ACTION FOR HEALTH PROMOTING SCHOOLS IN RURAL CAMBODIAN
Cambodia is one low-income country in Asia. People get up early at 5:00 in the morning with the rising sun. The big family happily eats breakfast together. After eating breakfast, they work in vast green rice fields. This is a small story of a health-promoting school program (HPSP) in rural Cambodia.
Beginning in 2001, Earthly Health Cantata (EHC), a small, nonprofit Japanese agency, introduced a school-based oral health program in the Puok district. We consist of a variety of volunteers from many fields including teachers, nurses, doctors and economists. In addition, in 2005, this program evolved into a comprehensive school health program in cooperation with the Ministry of Education Youth and Sports (MOE) in Cambodia.
When we stated the HPSP, we shared our idea with schools and health centers of the District. A school is an efficient place for all members of the school sector, health sector and community sector to work together to promote and protect the health of all individuals, from schoolchildren to community members. Then, we introduced the school health framework and assessment tool of HPSP. The assessment tool consists of five components with a total of 76 checklist items. The five components are: Personal Health Life Skills, Healthy School Environment, Health and Nutrition Services, Common Disease Control and Prevention, and School and Community Partnership.
In the initial work conducted from November to December in 2005, nine cluster principals and nine nurses interviewed 40 school principals and 600 schoolchildren and observed 40 schools’ conditions to understand baseline situations. After assessing the school conditions, 23 school principals, including the nine cluster principals, and the nine nurses developed school health action plans. In August 2006, the school principals and nurses evaluated and discussed the solutions to improve their plans. Regarding effective plans, over 70 percent of plans were implemented to create educational classes and encourage schoolchildren. In order to improve ineffective plans, the school principals have focused on improving parents' participation and the physical environment, and developing school policies in cooperation with the ministry of education.
In December 2006, the program was implemented in two rounds for assessment of school conditions and development of school health action plans by the 40 school principals and the nine nurses. In August 2007, those plans were reevaluated by the same members. Because of its success, this program will be sustained and expanded in other districts. If you are interested in this program, please feel free to contact me.
Emiko Koito Shidara, DDS, at koito@med.kawasaki-m.ac.jp
INSPIRING PEOPLE, STRENGTHENING COMMUNITIES
World Neighbors, an international development organization working in 18 countries in Asia, Africa and Latin America, has developed a unique integrated approach to HIV/AIDS in its East Africa (Kenya and Tanzania) program. Our first program focus is on dissemination of information and support. We do this in the following ways:
- Training of Community Health Workers (CHWs) on HIV/AIDS.
- Working collaboratively with Ministry of Health (MOH) on the trainings .
- Revision of the MOH curriculum.
- Work directly with people living with HIV/AIDS (PLWHA)1, helping with farming and agriculture.
- Working with a theatre group of young people, providing information on prevention, testing, care and support with drama, dance and music.
Our second program focus is working with and training home-based caregivers who are community volunteers certified by the government. These caregivers provide:
- Care for PLWHA.
- Counseling and moral support.
- Support with ADLs.2
- Training for family caregivers.
- Assurance that the PLWHA are getting adequate care (nutrition, medical, rest, etc.).
- Dispense minor medication (pain medication, antibiotics).
- Wound dressing, referrals to hospital, and mobilization of the community regarding transport.
Our third program focus is support for people living with HIV/AIDS, including the following:
o Receive psychological support from the group.
o Share experiences as PLWHA.
o Visit each other.
o Support each other, family members and community members to getting tested.
- Initiate income-generating activities (IGAs).3
o Light scale farming along with community health workers.
o Plant fertilizer trees – these are planted to help loosen the soil to make it easier to plant. The people living with HIV/AIDS have reduced energy to farm, so this helps them.
o Jump planter – a planting mechanism that allows the person to plant seeds while standing since leaning over is difficult if you are not feeling well.
o Sell produce; get cash to buy ARVs4 (they are not free in all places) and to buy food.
o Basket weaving and horticulture.
o Set up kitchen gardens – help to till the land, provide seeds, plant and harvest.
o Integrated approach between agriculture and health (the health coordinator identifies healthy foods, food preparation, need for clean water and the agriculture coordinator assists with planting, seeds, soil, irrigation, etc.).
o Provide dairy goats so they’ll have the milk to boost their immune system.
o Establish fruit farms (orchards), especially guava.
o Lessons on nutrition based on local available foods.
