Contrary to Ian Oliver's article (Time to prick a drug myth, Ecosse,
last week), needle syringe programmes have been largely responsible
for controlling HIV infection among injecting drug users.

Britain was one of the first to implement these programmes. This
decision - by the Thatcher government - was taken when the evidence to
support these programmes was not available. Now we have a vast
quantity of very compelling and consistent data which demonstrates the
effectiveness of needle syringe programmes in reducing the spread of
HIV without serious adverse consequences or an increase in illicit
drug use.

Viral infections result from the sharing of used injecting equipment
and these programmes reduce the time the equipment is in circulation.
Most studies comparing drug injectors who attend the programmes with
those who do not show less risky behaviour and lower rates of HIV
infection among participants.

Computer models of HIV infection among injecting drug users suggest
that they reduce infections by at least one third. We also know that
HIV spreads much faster in cities without needle syringe programmes.
Six reviews of international evidence carried out by American
government agencies (or on their behalf) have confirmed these
conclusions. The evidence is overwhelming.

The Australian experience bears this out. New Hepatitis C infections
are declining among young Australian injectors. An independent
evaluation of Australia's needle syringe programmes concluded that the
$A10m spent in 1991 prevented 2,900 infections and saved $A270m. The
programmes enjoy strong community support in Australia and America.
The United States is a good example of what can happen to HIV control
when rhetoric is valued higher than evidence.

Oliver is right that these programmes have made many people realise
that conventional drug policy has been expensive, ineffective and
often counter-productive. In many countries with a drug policy based
largely on law enforcement, deaths, disease, crime, corruption and
drug use are increasing rapidly. The resounding failure of
conventional drug policy suggests that we should expand needle syringe
programmes and review drug policy.

Dr Alex Wodak Director, Alcohol and Drug Service, St Vincent's
Hospital Sydney, Australia