Isles’ needle program
great at reducing HIV

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By Helen Altonn
haltonn@starbulletin.com

Compared with Asia, Hawaii is almost a "paradise" when it comes to controlling HIV among people who inject drugs, says a world-renowned specialist who evaluates the Statewide Syringe Exchange Program annually.

The number of syringes exchanged here, which is critical to reducing human immunodeficiency virus, is "going off the charts," said Don Des Jarlais, research director at the Chemical Dependency Institute at Beth Israel Medical Center in New York. The number jumped dramatically from 193,000 in 1999 and 219,000 in 2000 to 348,000 last year, he said.

Des Jarlais, a consultant to the U.S. Centers for Disease Control and Prevention, the U.S. National Institutes of Health and the World Health Organization, attributes the improvement to "greater penetration into the adverse community, more syringes being exchanged per visit and more secondary exchanging."

Another positive sign was that 13 percent of those who inject drugs were sharing needles last year, down from up to 25 percent a year earlier, he said.

Still, Des Jarlais noted some concerns.

Heroin is the major drug of choice but injection of amphetamines is steadily increasing, he said.

Mental health services also should be linked to people reached in the syringe exchange program, Des Jarlais said. Amphetamine use can exacerbate mental health problems, much more than heroin, with overdoses looking like psychoses, he said.

Des Jarlais, coordinator for a World Health Organization survey of HIV and drug use at 14 sites worldwide, visited China, Vietnam and Thailand the past few weeks. He helped Vietnam and China set up potential syringe exchange or pharmacy sales of syringes to drug users.

"Those programs potentially would be effective but they're already quite late," he said. "Worldwide, the problem of HIV among drug injectors is approaching catastrophe."

In Asia, he said, from 50 to 70 percent of drug injectors already have HIV, which is the virus that causes AIDS. "As best as we can tell, here in Hawaii, the percentage affected may be 1 or 2 percent. HIV is very low."

He said the rest of the United States appears to be stable in terms of HIV and drug injectors but HIV among young gay men seems to be increasing on the mainland.

Drug injectors are a "maturing group," averaging 42 or 43 years old, with fewer starting to inject, he said. "Clearly, there are some and it's not a trivial number, but most of those injecting currently have been injecting 20 or 25 years."

The decline in new drug users injecting probably is due to a "community learning effect," Des Jarlais said, with younger people seeing parents or older people having drug problems.

Hawaii in 1990 became the first state to start a syringe exchange program. It has been a national model, with annual evaluations required by law.

After his fifth year of evaluation, Des Jarlais said, "I almost wonder, can things continue to get better?"