NEEDLE EXCHANGE PART OF WHOLE PACKAGE

Editor, The News:

I feel I must respond to Bert Warden's recent letter arguing that the
effectiveness of needle exchanges in inhibiting the spread of HIV is in
doubt, citing the example of the Vancouver Needle Exchange as proof of
his allegation.

I'm afraid Mr. Warden has cited a single, dated observation from a
large, multi-year research study as proof of a conclusion opposite to
that drawn by the researcher herself and stated specifically in other
studies.

As Mr. Warden rightly noted, Dr. Stephanie Strathdee of the BC Centre
for Excellence in HIV/AIDS, observed in 1996 that 40 per cent of the
test group of IV drug users reported borrowing at least one unused
needle in the preceding six months and that within a period of eight
months, 18.6 per cent of those initially HIV-negative became infected
with the virus. This information is correct as far as it goes.

Nevertheless, further research within the same study has gone on to
support conclusions reached by many other research bodies, including the
U.S. Centres for Disease Control, that needle exchanges are very
effective in reducing the spread of HIV and other blood-borne pathogens.

In fact, a 1999 study paper co-authored by Dr. Strathdee, Dr. Martin
Schechter and others specifically concluded: "We found no evidence that
this NEP (note: Needle Exchange Program, referring to the Vancouver
Exchange) is causally associated with HIV transmission. The observed
association should not be cited as evidence that NEP may promote the
spread of HIV. By attracting higher risk users, NEP may furnish a
valuable opportunity to provide additional preventive/support services
to these difficult-to-reach individuals."

Over the years, Dr. Strathdee has been very vocal in her support of
needle exchanges in general and the Vancouver exchange in particular.

There were indeed factors which led to the explosion of HIV infection in
Vancouver during the mid-1990s. Among those cited by research were the
high prevalence of injected cocaine use and unstable housing within the
highest risk population.

Further, for more than a year during that period, users were indeed
having difficulty getting clean needles when they needed them as the
Vancouver Exchange was forced to cut back service due to inadequate
funding in the face of increasing demand, much of it coming from users
moving to the Lower Mainland as welfare rates were cut in other parts of
the country.

It is worth noting that current annual infection rates have fallen to
approximately four per cent in the highest risk IV-drug-using population
- - basically the same infection rate as in 1992.

While needle exchange has been conclusively shown to be a necessary part
of HIV prevention strategies - one which does not lead to further
addiction - it is not a silver bullet and will not, by itself, curtail
any epidemic.

It is the experience of our exchange that fully 70 per cent of the users
we deal with want to get off drugs now. In the absence of sufficient
services to meet those needs, needle exchanges provide a crucial means
to help keep users healthier long enough to receive help and make the
changes in their lives that so many desperately desire.

I encourage those living in Abbotsford to look seriously at how you can
help the users who live - mostly anonymously - in your midst.

Providing needle exchange and the many other services that should go
hand in hand with this type of harm reduction can facilitate reaching
those needing support in your community. Anonymity and ignorance are the
true facilitators of epidemics.

Judy McGuire, Manager

Downtown Eastside Youth Activities Society

Health Outreach

Vancouver