The point of needle exchanges

Taiwan's first needle exchange program, (exchanging non-sterile drug injection equipment for sterile materials) is scheduled to start tomorrow. It failed to get off the ground last month, and without support from the Ministry of Justice and NGOs, critics questions whether it will ever fully materialize.

Despite overwhelming international evidence that HIV (human immunodeficiency virus) infection rates among intravenous drug users can be reduced with comprehensive needle exchange programs (NEP), harm reduction efforts in Taiwan are being thwarted by a judicial system and public that stigmatizes easy access to injection equipment, according to the Center for Disease Control (CDC).

"If we wait for the regulations to be revised and consensus across the board then it will be too late, so we must act now," said director of the AIDS and STDs Division at the CDC, Tsai Su-fen (蔡淑芬).

Drug abuse has emerged as the driving force behind HIV transmission in Taiwan in the last three years. Statistics from the Department of Health (DOH) indicate that injecting drug users (IDUs) account for nearly 80 percent of all known infection routes; a dramatic increase from the 1.2 percent of new diagnoses in 2002. There were 556 intravenous drug users infected last year, a rapid surge from the 13 in 2003. In the first six months of this year alone, 925 Additional drug users have tested positive for HIV.

Taiwan's Pilot Program

The CDC is providing NT$30 million in aid to prevent AIDS and a set of guidelines to four counties, Taipei City, Taipei County, Taoyuan County (桃園縣) and Tainan County (台南縣). The selections are based on the percentage of HIV infected IDUs, Tsai said. The program, in theory, aims to provide access to clean injection equipment and drug substitutes, such as methadone and buprenorphine, as well as HIV testing and counseling services for those infected.

The program will run for 18 months, after which it will be reviewed and expanded to include all counties with further funding from the CDC, Tsai said.

Although each county health bureau has designed its own program, the CDC is pushing for sterile needles and syringes to be sold in pharmaceutical outlets across the island.

There is no law prohibiting people from carrying drug paraphernalia in Taiwan and access to sterile needles is both legal and inexpensive at NT$4 per syringe. Many pharmacies, however, opt not to stock injection equipment for fear of attracting unwanted clientele and the police who often loiter nearby watching for dubious purchases (such as a box of 100 syringes), Tsai said.

The CDC has arranged an "informal agreement" with police administration to "illegally tolerate" the plan and not stand outside pharmacies, Tsai said. The spokesperson for the Ministry of Justice would not confirm this agreement and only said the MOJ is still negotiating with the CDC.

"A needle exchange program would be against the law. We do not condone the use of drugs nor do we engage in programs dispersing drug paraphernalia to users," said Huang Jiou-zhen (黃久貞) a prosecutor for the MOJ.

The CDC's decision to implement the pilot, amid disagreement over its legality, is based on the success of countries that have seen epidemics averted, controlled or reversed.

A study published in the Health Outcomes International in Australia, and cited by the World Health Organization (WHO), compared HIV prevalence in 103 cities. The infection rate in 36 cities with needle programs declined by 19 percent, but increased by 8 percent in 67 cities without such programs. Furthermore there were no reports indicating unfavorable consequences such as an increase in the frequency of drug use from providing access to injecting equipment.