Skip to main content

Advertisement

Log in

The role of safer injection facilities in the response to HIV/AIDS among injection drug users

  • Published:
Current HIV/AIDS Reports Aims and scope Submit manuscript

Abstract

Many cities throughout the globe are experiencing ongoing infectious disease and overdose epidemics among injection drug users (IDUs). In particular, HIV has become endemic among IDUs in many settings. In an effort to reduce this and related public health concerns, medically supervised safer injecting facilities (SIFs), where IDUs can inject pre-obtained illicit drugs under the supervision of medical staff, have been established in several countries. The following review assesses the role that SIFs can play in reducing the harms associated with HIV infection among IDUs and points to ways in which SIFs can be further developed to better respond to the challenges associated with HIV/AIDS among this population.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

  1. Joint United Nations Programme on HIV/AIDS: Report on the Global AIDS Epidemic. Geneva: Joint United Nations Programme on HIV/AIDS; 2006.

    Google Scholar 

  2. Stein MD: Medical complications of intravenous drug use. J Gen Intern Med 1990, 5:249–257.

    Article  PubMed  CAS  Google Scholar 

  3. Kerr T, Wood E, Grafstein E, et al.: High rates of primary care and emergency department use among injection drug users in Vancouver. J Public Health (Oxf) 2005, 27:62–66.

    Article  CAS  Google Scholar 

  4. Wood E, Kerr T, Montaner JS, et al.: Rationale for evaluating North America’s first medically supervised safer-injecting facility. Lancet Infect Dis 2004, 4:301–306.

    Article  PubMed  Google Scholar 

  5. Drucker E: Drug prohibition and public health: 25 years of evidence. Public Health Rep 1999, 114:14–29.

    Article  PubMed  CAS  Google Scholar 

  6. Garfield J, Drucker E: Fatal overdose trends in major US cities: 1990–1997. Addict Res Theory 2001, 9:425–436.

    Google Scholar 

  7. US Office of National Drug Control Policy: Estimation of Heroin Availability 1995–1998. http://www.whitehousedrugpolicy.gov/publications/drugfact/heroin_report/heroin_report.pdf. Accessed August 2, 2007.

  8. Wood E, Tyndall MW, Spittal PM, et al.: Supply-side policies for control of illicit drugs in the face of the AIDS and overdose epidemics: investigation of a massive heroin seizure. CMAJ 2003, 168:165–169.

    PubMed  Google Scholar 

  9. Schiraldi V, Holman B, Beatty P: Poor prescription: the costs of imprisoning drug offenders in the United States. http://www.cjcj.org/pubs/poor/ppexec.html. Accessed August 2, 2007.

  10. Tyndall MW, Currie S, Spittal P, et al.: Intensive injection cocaine use as the primary risk factor in the Vancouver HIV-1 epidemic. AIDS 2003, 17:887–893.

    Article  PubMed  Google Scholar 

  11. Boys A, Farrell M, Bebbington P, et al.: Drug use and initiation in prison: results from a national prison survey in England and Wales. Addiction 2002, 97:1551–1560.

    Article  PubMed  CAS  Google Scholar 

  12. Broadhead RS, Kerr TH, Grund JP, Altice FL: Safer injection facilities in North America: their place in public policy and health initiatives. J Drug Issues 2002, 32:329–355.

    Google Scholar 

  13. Hedrich D: European Report on Drug Consumption Rooms. Luxembourg: Office for Official Publications of the European Communities; 2004.

    Google Scholar 

  14. Wood E, Kerr T, Small W, et al.: Changes in public order after the opening of a medically supervised safer injecting facility for illicit injection drug users. CMAJ 2004, 171:731–734.

    PubMed  Google Scholar 

  15. Wood E, Tyndall MW, Montaner JS, Kerr T: Summary of findings from the evaluation of a pilot medically supervised safer injecting facility. CMAJ 2006, 175:1399–1404.

    PubMed  Google Scholar 

  16. Medically Supervised Injecting Centre Evaluation Committee: Final Report of the Sydney Medically Supervised Injecting Centre. Sydney: MSIC Evaluation Committee; 2003.

    Google Scholar 

  17. Wood E, Tyndall MW, Li K, et al.: Do supervised injecting facilities attract higher risk injection drug users? Am J Prev Med 2005, 2:126–130.

    Article  Google Scholar 

  18. Wood E, Tyndall MW, Qui Z, et al.: Service uptake and characteristics of injection drug users utilizing North America’s first medically supervised safer injecting facility. Am J Public Health 2006, 96:770–773.

