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Isles better already good
role on needle exchange

By Helen Altonn
Star-Bulletin

TWO "nice to see changes" occurred in Hawaii's effective statewide Syringe Exchange Program last year, an internationally recognized expert in the field said today.

The total number of syringes exchanged in 1999 rose to 193,350 -- an all-time high, said Don Des Jarlais, research director at the Chemical Dependency Institute at Beth Israel Medical Center in New York City.

"That's a meaningful increase" of roughly 10 percent more than 1998, he said.

Also, Des Jarlais said, injection risk behavior dropped slightly, with only 21 percent of the people surveyed sharing needles in the month before they were interviewed.

The state Department of Health began the Community Health Outreach Work (CHOW) Project in 1989 and Hawaii was the first state to start a syringe exchange program in 1990. Annual evaluations are required by law.

Outreach workers in the program establish contact with people injecting drugs and try to encourage safer behavior, including exchanging sterile needles for used ones.

Among findings of Des Jarlais' 1999 evaluation, reported today to the Syringe Exchange Oversight Committee:

Only 17 percent of AIDS cases in Hawaii are related to injecting drug use -- a low rate credited to HIV prevention programs for injecting drug users.

Syringe exchange clients overall "are an 'aging' population with long histories of injecting drug use." The average age of clients last year was 42.2 years and they had been injecting drugs for an average of 19.5 years.

Heroin was the major drug injected, with 90 percent of clients reporting heroin use in the month before the survey.

Cocaine was the second most commonly injected drug, with 22 percent of clients reporting injection in the previous month.

Des Jarlais said Hawaii is doing as well or better than any other state with its needle exchange program and the HIV situation appears to be under control.

The state should "continue doing the good things that have been done" to keep HIV under control, he said. But it also must tackle hepatitis B and C infections, "which, in Hawaii, are undoubtedly going to cause more illness and death than HIV."

Des Jarlais said better epidemiological data is needed to assess the scope of the problems.

More preventative work also must be done for those viruses, including more vaccinations for hepatitis B and "more emphasis on not sharing the cookers and rinse water and other paraphernalia used to inject drugs," he said. "Sharing of that equipment is an inefficient way of transmitting HIV, but probably important to transmit hepatitis B and C."

He said he enjoys making his annual syringe exchange report here because Hawaii "has undoubtedly one of the best programs in the country."