Needle and Syringe Exchange in Poland and the Former Soviet Union: A New Approach to Community-Impact Studies

Abstract

This article describes a new approach to assessing the impact of needle- and syringe-exchange programs (NSEPs), designed for application in Eastern Europe and the former Soviet Union. In these parts of the world, use of a homemade opiate preparation made from poppy plants is common. The advance of AIDS has been associated with increasing use of this drug. However, NSEP might be less effective in that setting than in the West: with a liquid drug, virus transmission may take place through sharing or selling of the drug itself, even when each user has his or her own works and never shares them with others. NSEPs can be difficult to evaluate, however, particularly where users are stigmatized. Here, we propose methods to assess the community impact of NSEPs by evaluating syringes, not users. These methods involve labeling, tracking, and enumeration of syringes as well as testing of syringes for parenterally transmissible virus (e.g., human immunodeficiency virus). They allow for estimation of the total number of syringes in circulation, the average time each syringe spends circulating among users, and the rate of virus exposure among users. Examples are given of the implementation of these methods in Poland, with assessments of the community impact of local NSEPs there.