Transcript Bild 1 - Binero

25 years experience from a social worker working
in a Swedish needle exchange program (NEP)
aiming at limiting transmission of blood borne
viruses
Magnus Andersson
Social worker
University Hospital of Skane
Department 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 seropositive 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 test
anti-HCV negative – to help
them to remain HCV negative
There is also a version for
those testing positive to limit
spread
Malmö Sprutbytesprogram 2010
90
Intravenös
huvuddrog
och födelseår
Intravenous Main
Drug
and
Year
of birth 2010
för samtliga besökare 2010. Totalt 831 personer.
80
Heroin
Amfetamin
kokain
kokain+heroin
70
Subutex
Metadon
Morfin
60
Heroin+Amfetam in
Heroin+Subutex
Saknas
Antal
50
40
30
20
10
0
1939
1941-45
1946-50
1951-55
1956-60
1961-65
Födelseår
Year of
birth
1966-70
1971-75
1976-80
1981-85
1986-90
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