Needle and syringe exchange in Poland and the former Soviet Union: A new approach to community-impact studies

This article describes a new approach to assessing the impact of needle- an d syringe-exchange programs (NSEPs), designed for application in Eastern Eu rope and the former Soviet Union. In these parts of the world, use of a hom emade opiate preparation made from poppy plants is common. The advance of A IDS has been associated with increasing use of this drug. However, NSEP mig ht be less effective in that setting than in the West: with a liquid drug, virus transmission may take place through sharing or selling of the drug it self even when each user has his or her own works and never shares them wit h others. NSEPs can be difficult to evaluate, however, particularly where u sers are stigmatized. Here, we propose methods to assess the community impa ct of NSEPs by evaluating syringes, not users. These methods involve labeli ng, tracking, and enumeration of syringes as well as testing of syringes fo r parenterally transmissible virus (e.g., human immunodeficiency virus). Th ey allow for estimation of the fetal number of syringes in circulation, the average time each syringe spends circulating among users, and the rate of virus exposure among users. Examples are given of the implementation of the se methods in Poland, with assessments of the community impact of local NSE Ps there.