By: Nyoko Brown
A topic of increasing concern is the access individuals who use injection drugs have to clean and free needles. People in vulnerable populations, such as those who are unhoused, face a number of barriers to accessing clean needles ranging from lack of supplies to a lack of privacy when seeking services. Satellite exchange programs, such as Clean Needles Now in Los Angeles are actively improving their outreach and ability to supply clean needles. While there is still much progress to be made, the research papers presented here give much insight into the severity of the issue.
The paper titled, "Barriers to Condom Use and Needle Cleaning Among Impoverished Minority Female Injection Drug Users and Partners of Injection Drug Users" looks at risk factors associated with being unhoused that result in risky behaviors for injection drug users. High on the list of reasons for “perceived barriers to needle disinfection” presented are individuals not having their own needles and not having disinfectant available. Pressure for the increased supply of clean needles is supported by additional studies that found when access to clean needles is increased, the sharing of needles does not increase. Furthermore, increased access to clean needles also increased the number of individuals who were willing to seek treatment for substance abuse. (Nyamathi et al., 1995). The need for clean needles and disinfecting supplies can subsequently be seen as an emergent situation worthy of a swift, efficacious response in order to improve the safety of those who use injection drugs.
Needle exchange sites have continued to improve the efficacy of their programs, one method of such being satellite exchange. Satellite exchange is the use of a person already seeking services to also exchange needles for individuals who cannot come to the site themselves (Davidson & Howe, 2022). Even with the presence of exchange sites, barriers for individuals utilizing the service still exist. An individual may be concerned about being recognized by peers while seeking service, another may fear being identified as an injection drug user, and it may also come down to the limited hours of operation of the exchange sites. One successful satellite exchange site is Clean Needles Now (CNN) located in Los Angeles, which is modeled after the Homeless Youth Alliance (HYA) in San Francisco. Davidson and Howe detail the success and limitations of satellite exchange within these organizations.
The study aimed to improve these programs by re-targeting satellite exchange participants in order to expand the programs’ reach. CNN employed the methods from this study by first adding questions to their preexisting intake survey that asked people where and when they found themselves or their peers in need of needles. Second, the reported locations were mapped and ‘hot spots’ for needle shortages were identified. Third, the knowledge was used to deliver needles to areas in need. It was found that Skid Row and areas surrounding the existing exchange sites were hotspots, however efforts to deliver needles to these areas had to be made with local policy in mind, and deliberation on the matter is ongoing with City officials. (Davidson & Howe, 2022).
The maps generated in this study are especially useful because they not only illustrate the need for clean and free exchange of needles, but also that there may be a long term method for establishing that need, especially in times of change within unhoused communities (Davidson & Howe, 2022). The authors do acknowledge that only surveying those coming directly to the exchange site serves as a limitation to the range of the mapping, but the resources needed to reach those outside of the exchange site would be a drawback from the convenience that makes this method of mapping successful. The benefits, however, are clear. Using this method of mapping to increase the accuracy and reach of satellite programs is meeting the needs of injection drug users who cannot enter the exchange themselves. Furthermore, this method of surveying is easily implemented into the current structure of exchange sites, ensuring its continuity and data collection, and does not require additional resource expenditure (Davidson & Howe, 2022). Overall, this method for addressing the lack of access to clean needles proves to be a dependable first step.
Davidson, P. J., Scholar, S., & Howe, M. (2011, March). A GIS-based methodology for improving needle exchange service delivery. The International journal on drug policy. Retrieved January 17, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3070054/
Nyamathi, A. M., Lewis, C., Leake, B., Flaskerud, J., & Bennett, C. (1995). Barriers to condom use and needle cleaning among impoverished minority female injection drug users and partners of Injection Drug Users. Public health reports (Washington, D.C. : 1974). Retrieved January 17, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1382096/