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The European Journal of Public Health 2003 13(3):252-258; doi:10.1093/eurpub/13.3.252
© 2003 by European Journal of Public Health
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HIV

Legal access to needles and syringes/ needle exchange programmes versus HIV counselling and testing to prevent transmission of HIV among intravenous drug users

A comparative study of Denmark, Norway and Sweden

Ellen J. Amundsen1,2,4,*, Anne Eskild2, Hein Stigum2, Else Smith3 and Odd O. Aalen4

1 Norwegian Institute for Alcohol and Drug Research, Oslo, Norway 2 Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway 3 Department of Epidemiology, Statens Serum Institut, Copenhagen, Denmark 4 Section of Medical Statistics, University of Oslo, Oslo, Norway

Background: Countries have adopted different strategies to prevent the transmission of HIV among intravenous drug users. Legal access to needles and syringes/needle exchange programmes as part of such a strategy has been heavily debated. HIV counselling and testing has also been part of prevention strategies. The objective of this study was to discuss the effectiveness of legal access to needles and syringes/ needle exchange programmes versus HIV counselling and testing among intravenous drug users (IDUs) as part of HIV prevention strategies. Methods: Differences in HIV prevention strategies in Denmark, Norway and Sweden among IDUs are described. Outcome variables of effectiveness were HIV incidence rates over time. These were estimated by back calculation methods from 1980 through 1996, using data from the national HIV and AIDS registers. Results: A comparison of HIV prevention strategies in Denmark, Norway and Sweden suggests that a high level of HIV counselling and testing might be more effective than legal access to needles and syringes/needle exchange programmes. Sweden and Norway, with higher levels of HIV counselling and testing, have had significantly lower incidence rates of HIV among IDUs than Denmark where there was legal access to needles and syringes and a lower level of HIV counselling and testing. In Sweden there was no legal access to drug injection equipment. Conclusion: Promotion and accessibility of HIV counselling and testing among intravenous drug users should be considered in countries where such a strategy is not adopted or has low priority.

Keywords: AIDS, HIV, incidence, intravenous drug users, prevention

Received 24 October 2001. Accepted 27 May 2002.

* Correspondence: Ellen J. Amundsen, PhD, Norwegian Institute for Alcohol and Drug Research, PO Box 565 Sentrum, 0105 Oslo, Norway, tel. +47 22 340 432, fax +47 22 340 41, e-mail: eja{at}sirus.no


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