Needle Exchange Helps Cut HIV Rate: University Study Shows Changes Are Working

A new study finds Montreal's needle-exchange programs (NEPs) have helped reduce HIV incidence rates among injecting drug users (IDUs).

The city was one of the first in North America to adopt harm-reduction strategies in the 1990s. However, a 1995 study showed that HIV incidence was higher among IDUs who used NEPs than among those who did not. Acting on that knowledge, the Montreal Public Health Department (MPHD) began making improvements to the programs, including doubling the number of syringes available. The new study suggests those enhancements are working.

In the prospective cohort study of the period 1992 to 2008, researchers at the Université de Montréal followed 2,137 IDUs who had tested HIV-negative at enrollment.

Annual HIV incidence rates declined four times faster after 2000, when IDUs started obtaining clean syringes from NEPs or supervised injection sites. In 2000, HIV incidence among IDUs was 5.1 per 100 person-years. By 2007, it had dropped to 0.4, before rising to 1.8 in 2008.

"The evolution of the policies has led to a reduction in HIV incidence," said lead author Dr. Julie Bruneau. "Our study really shows that adapting services and opening new ways of reaching out to drug users that are at risk of HIV infection is the way to go."

However, much more work is needed, said MPHD Director Dr. Richard Lessard. "The significant reduction of HIV transmission among [IDUs] constitutes a real, though insufficient step forward," he said. "Since the early 2000s ... hepatitis C infection has taken on alarming proportions. During this period, the distribution of injection material has not attained the expected deployment, and for this reason, we have to increase our efforts."

The study, "Trends in Human Immunodeficiency Virus Incidence and Risk Behavior Among Injection Drug Users in Montreal, Canada: A 16-Year Longitudinal Study," was published in the American Journal of Epidemiology (2011;173(9):1049-1058).

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