What Is It About Needle and Syringe Programmes That Make Them Effective for Preventing HIV Transmission?
Published in: International Journal of Drug Policy, v. 14, 2003, p. 361-363
Posted on RAND.org on December 31, 2002
Ecological studies of the impact of syringe exchange programmes (SEPs) and syringe access are amongst the most powerful research tools available as they allow researchers to assess community-level effectiveness of interventions. However, there are also several limitations to the use of ecological studies. Most noteworthy is that they often rely on data collected for purposes other than studying the specific research question being posed. This often prohibits the use of key confounding and effect modifying variables, making it difficult to assess whether the observed relationship between exposure and outcome is spurious. While numerous studies have examined SEP effectiveness in preventing HIV transmission, few have studied how community context and SEP operational factors have an impact on effectiveness. It is important for researchers to study what types of SEPs are most conducive to stemming HIV transmission in different community contexts. Thus, it is crucial that studies of SEPs collect community contextual factors and report and control for them in analyses. Recent reviews of SEP studies suggest that inattention to SEP operational characteristics have biased interpretations of programme effectiveness. Very little research has been conducted on the impact of differences in operational characteristics on client HIV risk behaviours. Researchers should study which operational characteristics are optimal for which types of communities.