HIV/AIDS is a crosscutting theme. It is integrated in all sectors of our work (agriculture, health, economic development, gender, capacity building). Helping people living with HIV/AIDS to be healthy requires nutritious food, clean water, access to care and treatment and support.
1 PLWHA – People living with HIV and AIDS
2 ADLs – Activities of daily living
3 IGAs – Income generating activities
4 ARVs - Antiretrovirals
-- Linda Jo Stern, MPH, E-mail: ljstern@wn.org
-- Ruth Okowa, MA, E-mail: rowoka@wneastafrica.org
GICUMBI, RWANDA - PERFORMANCE-BASED FINANCING OF HIV SERVICES NETS IMPROVED RESULTS WITH REDUCED SERVICE COST
USAID and PEPFAR are collaborating with the MOH in Rwanda to roll-out the national performance-based financing initiative to improve access to and quality of HIV services. The system assures resources are available to contribute to service costs and also pays a performance bonus to health facilities, rewarding both outputs and efficiency.
Paying a performance bonus for HIV services is an attractive proposition from multiple angles. The health facility gains discretionary income that managers can use to increase staff motivation (individual performance bonuses) or for improving infrastructure. Communities benefit from better access to improved services. The health system benefits from both reduced per-service costs and enhanced leverage over quality (since service data are validated as a condition of the program). For PEPFAR (or any donor sponsoring such a program) we have shown in Gicumbi district that an input financing investment (the cost of supporting CAs ‘maintenance’ of support to HIV service sites) has garnered a higher quantitative result and a greater efficiency of PEPFAR resource use in reaching its own output goals. In addition there is a constant stream of health returns due to earlier diagnosis and treatment (VCT being the port d’entrée into HIV services) and better-targeted palliative care.
Return on PEPFAR investment: The USG paid a standard of $10,000 for annual maintenance of a ‘mature VCT site’ in June 2005 in the Gicumbi District, which produced 3,008 tests for Mukono, Rutare, Rwesero and Munyinya health centers. The cost to USG was $13.30 per test (4*10,000)/3,008). The cost to the provider was $4.68 excluding the HIV test.
Performance-based financing's impact has been dramatic. For instance, in just nine months of 2006/7 these health centers increased the production of VCT tests by 155 percent (on average) to 7,670. All other things kept equal, the USG will have paid less than $6.14 for each VCT test in Gicumbi (4*10,000/7,670). In terms of payment for results, this is a saving of $7.16 per VCT test (over 53 percent)!
It would only have taken 18 percent increase in the number of VCT tests in Gicumbi district for the investment in performance-based financing to ‘break even’ (totally neutralizing the cost of the program itself). Beyond that increase, the additional 137 percent improvement in performance has been free… every single incremental unit of VCT production has simply lowered the cost of a VCT test!
--Gyuri Fritsche, E-mail: gfritsche@msh.org;
--Thomas McMennamin, E-mail: tmcmennamin@msh.org
--David Collin, E-mail:E-mail: dcollins@msh.org
--John Pollock, E-mail: jpollock@msh.org
SURGICAL BURDEN OF DISEASE: A GLOBAL PUBLIC HEALTH CRISIS
The World Heath Organization’s Global Burden of Disease (GBD) text has become the definitive scientific account and principal framework for integrating, analyzing, and quantifying the impact of diseases, injuries, and risk factors on population health globally and by region. Its comprehensive approach has made the GBD the most relevant document for health policy and strategic planning purposes, often used to argue for allocation of resources where they are most likely to yield the greatest good. The beginning of the 21st century celebrated, for the developed world, an end to inevitable death from communicable disease and major public health advancements.
