Yes, Needle Exchange Programmes DO work
A recent scientific paper appearing in the journal Addiction has focused on the lack of scientific evidence for the effectiveness of Needle and Syringe Programmes (NSPs), one of the primary aspects of harm reduction. Under a headline reading, “Do needle-exchange programmes really work?”, this piece has been reported in a number of newspapers around the world. Despite the reasoned tone of the paper and its reporting by Reuters, the story has generated numerous abusive comments by members of the public delighted to find what they think is a scientific justification for their own anti-NSP prejudices.
In fact, the original paper, authored by Norah Palmateer and others, is a review of the literature relating to NSPs and their ability or otherwise to prevent the transmission of blood-borne viruses such as HIV and hepatitis C. It finds evidence that NSPs reduce risky injecting behaviour (such as sharing of needles), but argues that evidence for the actual reduction of HIV transmission is ‘tentative’. This is partly because most of the primary research on which the review is based did not look at the transmission of viruses, but at changes in behaviour. It was something that they did not try to measure- so the fact that they did not find it is not so surprising. In addition, the scientific criteria for proof are basically impossible to meet in these circumstances.
Unfortunately, however, those with pre-existing hostility to harm reduction and to drug users, have found in this review support for their ideologically driven beliefs that NSPs are a bad thing and should be abandoned. The reviewers themselves state the following:
“The findings of this review should not be used as a justification to close NSPs or hinder their introduction, given that the evidence remains strong regarding self-report IRB (injection related behaviour)…”
Looking around the globe, it is evident that those countries where NSPs are available tend to have low rates of infection, whereas those that don’t, have high rates; and in some cases—like the