Taking into account the cost of care for an AIDS patient, the needle exchange and drug counseling outreach programs represent a saving to the state if they succeed in preventing just seven new HIV cases among users or their sexual partners, said Dr. Don Des Jarlais of the Beth Israel Medical Center in New York.
Des Jarlais was to speak to lawmakers and public health officials here at 3 p.m. today in the Department of Health board room. He recently completed an evaluation report on the program.
The program, authorized in 1990, made Hawaii the first state to fund a statewide needle exchange as an AIDS prevention measure. Only a few other states have followed suit.
Other researchers say that almost 10,000 new cases of HIV infection could have been avoided between 1987 and 1995 had the United States instituted needle exchange programs for intravenous drug users (IDUs), according to a Reuters news service report. Dr. Peter Lurie at the Center for AIDS Prevention Studies at the University of California, San Francisco, and Dr. Ernest Drucker at Montefiore Medical Center in New York said that if U.S. policy is not changed, an additional 5,150 to 11,329 preventable HIV infections could occur by the year 2000.
Since 1988, federal law has banned such use of government funds unless it can be shown that needle exchange programs can reduce transmission of HIV and not lead to an increase in illicit drug use.
"In maintaining a ban on national funding for these programs, the USA is unique in the world," write Lurie and Drucker in a report published this week in the British medical journal The Lancet. Moreover, based on current government estimates of the costs of treating an HIV infection over an individual's lifetime, Lurie and Drucker note that the cost to the U.S. health care system of treating these preventable HIV infections ranges between $224 million and $538 million.
"The failure of the U.S. federal government to initiate a national program of needle exchanges has shifted the emphasis of HIV prevention among IDUs to the states," the authors write, even though "some states have used the federal opposition to justify their own inaction."
But some states and local communities have "risen to the challenge: Connecticut, Hawaii, Maryland, Massachusetts, New York, and Rhode Island have allocated funds to needle exchange programs," the authors state.
Des Jarlais reported that 77 percent of the Hawaii participants said they had not shared a needle in the preceding month. About half of those who did share equipment said they always used bleach as a disinfectant. "Thus, while some exchange participants remain at risk for infection with HIV, there is little chance of a sustained outbreak of HIV among participants," according to his summary.
In the survey year, which ended Sept. 30, there were three sites on Oahu and four on neighbor islands where a user could get a free new syringe for each used one brought in. The program also provides distribution of disinfecting bleach, condoms, education about HIV risk and referrals for drug counseling and HIV testing.
It was the first year since the program began that there was a decline, with 27 percent fewer visits to the exchange locations and 23 percent decrease in the number of needles exchanged. The report said factors in the decreases which occurred on Maui, Kauai and east Hawaii, included the opening of a local drug abuse treatment program, the arrests of local drug users who had been exchanging large volumes of needles, and staff turnover. Other local findings:
Of the 121 drug users referred to rehabilitation programs during the year, 24 percent were still in treatment or had completed it.
Some 96 percent said they had shot up heroin in the previous month, compared to 31 percent who injected cocaine.
In the year surveyed, the people who used the needle exchange were 67 percent male. They were 70 percent Caucasian, 13 percent Hawaiian/part Hawaiian, 11 percent Asian, and 6 percent others. They had a mean age of 40.5 years and had been injecting drugs for a mean of 17 years.
Des Jarlais recommends that Hawaii increase outreach and education to prevent the risk of hepatitis B, hepatitis C and sexually transmitted diseases besides HIV.
He said the rise in heroin use indicates the state needs to expand drug abuse treatment capacity.
The Lancet article said most of the 41,000 new cases of HIV infection each year occur among intravenous drug users and their sexual partners and children. "Thus, the prevention of HIV transmission among IDUs should be a cornerstone of any attempt to stem the HIV epidemic in the USA."