Evaluating the impact of global fund withdrawal on needle and syringe provision, cost and use among people who inject drugs in Tijuana, Mexico: a costing analysis

ObjectiveFrom 2011 to 2013, the Global Fund (GF) supported needle and syringe programmes in Mexico to prevent transmission of HIV among people who inject drugs. It remains unclear how GF withdrawal affected the costs, quality and coverage of needle and syringe programme provision.DesignCosting study and longitudinal cohort study.SettingTijuana, Mexico.ParticipantsPersonnel from a local needle and syringe programme (n=6) and people who inject drugs (n=734) participating in a longitudinal study.Primary outcome measuresProvision of needle and syringe programme services and cost (per contact and per syringe distributed, in 2017 $USD) during GF support (2012) and after withdrawal (2015/16). An additional outcome included needle and syringe programme utilisation from a concurrent cohort of people who inject drugs during and after GF withdrawal.ResultsDuring the GF period, the needle and syringe programme distributed 55 920 syringes to 932 contacts (60 syringes/contact) across 14 geographical locations. After GF withdrew, the needle and syringe programme distributed 10 700 syringes to 2140 contacts (five syringes/contact) across three geographical locations. During the GF period, the cost per harm reduction contact was approximately 10-fold higher compared with after GF ($44.72 vs $3.81); however, the cost per syringe distributed was nearly equal ($0.75 vs $0.76) due to differences in syringes per contact and reductions in ancillary kit components. The mean log odds of accessing a needle and syringe programme in the post-GF period was significantly lower than during the GF period (p=0.02).ConclusionsWithdrawal of GF support for needle and syringe programme provision in Mexico was associated with a substantial drop in provision of sterile syringes, geographical coverage and recent clean syringe utilisation among people who inject drugs. Better planning is required to ensure harm reduction programme sustainability is at scale after donor withdrawal.

‘You can say – we do not want the junkies and the sex workers. But they are here!‘: On the spatial exclusion of anti-social behaviour in Bratislava - Nové Mesto

The paper focuses on the discursive framing of drug users and sex workers as subjects of public space governance within the process of local policymaking. The core of this study analyses the non-governmental organisation OZ Odyseus grant application for a harm reduction programme and a subsequent debate of the Municipal Council Members of the Bratislava city district – Nové Mesto. The aim of the meeting and the debate was to approve funding for numerous social projects, including a fieldwork-oriented organisation OZ Odyseus, which provides harm reduction in numerous city districts of Bratislava. The analysis disclosed the application of specific subject positioning frames, which conceptualise drug users and sex workers as ‘out of place’, anti-social and not members of a local community. Results of the study point to the conceptualisation of (commercial) public space as ‘stolen from the normal people’ and the need for spatial segregation of sex workers and drug users in order to reclaim and revitalise it.

Does Use of Nicotine Replacement Therapy While Continuing to Smoke Undermine Cessation?: A Systematic Review

Aims: To review population surveys to assess (a) prevalence of the use of NRT for smoking reduction (SR) and temporary abstinence (TA) and (b) how far this is associated with attempts to stop smoking, smoking cessation and reduction in cigarette consumption.Methods: An electronic search was undertaken of EMBASE, MEDLINE, Web of Science and PsycINFO. Articles were selected if they (1) assessed whether smokers had used or were currently using NRT for SR and/or TA; (2) involved smokers who had not taken part in a harm reduction programme; and (3) assessed prevalence and/or association of SR and/or TA with reductions in cigarette consumption and/or attempts to stop smoking and/or with smoking cessation. Twelve studies met the inclusion criteria and results were extracted independently by two researchers.Results: Data were available from five countries (US, UK, Canada, Switzerland and Australia). Between 1% and 23% of smokers reported having ever used NRT for smoking reduction and between 2% and 14% during periods of temporary abstinence. Use of NRT for SR and/or TA was associated with little or no reduction in cigarette consumption. There was some evidence that it was positively associated with attempts to stop smoking and smoking cessation.Conclusion: In smoking populations use of NRT to aid SR and in situations where smoking is not permitted appears to be having little effect on achieving a reduction in cigarette consumption but does not undermine cessation and may promote it.

Psichoaktyvių medžiagų vartojimo žalos mažinimas:koncepcijos pokyčiai ir veiksmingumas

Infectious diseases such as HIV and virus hepatitis B and C are closely connected with drug use. These diseases are one of the hardest drug use results affecting health. The relation between drug injections and infection transmission is undeniable. Therefore, in many countries prevention of drug use harm and its reduction is the aim of societies‘ health policy and strategies of fighting against drugs. The aim of this work: to review the concept of harm reduction, to analyse and present literature material related to particularity of implementation, importance and effectiveness of one element of harm reduction programme - needle and syringe / exchange. The methodology of the study is analysis and synthesis of scientific literature and sources, meta-analysis, structuring and summarizing information.Harm reduction is a policy or programme oriented towards reducing negative drug use effects on health of an individual person and the whole society in general as well as social and economical areas without a strict requirement for a person to give up using drugs. Using clean injection equipment, its sterilization, reducing of risky habits while preparing drug mixtures/solutions and promotion of condom use are especially important kinds of intervention in programmes of reducing HIV, spread of hepatitis, overdosing and other drug connected death cases. However drug harm reduction programmes are not alternatives to other means of treatment for drug use. Harm reduction, widespread worldwide, is being consolidated and integrated with different health care and social services. Usually “packages“ of various services of harm reduction are provided in low threshold centres.