The leading burden of disease for the developed world is now non-communicable chronic disease (1). Historically, before antibiotics, surgery was a dominant force in saving lives by removing the offending part. With concomitant advances in technology, many of these chronic diseases are known to have surgical cures or treatments. Even HIV/AIDS may be impacted by surgery (2). But the promises of such public health advances have not been realized in the developing world, where basic surgical care and reproductive health care including routine access to Caesarean section coverage is often a distant luxury. Focus on emergency and essential surgery (3) by the WHO and other organizations, is bringing attention and, hopefully, resources to the issue, but the lack of access to surgical care is an overwhelming reality in much of the world.
The impact of surgery in public health and the burden of disease has gained renewed attention among many providing medical aid and intervention in the developing world. Recent WHO data and a World Bank publication, estimated as DALYs, suggests that 50 percent of diseases leading to death, including cardiovascular disease, maternal conditions, trauma, cancer, chronic illness and some infectious diseases, may be impacted by surgical intervention (4,5).
The worldwide surgical community has responded both in the literature (4, 6-11), and in organizing and promoting aid in the provision of surgery to underserved areas. Several academic institutions have received grants to study problems of surgical access and provision of care. With support of the Rockefeller Foundation, UCSF, in partnership with the World Bank, held an initial working group in Bellagio, Italy in June 2007 to explore the crisis situation brought about by lack of surgical access in sub-Saharan Africa.
The supporting infrastructure that allows surgical care to be practiced in these countries is also in crisis. “Health worker” shortages are at critical levels in many countries (1), especially where surgeons and anesthesiologists are so rare that programs are compelled to train “non-physician clinicians” (NPCs) to be the principal providers of basic surgical and anesthetic care. (11-14).
Surgeons and anesthesiologists have long understood the importance of the knife in public health. The time has come for surgical burden of disease to be recognized as a critical risk to global public health. Unfortunately, such awareness and recognition must come before any resources will be mobilized to support basic access, infrastructure, personnel, education, training, and materials for these desperate countries. Support of this concept by public health organizations, international donors, academic institutions and humanitarian aid and development organizations must first meet the existing emergency requirements of this crisis. However, it is crucial that the surgical community remain a strong ally and advocate if long-term solutions will be realized. If not, such neglect will simply erase any semblance of advancement that may have once appeared in the Global Burden of Disease framework.
--K A Kelly McQueen, MD, MPH
--Frederick M Burkle, MD, MPH
References:
- World Health Organization. The World Health Report 2006: Working together for health. Geneva, WHO. http://www.who.int/whr/2006/en/index.html. Accessed Sept. 5, 2007.
- Quarraisha AK. Prevention of HIV by male circumcision. BMJ. 2007; 335(7609):4-5.
- World Health Organization. Global Initiative for Emergency and Essential Surgical Care. Geneva, WHO. http://www.who.int/surgery/en. Accessed Sept 20, 2007.
- Debas, HT, Gosselin R, McCord, M, et al. Surgery. Disease Control Priorities in Developing Countries. World Bank. 2006: 1245-59.
- World Health Organization. World Health Report 2005: Make every mother and child count. Geneva, WHO. http://www.who.int/whr/2005/en/index.html. Accessed Sept. 5, 2007.
- Debas, HT. Surgery: A Nobel Profession in a Changing World. Annals of Surgery. 2002; 236(3):263-69.
- Massey B, Howard A. The Burden of Othopaedic Disease in Developing Countries. Journal of Bone and Joint Surgery. 2004:86A(8) 1819-22.
- Duda RB, Hill AG. Surgery in Developing Countries: Should surgery have a role in population-based healthcare? Bulletin of the American College of Surgeons. 2007; 92(5):12-19.
- Schecter WP, Farmer D. Surgery and Global Health: A mandate for training, research and service – A faculty perspective from UCSF. Bulletin of the American College of Surgeons. 2006; 91(5): 36-8.
