Do needle exchange programmes increase the spread of HIV among injection drug users?: an investigation of the Vancouver outbreak.

摘要: Objective: An association between needle exchange attendance and higher HIV prevalence rates among injecting drug users (IDU) in Vancouver has been interpreted by some to suggest that programmes (NEP) may exacerbate spread. We investigated this observed determine whether was causally associated with the spread of HIV. Design method: Prospective cohort study 694 IDU recruited downtown eastside Vancouver. Subjects were HIV-negative at time recruitment had injected illicit drugs within previous month. Results: Of subjects, 15-month cumulative incidence significantly elevated frequent NEP attendees (11.8 ± 1.7 versus 6.2 1.5% ; log-rank P = 0.012). Frequent (one or more visits per week) younger likely report: unstable housing hotel living, as their primary site, cocaine injection, sex trade involvement, 'shooting galleries', incarceration 6 months. The Cox regression model predicted 48 seroconversions attendees; 47 observed. Although significant proportions subjects reported obtaining needles, swabs, water bleach from NEP, only five (0.7%) meeting new friends people there. When asked where met sharing partners, one out 498 respondents cited exchange. Paired analysis risk variables baseline first follow-up visit did not reveal any increase behaviours attendees, regardless they initiated injection after establishment NEP. Conclusions: found no evidence is transmission. should be promote By attracting users, furnish a valuable opportunity provide additional preventive/support services these difficult-to-reach individuals.