NEEDLE EXCHANGES HELPFUL WEAPON IN WAR AGAINST AIDS

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