With rates of HIV infection skyrocketing among individuals who inject drugs and share needles, the APA Board of Trustees endorsed the use and expansion of needle-exchange programs as part of the strategy to combat the disease's spread. These programs are one of the few attempts that have met with some success to control the spread of AIDS among I.V. drug users and their sexual partners.

The policy statement on needle-exchange programs, which was developed by the APA Commission on AIDS and approved by the Board at its September meeting in Washington, D.C., acknowledges that several studies have now demonstrated the usefulness of such programs and encourages the government to remove "restrictions on the availability of sterile syringes specifically within the structure of organized needle-exchange programs."

The statement also calls on government officials to expand the number of these programs—which are still unavailable in many areas hit especially hard by the epidemic—and to implement public health education efforts that "promote safer hygiene practices among injection drug users." It also puts APA on record calling for "increasing the availability of quality detoxification and treatment programs for all substance users."

Presenting the proposed policy statement to the Board, AIDS Commission Chair Marshall Forstein, M.D., pointed out that the proportion of new AIDS cases attributable to injection drug use has been rising dramatically for several years, and the vast majority of AIDS cases among women and children are traceable directly or indirectly to persons injecting drugs.

Forstein noted that the American Medical Association, the Centers for Disease Control and Prevention, and the Institute of Medicine have all come out in favor of needle-exchange programs as a worthwhile tool in the battle against the spread of HIV.

He cited a major study by the Institute of Medicine published in 1995 that found such programs neither led to increased drug use by program participants nor raised the level of illicit drug use in communities in which the programs were operating.

The policy statement emphasizes that while psychiatrists recognize that programs whose goal is to promote abstinence are essential for treating substance abusers, the "frequently remitting and relapsing course of injection drug use. . .in conjunction with the deadly risk of AIDS with each use argues strongly for treatment approaches that start with reducing the associated harm of HIV transmission while attempting to engage the individual in a more comprehensive treatment process."

It also points out the need for needle-exchange programs to provide on-site counseling about alcohol and other substance abuse, referrals to comprehensive drug treatment programs, medical and reproductive care, HIV counseling and testing, and psychiatric and psychosocial services.

(Psychiatric News, October 18, 1996)