    Article  PubMed  Google Scholar 

  19. Benninghoff F, Dubois-Arber F: Résultats de l’étude de la clientèle du Cactus Biel/Bienne 2001. Lausanne: Institut universitaire de médecine sociale et préventive; 2002.

    Google Scholar 

  20. Happel V: Konsumräume—eine effektive Massnahme zur Schadensminimierung bei DrogengebraucherInnen und BürgerInnen. Akzeptanz-Zeitschrift für akzeptierende Drogenarbeit und humane Drogenpolitik; 2000:30–36.

  21. Benninghoff F, Solai S, Huissoud T, Dubois-Arber F: Evaluation de Quai 9 “Espace d’accueil et d’injection” à Genève: période 12/2001–12/2000. Lausanne: Institut universitaire de médecine sociale et préventive; 2003.

    Google Scholar 

  22. Kimber J, MacDonald M, van Beek I, et al.: Sydney Medically Supervised Injecting Centre: client characteristics and predictors of frequent attendance in the first 12-months of operation. J Drug Issues 2003, 33:639–649.

    Google Scholar 

  23. Zurhold H, Kreuzfeld N, Degkwitz P, Verthein U: Drogenkonsumräume. Gesundheitsförderung und Minderung öffentlicher Belastungen in europäischen Grossstädten. Freiburg: Lambertus; 2001.

    Google Scholar 

  24. Kemmesies U: Final Report: The Open Drug Scene and the Safe Injection Room Offers in Frankfurt am Main. Münster: INDRO; 1999.

    Google Scholar 

  25. Gerlach R, Schneider W: Consumption and Injecting Room (CIR) at INDRO, Münster, Germany: Annual Report 2002 (English Version). Münster: INDRO; 2003.

    Google Scholar 

  26. O’Connell J, Kerr T, Li K, et al.: Requiring help injecting independently predicts incident HIV infection among injection drug users. J Acquir Immune Defic Syndr 2005, 40:83–88.

    Article  PubMed  Google Scholar 

  27. Wood E, Tyndall M, Stoltz J, et al.: Safer injecting education for HIV prevention within a medically supervised safer injecting facility. Int J Drug Policy 2005, 29:126–130.

    Google Scholar 

  28. Des Jarlais DC: Structural interventions to reduce HIV transmission among injecting drug users. AIDS 2000, 14(Suppl 1):S41–S46.

    Article  PubMed  Google Scholar 

  29. Dubois-Arber F, Jeannin A, Spencer B, et al.: Evaluation of the AIDS Prevention Strategy in Switzerland (6th synthesis report 1996–1998). Lausanne: Institut universitaire de médicine sociale et préventive; 1999.

    Google Scholar 

  30. Benninghoff F, Geense R, Dubois-Arber F: Résultats de l’étude ‘La cliententèle des structures à bas seuil d’accessibilité en Suisse’ 2000 Bienne. Lausanne: Institut universitaire de médicine sociale et préventive; 2001.

    Google Scholar 

  31. Ronco C, Spuhler G, Coda P, Schopfer R: Evaluation for alley-rooms I, II, and III in Basel. Soc Prev Med 1996, 41:S58–S68.

    Article  Google Scholar 

  32. Jacob J, Rottmann J, Stöver H: Entstehung und Praxis eines Gesundheitsraumangebotes für Drogenkonsumierende. Abschlußbericht der einjährigen Evaluation des ‘drop-in Fixpunkt’ in Hannover. Oldenburg: Bibliotheks-und Informationssystem der Universität Oldenburg, Schriftenreihe Sucht-und Drogenforschung; 1999.

    Google Scholar 

  33. Nejedly MM, Burki C: Monitoring HIV Risk Behaviors in a Street Agency with Injection Room in Switzerland. Bern: Medizinischen Fakultat, Universitat Bern; 1996.

    Google Scholar 

  34. van der Poel A, Barendregt C, van de Mheen D: Drug consumption rooms in Rotterdam: an explorative description. Eur Addict Res 2003, 9:94–100.

    Article  PubMed  Google Scholar 

  35. Meijer G, de Jong A, Koeter M, et al.: Evaluatie gebruiksruimnte Binnenstad-Zuid Groningen. Amsterdam/Groningen: Amsterdam Institute for Addiction Research/Intraval; 2001.

    Google Scholar 

  36. Wood E, Tyndall M, Stoltz J, et al.: Factors associated with syringe sharing among users of a medically supervised safer injection facility. Am J Infect Dis 2005, 1:50–54.

    Article  Google Scholar 

  37. Kerr T, Tyndall M, Li K, et al.: Safer injection facility use and syringe sharing in injection drug users. Lancet 2005, 366:316–318.

