UTILIDAD CLINICA DEL DIAGNOSTICO MOLECULAR DEL VPH

Needles exchange programmes

Different types of needles exchange programmes are available in the country except in the German Community: stationary, street programme and programmes in pharmacists (structured questionnaire 23, 2004). Safe injection rooms do not exist in Belgium.

In every province of the Flemish Community a coordinator for syringe exchange was appointed and several exchange places exist (low threshold organisations, pharmacies, outreach workers, …). Via the projects, syringe exchange injection kits are spread among users, including: syringe, sterilised water and alcohol swaps (to clean the spoon). Collaborators of the project also distribute baking soda (for cooking base-cocaine) and make users sensitive to base-cocaine. A handbook for syringe exchange programmes was developed about e.g.: the legal framework, good practice, infectious diseases, health problems related to injecting and alternative ways of using (Windelinckx, 2005).

Over the whole Flemish community, 237 023 syringes were distributed and 239 452 were given back in 2003. In 2004, 309 666 were given and 306 594 were brought back (Windelinckx, 2005).

In the French Community, needles exchange programmes are available in 5 cities (Brussels, Charleroi, Liège, Dinant, Arlon).

More than 250 000 syringes have been distributed in 2004 through needles exchange programmes within the French Community (Fabienne Hariga, Personal Communication). According to cities, one can observe completely opposite trends. In Liège, since 2001, the number of needles distributed has decreased while in the other cities it has increased. Currently there is no clear explanation about the decrease in Liège. In 2004, needle exchange projects, both on the street and in services allowed for more than 25 000 contacts with IDUs.

The rate of exchange in 2004 is 103%. In other words more needles were brought back than distributed. Rules of exchanges vary in relation to a city or a service :e.g. in some places strict exchange might be applied (same number of syringes is distributed as the number of brought ones), in other places this rule does not exist.

0 50000 100000 150000 200000 250000 300000 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 Given Syringes Brought back syringes

Figure 5 : Volume of the exchanged syringes, French Community, 1994-2004.

The access to other injection equipment is much lower. For example the number of Stéricups distributed in 2004 in the French Community is about a third of the number of syringes due to the lack of funding. This illustrates the weakness in terms of hepatitis B and C prevention.

Injection kits: Stérifix

Stérifix is a kit containing 2 syringes/needles, water for injection, disinfectant swabs,

information on the risk of transmission by syringe sharing and addresses of HIV screening centres and needle exchange programmes. The package is sold at EUR 0.5 in pharmacies in the French Community. The participation rate in “high risk” areas of Brussels is 30%, but lower in other areas. Promotion of kits is done by drug users within the framework of a participative project.

Table 25 : Number of Sterifix sold by pharmacists in the French Community,

2000-2004.

2000 2001 2002 2003 2004

N injection kits 14493 12083 14000 15925 23425

Prevention of HIV/hepatitis in prison

There is no access to safe injection equipment, nor to disinfectant, limited access to condoms and no access to lubricants. Sentenced prisoners can ask for hepatitis B vaccination.

Prevention of sexual transmission: all harm reduction projects have a component on

safe sex and provide condoms (lubricants).

Prevention of hepatitis C transmission through “sniffing” drugs

Sniffing kits are available in limited number in some harm reduction projects in recreational settings. These kits contain an information flyers and a straw.

Hepatitis B immunisation is poorly available, as intravenous drugs users are not

identified as a priority group for hepatitis B immunisation policy. Therefore, the high costs of the vaccines make its access low. Programmes of vaccination against hepatitis B are developed but only target children.

The results of the snowball peers project indicate that the immunisation rate against hepatitis B among IDUs is very low and varies from 14% for recent IDUs (less than 2 years) up to 18% among all IDUs (Hariga 2005 Personal Communication).

Information brochures

In the French Community, the NGO Modus Vivendi is responsible for the HIV/Aids prevention activities specifically targeting drug users and then develop and disseminate information material:

- about Aids;

- time table flyer with the addresses of the different needles exchange programmes;

- brochure “Shooter propre”, targets intravenous drug users and provides information on how to inject safely;

- brochure “A,B,C des hépatites”: information brochures for drug users on hepatitis prevention.

These brochures are distributed through peers prevention projects (snowball), specialised ambulatory treatment centres and needles exchange programmes, in some prisons and finally by a limited number of pharmacists. In addition, a Flyer “sniff” (see kit sniff), is distributed in recreational settings.

Other HIV and hepatitis C prevention activities

A small brochure ( “Vous êtes en contact avec des seringues usagées”) targeting staff of public parks, police or any professional who might be in contact with used syringes in public areas was published. The objective is to inform them objectively on the risks of contamination, on how to prevent accidental punctures and how to react in case of accidents.

Peers prevention project

The ‘Operation Boule de neige’, is a peers prevention project, concerns HIV, hepatitis and other drug-related risks and aims at reaching, through a snowball methodology, specific groups not easily accessible. (Ex)-drug users in short-term contracts ('jobist'), training them on HIV, hepatitis or overdoses prevention. After their training, the “jobists” go back to the “ drug scene ” to contact drug users, diffuse their prevention messages and material and recruit new candidates jobists. The jobists are assisted in their work by a questionnaire, used also to collect data on patterns of use and attitudes. Evaluation of each intervention is made with the “jobists” and is both collective and individual. About 1500 drug users, mainly IDUs are reached every year in the French Community.

In 2002, with the support of EC-DGV, the project “Euro Boule de neige” was transferred to Finland, Greece, Italy, Portugal, Spain, and Slovenia.

Due to the lack of funding, and despite its positive evaluation, the pilot snowball project in prison implemented in 2002 and 2003 was not extended in 2004.