evidence that SEPs are an effective public health intervention that reduces HIV transmission and does not encourage the illegal use of drugs.

As of 1998, SEPs operated in 81 cities in 31 states, including the District of Columbia and Puerto Rico; the greatest number of SEPs existed in California, New Mexico, New York and Washington. In 1998, 19.4 million syringes were exchanged, compared with 8 million in 1994; 95% of SEPs offered referral to substance abuse programs; nearly all reporting SEPs provided additional risk-reduction supplies (ie, alcohol pads, bleach and condoms); and 64% of SEPs provided on-site voluntary counseling and HIV testing.

SEP size was an important factor in the number of on-site medical and social services provided, as well as the mode of sterile syringe distribution and the receipt of public finding. The 12 largest programs, among a total of 110, exchanged 62% of all syringes and were able to provide more on-site services to participants than the smaller ones. Larger programs were also able to offer supplemental health services such as influenza and hepatitis B vaccinations. SEP services were delivered in a variety of settings, including health vans, community sidewalk tables, health clinics and outreach by SEP staff for one-on-one visits

In examining the budgets and funding of SEPs, the size of the program was strongly related to the amount of public funding received. Fifty-one SEPs in 15 states and Puerto Rico received public funding that accounted for approximately two-thirds of the total budgets of SEPs in 1998. In addition, New Hampshire, New York and Rhode Island recently either partially or entirely removed prescription requirements and legal penalties for needle possession.

The AMFAR-funded SEP study was conducted in 1999 by research staff of Beth Israel Medical Center, in collaboration with the North American Syringe Exchange Network (NASEN). Surveys were mailed to the directors of the nation’s 131 SEPs, as identified by NASEN. Beth Israel Medical Center staff performed phone interviews; of the 131 SEPs, 110 completed the survey.

Hospital admissions for chronic viral hepatitis rising among HIV patients

MADRID, Spain — The proportion of hospital admissions caused by chronic viral liver disease in HIV-infected patients has increased in the last 5 years. End-stage liver disease currently represents 45% of causes of in-hospital death among HIV-positive individuals. Therefore, strategies like hepatitis B vaccination to prevent infection by hepatitis viruses and specific treatment like interferon plus ribavirin for hepatitis C virus (HCV) should be encouraged.

Researchers assessed the impact of chronic viral liver disease on hospital admissions and death among HIV-positive patients since the introduction of HAART. They reviewed all hospital charts from January 1996 to December 2000 in a reference center for HIV/AIDS located here. Demographics, discharge diagnosis, complications during the in-hospital stay, and number and causes of death were examined.

A total of 1334 hospital admissions in 875 HIV-infected persons were recorded. Overall, 82% were injection drug users and 48.4% fulfilled criteria for chronic viral hepatitis. During the study period, 158 patients (11.8%) were admitted because of decompensated liver disease, or developed it during their admission for another reason. Both absolute number and proportion of admissions caused by chronic viral liver disease tended to increase over time: 9.4% (31/330) in 1996; 11.7% (25/213) in 1997; 7.8% (20/255) in 1998; 14.5% (36/249) in 1999 and 16% (46/287) in 2000.

The total number of in-hospital deaths has declined progressively, but liver mortality has increased relatively: 9.3% (5/54) in 1996; 19.2% (5/26) in 1997, 26.3% (5/19) in 1998; 33.3 (3/9) in 1999 and 45% (9/20) in 2000. Chronic hepatitis C was present in more than two-thirds of subjects with hospital admission or death caused by chronic viral liver disease.

UNAIDS welcomes U.S. contribution to international fund

GENEVA — The U.S. government recently contributed $200 million to a global HIV/AIDS and health fund aimed at fighting AIDS, tuberculosis and malaria.

UNAIDS applauded the United States’ leadership in being the first country to respond to the call made by the U.N. Secretary-General at the Organization of African States summit in Abuja, Nigeria, in April for a global trust fund. UNAIDS estimates that $7 billion to $10 billion is needed annually to combat AIDS in low- and middle-income countries for an effective response to the epidemic.

The call for urgent action comes at a time when antiretroviral drugs are becoming more affordable in the wake of commitments made recently by some of the world’s major pharmaceutical companies. According to an expert group, investment now would prevent tens of millions of new infections while extending the lives of additional millions of people already living with HIV.