Hepatitis C and needle exchange (2003)

ENGLISH :
In this issue it's established that hepatitis C has already infected a substantial minority of British injectors and is spreading rapidly due to continued "sharing" - shorthand for the various practices which risk blood-to-blood contact mediated by materials and equipment used to inject. Without harm reduction measures such as needle exchange, its spread might have been even worse, but their impact has been nowhere near enough to prevent the hepatitis C epidemic. Given current services, progress has plateaued at a level which leaves HIV a potential threat and hepatitis C leaking in volumes through the gaps. In later issues it's argued that rising above this level will require more intensive and extensive service provision and a determined strategic focus on eliminating risk behaviour. In this exchanges will be pivotal, but success is not guaranteed. Exchanges do not automatically reduce risk behaviour or eliminate the potential for epidemic viral spread; it all depends on the volume and nature of the service. In Britain, evidence for effectiveness in reducing risk behaviour or curbing infection is extremely limited. Across the world, studies have generally yet to prove effectiveness against hepatitis C. Rather than these findings casting doubt on continuing with needle exchange, the overriding conclusion is that we need far more. Exchanges should be the vanguard of a harm reduction effort of sufficient volume to safeguard the health of the vast majority of injectors (and their associates), not just those looking for ways out through treatment. More resources and support could also pave the way for a proactive working style which maximises the opportunities for intervention. With the core exchange function optimised, attention could be turned to extensions which harness drug user networks and take exchanges closer to a one-stop, comprehensive harm reduction service. (Extract of the publication)