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Needle exchanges and HIV transmission in NZ – Expert Reaction

Needle exchanges have contributed to reducing transmission of the disease, new research suggests.

Of more than 1650 people diagnosed with HIV between 1996 and 2018, only 2.9 per cent of cases were in people who use needles for drugs—an average of just one HIV diagnosis per year. New Zealand’s needle exchange programme, established in the late 1980s, provides free, sterile needles and advice to injecting drug users, which the researchers say has helped avoid the high rates of HIV found in other countries. The research is published in Drug and Alcohol Review.

The Science Media Centre has gathered the following expert comments.

Prof Mark Henrickson, Professor of Social Work at Massey University, Auckland comments:

“It is very pleasing to see New Zealand HIV research on men who have sex with men (MSM) who also inject drugs. This research methodology is sound and reinforces the value of New Zealand’s early policy on decriminalising possession of injecting equipment and funding syringe access schemes in response to HIV. As a result, the HIV incidence in injecting drug users, and in MSM who inject drugs in particular, has been remarkably low over the history of the epidemic in New Zealand. This is something about which New Zealand can be very satisfied. The findings of the present study clearly demonstrate the value of putting what can only be called common-sense policy interventions—responding to what is— over ideologically pure interventions that set health policy only based on what some groups think should be ideal human behaviour.

“Remembering that all injecting drugs are very likely to be illegal, creating an intervention strategy—access to needles and syringes—based on public health rather than criminalising the behaviour has worked. The study, therefore, has implications for testing of drugs at festivals and other events, the full implementation of the 2013 Psychoactive Substances (the ‘legal highs’) Act, for the upcoming cannabis referendum, and indeed for a health-driven (rather than criminalising) approach to recreational drug use in general. The history of drug policies over the centuries has largely been driven by responses to socially stigmatised people who use drugs, rather than rational responses to the drugs themselves. This study suggests that when policymakers make rational choices led by concerns for public health then those policies work.

“Nevertheless, there are some concerning findings in this study, notably the over-representation of Māori who have sex with men and also inject drugs and are infected with HIV. The present study highlights the lack of research in this area, and the apparent inability of the public health, iwi health, and HIV-prevention infrastructures to reach Māori. Previous research has found that Māori MSM are also more likely than tauiwi MSM to have sex with women; the disproportionately large number of Māori living with HIV is therefore very concerning for several reasons. It is not adequate to say that we do not know why Māori MSM who also inject drugs are overrepresented: even though the actual numbers are small, this finding signals the apparent systemic failure of existing prevention responses to attend to Māori. Funding for research in this population and appropriate interventions are urgently required.

“In addition, that the group of recent injectors tends to be younger is concerning: clearly there must be additional injection drug prevention education and intervention targeted at younger MSM. New Zealand has well-developed domestic methamphetamine manufacture and distribution networks, and public responses must realistically consider health risks and responses as well as the criminality of these networks.”

No conflict of interest.

Dr Rhys Ponton, School of Pharmacy, University of Auckland, comments:

“This study further demonstrates the benefit and effectiveness of needle exchange in reducing the spread of HIV. The dedicated needle exchange services, alongside the wide network of community pharmacy needle exchange providers, are a key part of New Zealand’s successful approach to this public health issue.”

Conflict of interest statement: I am currently working alongside Dr Geoff Noller and Kathryn Leafe on another project involving needle exchange/drug injecting. I work alongside David Newcombe and collaborate on a couple of unrelated projects. Peter Saxton is based at the University of Auckland and we have previously discussed future collaboration (but are not currently working on anything as a team).