Australia’s most famous harm reduction initiative came in response to the emergence of HIV and the identification of injecting drug use as a high risk activity. In 1986 Australia’s first NSP was trialled in Sydney. This pilot project revealed an increase in HIV prevalence through their testing of returned syringes, suggesting that HIV was already spreading among this community. In the following years, NSPs became policy throughout Australia as governments realised the provision of sterile injecting equipment was essential to reducing the spread of HIV, in addition to hepatitis B and C.
NSPs are an important public health measure, and a key feature of Australia’s National Drug Strategy’s harm minimisation framework. NSPs provide a wide range of services including:
- provision of sterile injecting equipment,
- education on reducing drug use,
- health information, and
- supported referral to drug treatment, medical care and legal and social services.
NSP workers educate injecting drug users on responsible disposal and assist in the appropriate collection and disposal of used equipment.
NSPs do not supply drugs or allow people to inject drugs on the premises.
Why NSPs work
Studies continue to confirm the beneficial effect of Needle and Syringe Programs in reducing transmission of HIV.
A study conducted between 1978 and 1999 compared HIV prevalence in 103 cities around the world. In the cities that had introduced Needle and Syringe Programs, the HIV prevalence had decreased by an average of 19 per cent annually. In the cities that had not introduced Needle and Syringe Programs, the HIV prevalence had increased by an average of 8 per cent annually.
The World Health Organization commissioned a review of evidence of the effectiveness of Needle and Syringe Programs to reduce HIV which concluded:
There is compelling evidence that increasing the availability and utilisation of sterile injecting equipment for both out-of-treatment and in-treatment injecting drug users contributes substantially to reductions in the rate of HIV transmission.
Research from around the world clearly indicates that NSPs make a significant contribution to preventing the spread of HIV/AIDS and hepatitis C.
In Australia, the 2009 Return on Investment Report highlighted the health, social and financial benefits associated with preventing blood borne virus transmission by supporting needle and syringe programs.
It is unclear as to how many Australians currently inject drugs. A recent study estimated it ranged from 105,000 to 236,500 people. The latest National Australian Drug Strategy Household Survey showed that 328,100 Australians had injected an illicit drug at some point in their lives. More than 13 tonnes of illicit drugs were seized by Australian law enforcement agencies and customs across 2008/09. The 83,873 arrests related to illicit drug use in 2008/09 – represented as an increase of seven per cent compared with the previous year. Over 2006 and 2007, more than 78,545 Australians were treated for problematic drug use
Between 2000 and 2009, the Australian Government invested $243 million in Needle and Syringe Programs. This resulted in the prevention of an estimated 32,050 new HIV infections and 96,667 cases of hepatitis C. $1.28 billion dollars were saved in direct healthcare costs.
If patient/client costs and productivity gains and losses are included in the analysis, then the net present value of NSPs is $5.85 billion; that is, for every one dollar invested in NSPs, $27 is returned in cost savings.
The report states: “If NSPs were to decrease in size and number, then relatively large increases in both HIV and hepatitis C could be expected with associated losses of health and life and reduced returns on investment. Significant public health benefits can be attained with further expansion of sterile injecting equipment distribution.”
Countries, like Australia, that have implemented NSPs have averted HIV epidemics among injecting drug users and, therefore, the community at large. Those countries that have not implemented these measures have often experienced uncontrolled HIV epidemics. There is strong evidence to suggest that when HIV becomes endemic among the injecting drug user community it can then spread to their sexual partners and children, resulting in high mortality rates and large social and economic costs to the entire community.
In addition to greatly reducing the risk of blood borne viruses and other injecting related illness and disease, NSPs are also instrumental in assisting people who inject drugs to address other health and welfare needs. NSPs often act as unique referral points into drug treatment services.