Australia’s most well known harm reduction initiative are Needle and Syringe Programs (NSP). NSPs were a 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. By testing returned syringes, this pilot project found an increase in HIV prevalence, suggesting that HIV was already spreading among injecting drug users. 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
- 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 NSPs 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 NSPs, the HIV prevalence had decreased by an average of 19 per cent annually. In the cities that had not introduced NSPs, the HIV prevalence had increased by an average of 8 per cent annually.
A 2004 World Health Organisation review of evidence of the effectiveness of NSP to reduce HIV 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 shows that NSPs make a significant contribution to preventing the spread of HIV/AIDS and hepatitis C.
The most recent Australian evaluation of the cost effectiveness of NSP is the 2009 Return on Investment Report released by the Federal Government. This report highlights the health, social and financial benefits associated with preventing blood borne virus transmission by supporting NSP.
The report estimates that between 105,000 to 236,500 people currently inject drugs in Australia. The 2007 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 NSPs. This resulted in the prevention of an estimated 32,050 new HIV infections and 96,667 cases of hepatitis C. The Return on Investment Report estimates that $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.