Secondary syringe exchangers: means for expanding syringe exchange program's coverage in response to the recent federal ban on funding for syringe exchange programs

Since the beginning of the HIV epidemic, intravenous drug use has been directly and indirectly accountable for more than 1/3 of all cases. It has been shown that syringe exchange programs (SEPs) prevent and reduce incidence of HIV and other blood borne pathogens among IDUs. Approximately 203 SEPs are operating in 34 different states, but less than 10% of IDUs can access their services. This is of strategic public health significance due to the recent federal ban on funding for SEPs in January 2012. One response to this, in an effort to increase coverage and reduce incidence of blood borne pathogens, IDUs have spontaneously emerged as “secondary syringe exchangers” (SSEs) to disseminate sterile injection equipment in the community. Although secondary exchangers exist, minimal data exists on their effectiveness and risk for HIV and other blood borne pathogens. A critical literature review included peer-reviewed studies on SSEs anywhere in the United States. Relevant research with regard to SSEs was accessed primarily through medical, public health, and social science databases. In order to ensure that relevant studies were included, the search terms used employed multiple synonyms for SEPs and SSEs, with no publication date restrictions. The studies included in the review were concentrated in two states and were subject to several different types of bias including: recall, response, interviewer, and sampling. The majority of studies found that SSEs were likely to be African American, male, unemployed, and had more extensive social interactions with other IDUs and larger networks. HIV risk-related behaviors were higher among receptive secondary exchangers versus distributive exchangers; however, both were more likely to be protected against HIV versus non-exchangers. Although the majority of studies show that SEPs reduce HIV risk-related behaviors for IDUs, they do not eliminate the risk entirely. SSE extends the benefits of needle exchange to people at times beyond the capability of SEPs. A major strategy that should be employed is peer-based education about prevention and risk reduction for those participating in SSE