25 years experience from a social worker working in a Swedish needle exchange program (NEP) aiming at limiting transmission of blood borne

viruses

Magnus AnderssonSocial worker

University Hospital of SkaneDepartment of Infectious Diseases

Malmö, Sweden

The Malmö Needle Exchange Program opened in 1987 as a measure of HIV prevention among injecting drug addicts and has since developed into a wide array of medical and social interventions

Press comments from 1986-7 “Doctors from Lund ignore ban on needle exchanges”

The participants are regularly screened for HIV as well as hepatitis B and C. They are ready to cooperate and to give blood-samples and allow sera to be stored frozen.

Our extensive contacts and close relations with the local injection drug addict population, enable us, when needed, to carry out contact tracing with great efficiency, via mobile phones, calls to hostels, etc

In 1989 a newly discovered HIV-infection in a young Malmö IVDU girl, led within few weeks to more than 60 suggestions of addicts that we ought to test.Following the suggestions we discovered an additional 7 HIV sero-positive addicts

Annual numbers of all NEP visitors and First time NEP visitors 1990 – 2011, respectively

Year

Despite that we have detected very few locally infected HIV-positive addicts during the last 20 years, we have seen continued spread of HCV

62% of first time visitors (new visitors) prove to be already positive for hepatitis C.

Figured for 2010 show seropositivity of over 90 % in participant older then 40 years and 66 % for younger participant.

NEPs need to be evaluated….

Needles and syringes are however not everything....

Flyer given to those who testanti-HCV negative – to help them to remain HCV negative

There is also a version for those testing positive to limit spread

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1939 1941-45 1946-50 1951-55 1956-60 1961-65 1966-70 1971-75 1976-80 1981-85 1986-90

An

tal

Födelseår

Heroin

Amfetamin

kokain

kokain+heroin

Subutex

Metadon

Morfin

Heroin+Amfetamin

Heroin+Subutex

Saknas

Intravenös huvuddrog och födelseår för samtliga besökare 2010. Totalt 831 personer.

Malmö Sprutbytesprogram 2010

Intravenous Main Drug and Year of birth 2010

Year of birth

A large number of urgent minor health care interventions are carried out in an out-patient setting, enabling addicts to avoid long waiting hours elsewhere.

The NEP also provides excellent platform for HBV and HAV vaccination

Administration of three doses of hepatitis B vaccine in addicts is very difficult in any other setting. Easier in needle exchange programs or in a prison

A midwife joined our NEP 1993 with the purpose of preventing unwanted pregnancies, offers contraceptives, gynaecological check-ups, including detection and treatment of sexually transmitted infections.

The number of positive pregnancy tests among the women in the project has diminished.

Prevention of overdoses - a special film running nonstop in the waiting room

An updated information site…

Listen to the experience form IVDUs - here from an HIV infected drug addict in Kalingrad in 2000: How to become HIV infected.

Tools available to us

• Trustful talk with a non-repressive person• Linking IVDUs to detoxification and drug

free rehabilitation centers• or transfer to methadone / buprenorfine

maintenance units• Active visits to hospitalized NEP participants • Connecting to the social welfare system - or

NGOs

My personal experience

• I acquire an updated knowledge of abuse trends and drug culture like injecting modes, drug preparation modes and trends, heroine smoking, cocaine use

• To meet marginalized persons with respect• Staff continuity is important• Fight with government has not always been

easy

 

 

    - -  

Benefits of the Needle exchange

program Malmö (1).• Extensive contacts and close relations with

local addict population• Epidemiological surveillance• Unique potential for research among active

drug addicts • HIV-testing repeated at regularly intervals.• Early detection of HIV and Hepatitis• Efficient contact tracing/ partner notification

on an outreach basis

Benefits of the Needle exchange program Malmö (2)

• Midwife associated with NEP works to prevent unwanted pregnancies.

• Female addicts visiting the NEP are offered pregnancies test

• Prompt intervention by physician or nurse when needed.

• Hepatitis A and B vaccination• Addicts admitted to wards in our hospital will

be contacted by the NEP social worker• Encouragement for detoxification or

maintenance therapy