EVALUATION OF SYRINGE-EXCHANGE FOR HIV PREVENTION AMONG INJECTING DRUG-USERS IN RURAL AND URBAN AREAS OF WALES

This paper considers the prevention of HIV in rural and urban areas among both opiate and non-opiate drug injectors. A 2-year study evaluated specialist and community based syringe-exchange provision in Wales. Numbers of clients and patterns of attendance at eight syringe-exchange schemes were monitored together with comparative cross-sectional studies of attenders (n = 152) and non-attenders (n = 176) from the population of drug injectors in 1990 and 1991. A total of 1171 clients made 7553 visits in the 2-year period, 110 000 syringes were issued and 80% of needles and syringes were returned. There were few demographic differences between attenders and non-attenders, but large and significant differences in HIV risk behaviour; only 9% of attenders had recently shared syringes in 1990 (10% in 1991) compared to 41% of non-attenders (39% in 1991). The catchment areas of specialised services were limited (5 miles or less) and insufficient in rural areas. Alternative community approaches to syringe distribution and exchange are examined.