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American Psychiatric Association
Position on Needle Exchange Programs
Sep 1996
This statement was written by the Commission on AIDS. It was approved by the Board of Trustees in September 1996.

Current treatment strategies for the acquired immune deficiency, syndrome (AIDS) and its seqluelae reflect major advances in both knowledge about the human immunodeficiency virus (HIV) and effective new therapies, but there is still no known cure, and the most effective public health approach to this devastating epidemic remains the Prevention of HIV transmission.

Injection drug users are the second largest group at risk for transmitting HIV in the United States. HIV and other blood-borne pathogens are transmitted easily from person to person through the sharing of contaminated needles and other contaminated drug injection equipment. High rates of HIV infection among injection drug users also may increase the risk of transmission of the virus to the non-drug-using sexual partners and children of injection drug users. In fact, the majority of AIDS cases among women and children in the United States can be directly or indirectlv traced to injection drug use.

Psychiatrists recognize the challenges achieving significant behaviorial change, particuilarly with regard to the addictions. Programs that provide adequate therapeutic support and interventions directed toward the ultimate goal of abstinence are essential. However, the frequently remitting and relapsing course of injection drug use, in conjunction with the deadly risk of AIDS with each use, argues strongly for treatment approaches that start with reducing the associated harm of HIV transmission @vhile attempting to engage the individual in more comprehensive treatment . Studies prepared for the U.S. General Accounting Office, the U.S. Centers for Disease Control and Prevention, and the X and XI International Congresses on AIDS have concluded that needle exchange programs are effective in reducing, the sharing of drug injection equipment and in preventing significant numbers of HIV infections among those using such programs, their drug and sexual partners, and their children.

The Institute of Medicine released a major report that needle exchange programs are effective in reducing HIV transmission. After extensive review of the current available research, the panel members further concluded that needle exchange programs do not increase the amount of drug use by those using such programs and do not increase overall community levels of new or continued use of injection or noninjection drugs. The recommendations of the reports from the Centers for Disease Control and Prevention and from the Institute of Medicine to remove government restrictions on the availability of sterile syringes through needle exchange programs as a viable strategy for preventing the spread of HIV have also been endorsed by the American Medical Association.

Needle exchange programs should provide on-site counseling and education about alcohol and other substance use, as well as referrals and improved access to comprehensive drug treatment programs, medical and reproductive care, counseling and testing for HIV and other sexually transmitted diseases and blood-borne pathogens, psychiatric and psychosocial services, and alternative methods for further reducing the harm asssociated with drug use.

Therefore, the American Psychiatric Association supports the removal of government restrictions on the availability of sterile syringes specifically within the structure of organized needle exchange programs, encourages government-sponsored efforts to broaden the availability of these programs in targeted areas and provide public health education to promote safer hygiene practices among injection drug users, and continues to endorse the availability of quality detoxification and treatment programs for all substsance abusers.