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Advancing the Health Protection agenda: Needle Exchange in Wales – raising the profile and identifying new initiatives. Josie Smith Research Scientist, NPHS. Aims. Evidence Recent research within Wales Development of the All Wales Needle Exchange Forum Key aims Working groups Website

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Josie smith research scientist nphs

Advancing the Health Protection agenda: Needle Exchange in Wales – raising the profile and identifying new initiatives

Josie Smith

Research Scientist, NPHS

Josie smith research scientist nphs

  • Evidence

  • Recent research within Wales

  • Development of the All Wales Needle Exchange Forum

    • Key aims

    • Working groups

    • Website

    • Raising the profile in Wales and beyond…

Comprehensive review of international evidence alex wodak and annie cooney 2006

Comprehensive review of international evidenceAlex Wodak and Annie Cooney 2006

‘ There is compelling evidence that increasing the availability and utilisation of sterile injecting equipment by IDUs reduces HIV infection substantially’

‘There is no convincing evidence of any major, unintended negative consequences’

Hiv prevention

HIV prevention

‘NSE are cost effective’

‘NSE have additional worth while benefits apart from reducing HIV infection….’

‘….not enough on own to control HIV infection among IDUs’

Hcv prevention

HCV prevention

Lack of control studies & not going to happen

But – in countries with poor NSE – high HCV prevalence

HCV is transmitted by injecting risk behaviour – there is evidence the NSE reduces injecting risk behaviour

therefore NSE has to be a pillar in HCV prevention

Reducing sharing challenges in the provision of nse
Reducing sharing: challenges in the provision of NSE

Structural: the environment that creates situations where sharing is the default option (homeless/public injecting, prison injecting, poor NSE availability)

Marginalisation: low self esteem, poor knowledge, vulnerability all disempowering the individual

The social role of sharing: Sharing between partners & close friends not perceived as high risk, unequal power within relationships

The drugs used: Heroin withdrawal and crack or amphetamine binges can create situations where sharing becomes the easiest option or accidental option

Hcv incidence
HCV incidence

Highest amongst the homeless

Correlated with reports of paraphernalia sharing

Correlated with reports of high rates of NS sharing

Infection early in injecting careers

Hcv incidence study
HCV incidence study

NSE use amongst the follow up sero-negative cohort

Drug agency / mobile 65%

Pharmacy 22%

Other people 12%

How is nse perceived by idus in wales needs assessment
How is NSE perceived by IDUs in Wales? Needs Assessment

Majority 88% of IDUs used NSE in area regularly, positive experiences were reported

Approximately one fifth relied on someone else to get NS (distance, travel time, opening times, confidentiality & privacy)

Swabs, citric acid water not available in many areas

Pharmacy exchange - perception that exchange was often not confidential and concerns around staff attitude

Barriers to nse use qualitative study 49 in depth interviews
Barriers to NSE useQualitative study (49 in depth interviews)

  • Availability Generally good in larger towns/cities Sometimes stock shortages in pharmacy NSE especially weekends

  • Type At times range of equipment limited Quality sometimes substandard

  • Quantity Number needed may vary – distance from exchange / work / injecting practices / other responsibilities Consistency across NSE important

Barriers to nse use qualitative study
Barriers to NSE useQualitative study

  • Geographic access Access can be a problem in some areas, particularly smaller towns and rural areas relaying on a single outlet

  • Opening times Perceived to be slightly restrictive

  • Fear of public exposure Key theme – particularly if close to family home - reluctance to disclose identity

  • Homeless IDUs Absence of secure storage space

Barriers to nse use qualitative study1
Barriers to NSE useQualitative study

  • Attitudes of staff IDUs Perceptions of negative stereotyping and discriminatory treatment by pharmacy NSE staff indicated as a barrier to accessing services

  • Awareness among recent IDUs A priority

Josie smith research scientist nphs

So how can services best move forward to address the challenges and barriers identified?What is the role of Health Protection in facilitating change?

  • Important to acknowledge:

    • Strong network of needle exchange services in

    • Wales

    • Range of outlets - pharmacy, voluntary, statutory,

    • mobile and outreach

    • Many highly motivated, experienced and

    • dedicated needle exchange staff

Development of the forum
Development of the Forum


To raise profile:

- Challenge uninformed views with evidence and ongoing discussion

  • Challenge practice of ‘anyone who is available’

  • Ensure presence in policy making and strategy development at regional and national level

    To highlight the extent and importance of the role of needle exchange services in Wales:

  • In the wider context of harm reduction

  • In the reduction in transmission of chronic disease especially hepatitis C and HIV

  • Frontline in engaging injecting drug users

Development of the forum1
Development of the Forum

To ensure high quality, accredited training and education available and received by all relevant staff:

  • Recognition of ‘relationship’, confidentiality etc, interaction not transaction

  • Interagency training

    To address issues of supply:

  • Centralised purchasing – economies of scale

  • Maximise consistency of supply including injecting paraphernalia

Development of the forum2
Development of the Forum

To ensure equity of service

To establish a standardised data collection system and build an evidence base for planning and developing services

Progress to date
Progress to date

  • Established a Forum planning group

  • Representation from all regions:

    • Statutory and voluntary sector drug services

    • community pharmacy

    • CSP

    • CPA

    • Public Health

    • Service Users

Progress to date1
Progress to date


  • Central to open discussion and communication

  • What you will find:

    • Location mapping

    • Resource library

    • What’s new

    • Forum

    • About us – minutes, terms of reference etc

    • Working groups

Progress to date2
Progress to date

Working groups:

  • Special interest

  • Initiated and developed by forum members

  • Task led

  • Research

  • Development of best practice guidance and monitoring/evaluation tools

  • Opportunity to work with individuals within and beyond Wales

Future developments
Future developments

  • Secure funding e.g. for maintaining website, developing working groups etc

  • Develop working groups programme

  • Continue to raise profile and influence policy and guidance e.g. WAG substance misuse strategy and forthcoming NICE guidance

  • Tie in developments of Forum with those of the blood borne viral hepatitis action plan for Wales