Syringes in ParadiseOver 20 Years of

Syringe Exchange in Hawaiʿi

Heather LuskCHOW Project

hlusk@chowproject.org

Overview of Syringe Exchange in Hawaiʿi

• Started in 1989 – first statewide program• Initially 2 year pilot project, then Act 152

– HI legislature and Governor support– Allocated monies to HI Dept. of Health

• HIV/STD/hep program contracts out services to one agency through– DOH is ally and advocate– CHOW Project has been only recipient

[325-111] Sterile Needle and Syringe Exchange

Established• Establishes SEP through Department of

Health (may be contracted out)• Requires one-for-one exchange• Extensive data collection and annual

evaluation to demonstrate effectiveness• Syringe Exchange Oversight Committee

– Comprised of law enforcement, policy makers, Attorney General’s office, DOH

[325-114] Criminal Liability

“Exchanges under the sterile needle and syringe exchange program shall not constitute an offense under section 329-43.5 for the participant or for the employees of the department or its designees”

[325-21] Sale of Sterile Syringes for the

Prevention of Disease• Allows the sale of sterile syringes by:

– Pharmacist– Physician– Healthcare provider– Authorized agent of pharmacy

• Must provide education about diseases, drug treatment and proper disposal

• “Sale or purchase of sterile hypodermic syringes under subsection (a) shall not constitute an offense under section 329-43.5”

Blessing and CurseSyringe Exchange Codified

Blessing•Long-term legitimacy•Demonstrates wide support at the time•Requires stakeholders to be involved•Facilitates police support•Helps related legislation

Curse•Required components

– One-for-one

•Extensive data collection and research•Director of Health has ability to end•Opening up law for changes could go either way

Hawaiʿi Syringes Exchanged 1993-2011

CHOW’s OldMission Statement

To prevent the transmission of HIV/AIDS and other blood-borne pathogens among high-risk drug users, especially injection drug users (IDUs) in the State of Hawaii.

CHOW’s Mission Statement

The Community Health Outreach Work (CHOW) Project is dedicated to serving individuals, families and communities adversely affected by drug use, especially people who inject drugs, through a participant-centered harm reduction approach. CHOW works to reduce drug-related harms such as but not limited to HIV, hepatitis B/C and overdose. CHOW supports the optimal health and well-being of people affected by drug use throughout the State of Hawaiʿi

Current CHOW Programs

• Outreach– hygiene kit distribution

• Harm reduction– Syringe exchange, wound care, overdose etc

• HIV and viral hepatitis prevention program– Includes testing for HIV and hepatitis C

• Referrals and linkage to care • Drug treatment on demand

– CHOW pays for drug treatment when person is ready and has no other way to pay

CHOW Operations• Statewide

– Maui– Kauai– East and West Hawaiʿi– Oʻahu

• Honolulu – set mobile van on River street and Vineyard

• Individually scheduled syringe exchange services (ISES) across the island– Will meet clients where they are

New CHOW Participant Card

Starting in July, 2012 CHOW will require participants to register and attain a participant card.

Data Collection

• Anonymous so people aren’t tracked• Daily logs capture demographics and

supplies distributed• Act 152 requires annual research

report to demonstrate effectiveness– 150 participants randomly sampled– 30 minute interview– Recently HIV and hepatitis C antibody

testing added

“I really feel you guys are sincere and genuine and really care about us out here. I always feel comfortable with you guys and really appreciate you always being there for us.”

-CHOW participant 6/16/09

Age of SEP Participants1999-2011

Receptive Needle Sharing

1999-2011

Drug Use1995-2011

Actual HIV Prevalence2002-2011

Hepatitis C Prevalence2010-2011

Lessons Learned

• Staff are the greatest resource • Prioritize building bridges and community

support – it is worth it!• Just because its been done for 20 years,

doesn’t mean it should continue– Program evaluation essential– Data collection important but why?

• Don’t reinvent wheel – best practices available– Adapt to local area/issues/needs

Lessons Learned• People are much more than their drug use

– Know participants, listen to their stories

• Harm reduction doesn’t mean lack of accountability

• Track drug, policing and other relevant trends in community

• HIV and hepatitis C are preventable– Support any positive change

• Manage and supervise from harm reduction perspective

Mahalo!For more info:

hlusk@chowproject.org