YSM Issue 86.3

Inhibiting
Infection
Rates
Inhibiting
Infection
Rates
BY CHRISTINA DE FONTNOUVELLE
Imagine that HIV rates in crowded cities
could be reduced with a single public
health program. Imagine that this program
could make both its users and police
safer. Imagine that this program is incredibly
simple and cheap.
Now realize this: such programs exist, yet
they are so controversial that few American
cities reap their benefits and the government
refuses to fund them. Upon hearing
their names without knowing the facts
behind them, it isn’t hard to imagine why.
They are syringe exchange programs, which
provide clean needles to drug users at no
cost.
HIV/AIDS and Injection Drugs
In cities, contaminated drug syringe use
is one of the most common mechanisms
of HIV transmission, causing 30 percent
of HIV infections outside Sub-Saharan
Africa. Whenever an addict injects heroin or
cocaine, the syringe retains trace amounts
of blood. While these droplets are miniscule,
they contain millions of HIV particles,
easily enough to infect anyone else who
uses the syringe again. When faced with
withdrawal and a shortage of syringes, drug
addicts often feel trapped and are forced to
use dirty syringes.
26 Yale Scientific Magazine | April 2013
This problem has become the focus of
research for many public health professionals,
including Yale Professor of Epidemiology
Kaveh Khoshnood. Khoshnood became
interested in syringe-transmitted HIV
as a graduate student in New Haven. For
his Master’s thesis, he conducted a smallscale
study on New Haven drug users with a
focus on identifying barriers to methadone
treatment program. For his Ph.D. dissertation
research, Khoshnood conducted a
study evaluating the utilization and efficacy
of New Haven’s syringe exchange program.
Khoshnood wanted to continue this
research and demonstrate that syringe exchange
programs are powerful tools in slowing
the spread of HIV. In a five-year study,
he and his colleagues recruited close to
1,000 drug users in New Haven; Hartford;
and Springfield, Massachusetts. While New
Haven and Hartford have syringe exchange
programs and pharmacies that sell syringes
over the counter, Springfield does not.
“We wanted to learn the ‘natural history’
of syringes in these cities, so to speak,”
said Khoshnood, including “where they
come from, how they are used and discarded,
what are the various influences on
this natural history, where disease risks are
introduced.” By tracing syringes and surveying
drug users, the researchers found that
in Springfield, syringes were used over and
over again by many different people much
more often than in New Haven or Hartford.
Springfield also had a higher rate of HIV in
drug users than the two other cities did. The
syringe exchange programs and access to
syringes through pharmacies were working.
Recruiting and obtaining meaningful
survey responses from all 1,000 drug users
was not an easy task. “Drug users have been
shunned and stigmatized by society and are
distrustful of any authorities that try to approach
them,” said Professor Khoshnood.
“It took a long time to establish trust with
drug users, but they learned that our intentions
were not to harm them. My prior
experience with research on drug users as a
graduate student was useful in this respect.”
Drug users are wary of authorities for
good reason. Many are known to police,
which makes them prone to pat-downs
when walking the streets. The fear of being
arrested reduces clean syringe use, even
when syringe exchange programs are available
— being caught with syringes, even
clean ones, can serve as evidence of illegal
drug use. Many addicts thus choose to avoid
carrying clean syringes and take risks with
used syringes later when they cannot quickly
obtain clean ones. Thus, criminal issues carry
over into public health, and Khoshnood
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