Syringes in Paradise
Over 20 Years of Syringe
Exchange in Hawaiʿi
Heather Lusk
CHOW 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 32943.5 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 Curse
Syringe 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 Old
Mission 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 Participants
1999-2011
Average Age
46
45
44
43
42
41
40
39
38
37
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
Receptive Needle Sharing
1999-2011
Receptive Needle Sharing
30
25
20
15
10
5
0
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
Drug Use
1995-2011
100
90
80
70
60
50
40
30
20
10
0
1995
1996
1997
1998
1999
2000
2001
Heroin
2002
Opiates
2003
2004
2005
Methamphetamine
2006
2007
2008
2009
2010
2011
Actual HIV Prevalence
2002-2011
Percent HIV
7
6
5
4
3
2
1
0
2005
2006
2007
2008
2009
2010
2011
Hepatitis C Prevalence
2010-2011
90
80
70
60
50
2010
2011
40
30
20
10
0
HCV
OI
YI
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