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One of the key populations in the global fight against HIV/AIDS is the injection drug users. The practice of drug injection coupled with the practice of sharing needles within this populace presents a significant challenge in the fight against HIV/AIDs. One way of advancing the fight against HIV/AIDS in this group is the needle exchange program. The program aims to reduce harm through the provision of injection kits at little or no cost with the main aim of reducing equipment sharing and thus HIV transmission. Worldwide, the Dutch government was the first to approve this program among its citizens. While at first the program was aimed at curtailing the spread of hepatitis B (also an STI), with the advent of the HIV/AIDS pandemic, the program was quickly adopted around the world (Strathdee & Beyrer, 2015). Currently, both the developing and developed nations have these programs running either through government initiatives, Church based organization or non-governmental organizations. Countries with notable success through the use of this program apart from the United States include most countries in Europe, Australia, Iran and Brazil.
Those who support the program argue for harm reduction. They question the ability of human beings to always be rational. As such the injection drug users should be supported to continue with their behavior in a less harmful way (Macneil & Pauly, 2011). The morality of this approach of fighting sexually transmitted infection and HIV among injection drug users is founded on the fact that this practice neither condemns nor condones the practice. In addition, there is evidence for the reduction in needle sharing in the target population where this program has been rolled out.
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The Catholic Church, which boasts of approximately a billion follows argues against the harm reduction approach to tackling sexually transmitted infections and HIV. It asserts that this approach handles the injection drug users are mere objects devoid or morality compass. To support this view was George W. Bush. He posited that the rapid advancement of the needle exchange program in the United States during the Clinton-Gore tenure was nothing but an abdication of responsibility. In the US the National District Attorneys Association argues against the harm reduction approach since it is their take that it goes against common sense and contravenes criminal statutes (Weinmeyer, 2016). Furthermore, challenges with needle return rates pose a challenge to the surrounding community and environment.
While the needle exchange program hasn’t proven to be the silver bullet for controlling STI/HIV among injection drug users, there is evidence to support its use. A meta-analysis that the odds of acquiring STI/HIV among those not in the program was 3.22 times the odds among those in the program. Despite this success poor needle return rates pose a risk to the community due to poor disposal mechanisms. Others argue that this program mediates helplessness in this key population rather than challenging them or helping them to make better choices. One possible solution to the challenges affecting this program is provision of auto disable syringes to cut on sharing and reuse. Additionally, community volunteers can be used to ensure a higher needle return rate to reduce risk to the community. This program should also be integrated with addiction treatment programs.
Despite the shortfalls success of this program can’t just be wished away, especially when there isn’t a superior alternative. The integration of the program with addiction treatment and the straightening of the other gaps or kinks in the program is all that is needed to ensure the success of this program.
- Macneil, J., & Pauly, B. (2011). Needle exchange as a safe haven in an unsafe world. Drug and Alcohol Review, 30(1), 26–32.
- Strathdee, S. A., & Beyrer, C. (2015). Threading the Needle — How to Stop the HIV Outbreak in Rural Indiana. New England Journal of Medicine, 373(5), 397–399.
- Weinmeyer, R. (2016). Needle Exchange Programs’ Status in US Politics. The AMA Journal of Ethic, 18(3), 252–257.