Reducing human immunodeficiency virus (HIV) infection rates in persons who inject drugs (PWID) has been one of the major successes in HIV prevention in the United States. [...] Because syringe service programs (SSPs) have been one effective component of these risk reduction efforts for PWID, and because at least half of PWID are estimated to live outside major urban areas, a study was undertaken to characterize the current status of SSPs in the United States and determine whether urban, suburban, and rural SSPs differed. Data from a recent survey of SSPs were analyzed to describe program characteristics (e.g., size, clients, and services), which were then compared by urban, suburban, and rural location. Substantially fewer SSPs were located in rural and suburban than in urban areas, and harm reduction services were less available to PWID outside urban settings. [...]
The basic service offered by SSPs allows PWID to exchange used needles and syringes for new, sterile needles and syringes. Providing sterile needles and syringes and establishing appropriate disposal procedures substantially reduces the chances that PWID will share injection equipment and removes potentially HIV- and HCV-contaminated syringes from the community. Many SSPs have become multiservice organizations, providing various health and social services to their participants. HIV and HCV testing and linkage to care and treatment for substance use disorders are among the most important of these other services. The availability of new and highly effective curative therapy for HCV infection increases the benefits of integrating testing and linkage to care among the services provided by SSPs.
During the last decade, an increase in drug injection has been reported in the United States, primarily the injection of prescription opioids and heroin among persons who started opioid use with oral analgesics and transitioned to injecting. Much of this drug injection has occurred in suburban and rural areas. Outbreaks of HCV infection, and more recently HIV infection, in these nonurban areas have been correlated with these injection patterns and trends.
The recent HIV outbreak in Scott County, Indiana, and the emerging HCV epidemics in multiple areas throughout the United States have focused attention on the limited coverage of prevention services for both types of infections among PWID in rural and suburban areas. This report summarizes data from a survey of U.S. SSPs, and compares selected characteristics of these programs by urbanicity. [Extracts]