THE HEALTH OF THE NATION TARGET ON SYRINGE SHARING - A ROLE FOR ROUTINE SURVEILLANCE IN ASSESSING PROGRESS AND TARGETING INTERVENTIONS

The Health of the Nation initiative in the United Kingdom includes a t arget aimed at reducing the proportion of current injecting drug users who share syringes. The PHLS Collaborative Survey of Salivary Antibod ies to HIV and Hepatitis B core in injecting drug users is a comprehen sive and national surveillance mechanism which routinely collects data that can be used to monitor progress toward this target. Nineteen per cent of injecting drug users (353/1876) in 1992 and 18% (375/2138) in 1993 shared previously used injecting equipment (difference of - 1.3% , 95% Cl - 3.7%, 1.1%). Only with further years of data collection wil l it be possible to tell if this decline represents a real change in b ehaviour. There was a substantial reduction in the proportion of share rs who received previously wed needles and syringes from move than one person, from 45% (138/305) in 1992 to 27% (81/298) in 1993 (fall of 1 8%, 95% Cl 11%, 26%). This decline could indicate a real reduction in risk behaviour that is not reflected in the target. Monitoring this as pect of sharing could be an important supplementary measure. Women wer e more likely to have shared (adjusted OR = 1.87, 95% Cl 1.53, 2.28) a nd the likelihood of sharing declined with age (adjusted OR of each 5- year age band = 0.75, 95% Cl 0.72, 0.79). Particular attention should be given to interventions which aim to reduce sharing among women and young people. Clients of agencies at which the main service provided w as syringe exchange were less likely to have shared than attenders of other types of agencies (adjusted OR = 0.69, 95% Cl 0.51, 0.93). This suggests that syringe exchange schemes play a role in reducing the tra nsmission of HIV infection.