    Article  PubMed  Google Scholar 

  38. Celentano DD, Vlahov D, Cohn S, et al.: Risk factors for shooting gallery use and cessation among intravenous drug users. Am J Public Health 1991, 81:1291–1295.

    Article  PubMed  CAS  Google Scholar 

  39. Kimber J, Dolan K: Shooting gallery operation in the context of establishing a medically supervised injecting center: Sydney, Australia. J Urban Health 2007, 84:255–266.

    Article  PubMed  Google Scholar 

  40. Wood E, Tyndall MW, Lai C, et al.: Impact of a medically supervised safer injecting facility on drug dealing and other drug-related crime. Subst Abuse Treat Prev Policy 2006, 1:13.

    Article  PubMed  Google Scholar 

  41. Wood E, Tyndall MW, Spittal P, et al.: Needle exchange and difficulty with needle access during an ongoing HIV epidemic. Int J Drug Policy 2002, 13:95–102.

    Article  Google Scholar 

  42. Wood E, Li K, Palepu A, et al.: Sociodemographic disparities in access to addiction treatment among a cohort of Vancouver injection drug users. Subst Use Misuse 2005, 40:1153–1167.

    Article  PubMed  Google Scholar 

  43. Wood E, Spittal PM, Li K, et al.: Inability to access addiction treatment and risk of HIV-infection among injection drug users. J Acquir Immune Defic Syndr 2004, 36:750–754.

    Article  PubMed  Google Scholar 

  44. Kimber J, Dolan K, van Beek I, et al.: Drug consumption facilities: an update since 2000. Drug Alcohol Rev 2003, 22:227–233.

    Article  PubMed  CAS  Google Scholar 

  45. Dolan K, Kimber J, Fry C, et al.: Drug consumption facilities in Europe and the establishment of supervised injecting centres in Australia. Drug Alcohol Rev 2000, 19:337–346.

    Article  Google Scholar 

  46. Wood E, Tyndall MW, Zhang R, et al.: Attendance at supervised injecting facilities and use of detoxification services. N Engl J Med 2006, 354:2512–2514.

    Article  PubMed  CAS  Google Scholar 

  47. Wood E, Tyndall MW, Zhang R, et al.: Rate of detoxification service use and its impact among a cohort of supervised injecting facility users. Addiction 2007, 102:916–919.

    Article  PubMed  Google Scholar 

  48. Poschadel S, Höger R, Schnitzler J, Schreckenberg D: Evaluation der Arbeit der Drogenkonsumräume in der Bundesrepublik Deutschland: Endbericht im Auftrag des Bundesministeriums für Gesundheit. Baden-Baden: Nomos-Verlags-Gesellschaft; 2003.

    Google Scholar 

  49. Geense R: Evaluation of the Federal measures to reduce the problems related to drug use. To have or to have not: That’s the question: a qualitative study on four low threshold needle exchange serviced for drug users in Switzerland. Lausanne: University Institute of Social and Preventative Medicine; 1997.

    Google Scholar 

  50. Palepu A, Tyndall MW, Leon H, et al.: Hospital utilization and costs in a cohort of injection drug users. CMAJ 2001, 165:415–420.

    PubMed  CAS  Google Scholar 

  51. Rhodes T, Kimber J, Small W, et al.: Public injecting and the need for ’safer environment interventions’ in the reduction of drug-related harm. Addiction 2006, 101:1384–1393.

    Article  PubMed  Google Scholar 

  52. Spreyerman C, Willen C: Evaluationsbericht Öffnung der Kontakt-und Anlaufstellen für risikoärmere Konsumformen. Evaluation der Inhalationsräume der Kontakt und Anlaufstellen Selnau und Seilergraben der Ambulanten Drogenhilfe Zürich. Berne: Sfinx; 2003.

    Google Scholar 

  53. Prinzleve M, Martens MS: Evaluation der Abendöffnungszeiten des Drob Inn. Forschungsbericht im Auftrag des Jugendhilfe e.V. Hamburg. Hamburg: Zentrum für Interdisziplinäre Suchtforschung (ZIS); 2003.

    Google Scholar 

  54. Thein HH, Kimber J, Maher L, et al.: Public opinion towards supervised injecting centres and the community impact of Sydney Medically Supervised Injecting Centre. Int J Drug Policy 2005, 16:275–280.

    Article  Google Scholar 

  55. Salmon A, Thein R, Kimber J, et al.: Five years on: what are the community perceptions of drug-related public amenity following the establishment of the Sydney Medically Supervised Injecting Centre? Int J Drug Policy 2007, 18:46–53.

    Article  PubMed  Google Scholar 

  56. Linssen L, de Jong W, Wolf J: Gebruiksruimten. Een systematisch overzicht van de voorziening en de effecten ervan. Utrecht: Trimbos Instituut; 2001.

    Google Scholar 

  57. Stoltz JA, Wood E, Small W, et al.: Changes in injecting practices associated with the use of a medically supervised safer injection facility. J Public Health (Oxf) 2007, 29:35–39.

    Article  Google Scholar 

  58. Drug situation Spain 2001. Report to the EMCDDA by the Reitox National Focal Point ‘Delegación del Gobierno para el Plan Nacional Sobre Drogas’. Madrid: Plan Nactional Sobre Drogras (PND); 2002.

  59. Small W, Wood E, Tyndall M, et al.: Accessing care for injection-related infections through a medically supervised safer injection facility: the perspectives of injection drug users. Can J Infect Dis 2007, 18(Suppl B):18B.

  60. Tyndall MW, Craib KJ, Currie S, et al.: Impact of HIV infection on mortality in a cohort of injection drug users. J Acquir Immune Defic Syndr 2001, 28:351–357.

    PubMed  CAS  Google Scholar 

  61. Bluthenthal RN, Kral AH, Lorvick J, et al.: Harm reduction and needle exchange programmes [letter; comment]. Lancet 1998, 351:1333.

    Article  Google Scholar 

  62. National Institutes of Health/National Consensus Development Panel on Effective Medical Treatment of Opiate Addiction: Effective medical treatment of opiate addiction. JAMA 1988, 280:1936–1943.

    Article  Google Scholar 

  63. Böllinger L, Stöver H, Fietzek L, eds: Druckräume: Angebote, in denen der intravenöse Drogenkonsum toleriert wird. In Drogenpraxis, Drogenrecht, Drogenpolitik. Frankfurt: Fachhochschulverlag; 1995:142–145.

  64. Beek I, Kimber J, Dakin A, Gilmour S: The Sydney Medically Supervised Injecting Centre: reducing harm associated with heroin overdose. Critical Public Health 2004, 14:391–406.

    Article  Google Scholar 

  65. Kerr T, Tyndall M, Lai C, et al.: Drug-related overdoses within a medically supervised safer injection facility. Int J Drug Policy 2006, 17:436–441.

    Article  Google Scholar 

  66. Wurcel A, Zaman T, Zhen S, Stone D: Acceptance of HIV antibody testing among inpatients and outpatients at a public health hospital: a study of rapid versus standard testing. AIDS Patient Care STDS 2005, 19:499–505.

    Article  PubMed  Google Scholar 

  67. Wood E, Kerr T, Hogg RS, et al.: Impact of HIV testing on uptake of HIV therapy among antiretroviral naive HIV-infected injection drug users. Drug Alcohol Rev 2006, 25:451–454.

    Article  PubMed  Google Scholar 

  68. Wood E, Hogg RS, Bonner S, et al.: Staging for antiretroviral therapy among HIV-infected drug users. JAMA 2004, 292:1175–1177.

    Article  PubMed  CAS  Google Scholar 

  69. Wood E, Lloyd-Smith E, Li K, et al.: Frequent needle exchange use and HIV incidence in Vancouver, Canada. Am J Med 2007, 120:172–179.

    Article  PubMed  Google Scholar 

  70. Kerr T, Craib KJ, Gataric N, Hogg RS: Assessing the impact of an adult day program on hospital utilization by persons living with HIV/AIDS. J Acquir Immune Defic Syndr 2002, 31:117–119.

    PubMed  Google Scholar 

  71. Petrar S, Kerr T, Tyndall MW, et al.: Injection drug users’ perceptions regarding use of a medically supervised safer injecting facility. Addict Behav 2007, 32:1088–1093.

    Article  PubMed  Google Scholar 

  72. Kerr T, Small D, Moore D, Wood E: A micro-environmental intervention to reduce the harms associated with drug-related overdose: Evidence from the evaluation of Vancouver’s safer injection facility. Int J Drug Policy 2007, 18:37–45.

    Article  PubMed  Google Scholar 

  73. Kimber J, Hickman M, Degenhardt L, et al.: Estimating the size of the local IDU population using client visits to the Sydney Medically Supervised Injecting Centre. Paper presented at the 16th International Conference on the Reduction of Drug Related Harm. Belfast, Ireland; March 20–24, 2005.

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Thomas Kerr.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kerr, T., Kimber, J., DeBeck, K. et al. The role of safer injection facilities in the response to HIV/AIDS among injection drug users. Curr HIV/AIDS Rep 4, 158–164 (2007). https://doi.org/10.1007/s11904-007-0023-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11904-007-0023-8

Keywords

Navigation