- Ozgediz D, Roayaie K, Wang J. Surgery and global health: The perspective of UCSF residents on training, research and service. Bulletin of the American College of Surgeons. 2006; 91(5): 26-35.
- Spiegel DA, Gosselin RA. Comment: Surgical services in low-income and middle income countries. Lancet 2007; 370:1013-1015.
- Hodges SC, Mijumbi C, Okello M et al. Anaesthesia Services in Developing Countries: Defining the problems. Anaesthesia. 2007; 62:4-41.
- American Society of Anesthesiologists. Overseas Teaching Program. http://www.asahq.org. Accessed Sept. 19, 2007.
- Mullan F, Frehywot S. Non-physician clinicians in 47 sub-Saharan African Countries. Lancet. 2007; DOI: 10.1016/S0140-6736(07)60785-5.
CHANGING DYNAMICS OF HIV/AIDS IN THAILAND
The complexity of preventing and treating AIDS is exacerbated by the multiple and intertwined social, economic, political, and cultural forces that shape and divide the epidemic into sub-groups that require specific interventions based on these forces. Out of the approximate 40 million people with HIV/AIDS, an estimated 18 million are women (UNAIDS 2004). In some regions, commercial sex workers are an important mode of transmission.
The Thai sex industry is striving to recruit younger girls from villages who are perceived to be safe from the AIDS epidemic. Young girls are at a higher risk for HIV infection due to their physiological immaturity (Human Rights Watch 2004). After the initial period in which virgin girls and women are sold to a few men, the number of customers may rise to 10 or 15 a day (Human Rights Watch 2004). Clearly, the increase of men equals the increased chance of infection. Also, these girls lack the power to negotiate the terms of the sexual interaction and even the use of condoms. The official Thai AIDS prevention programs heavily rely on the use of condoms; however, this propaganda becomes almost irrelevant when workers are unable to negotiate the terms of the contract, the use of condoms, and even the number of customers.
The tourist industry is also a large factor in this complex problem. Just one province in Thailand is a multi-billion dollar multinational sex industry (CATW 2004) and approximately $12-$15 billion per year of Thailand’s GDP is through the prostitution industry (Beadle 2003). AIDS education in the official media was also banned by the government, but a nationwide AIDS program began in 1991 (Nakashima 2004).
Thailand registered a drop in annual new infections from an estimated 143,000 to about 19,000 from 1991-2003 (Nakashima 2004). Despite these encouraging numbers, approximately 12 percent of commercial sex workers are still infected, and HIV is beginning to spread to the general population (Nakashima 2004).
Whereas commercial sex work is still a large factor in the transmission of HIV/AIDS in Thailand, the country is experiencing a new pattern of risky behavior — unsafe injection drug use. A decade ago, approximately one-twentieth of all new HIV cases were occurring through this method; the current estimate is that one-fifth of the new HIV cases are through unsafe injection drug use (Thai Working Group on HIV/AIDS Projections, 2001). Prevention policies must be constantly reassessed as regions and even sub-groups undergo dynamic changes.
References
Beadle, Monique. The Sangha and the Thai Sex Industry. 2003. The Institute for
Global Engagement. Retrieved Sept. 24, 2004, from http://www.globalengagement.org/issues/2003/08/sangha.htm
CATW: The Factbook on Global Exploitation: Thailand. Coalition Against Trafficking in Women http://www.catwinternational.org/fb/Thailand.html
Forced Prostitution and AIDS. Human Rights Watch.
http://www.hrw.org/about/projects/womrep/General-137.htm.
Global Summary of the HIV/AIDS Epidemic. December 2004. Joint United Nations
Programme on HIV/AIDS. http://www.unaids.org/wad2004/EPIupdate2004_html_en/epi04_00_en.htm.
Nakashima, Ellen. “Record Numbers Infected with HIV: U.N. Cites Rapid Rise in Asia
and E. Europe.” July 7, 2004. Washington Post Foreign Service.
http://www.washingtonpost.com/ac2/wpdyn/A302732004Jul6?language=printer.
Nakashima, Ellen. “Thailand’s AIDS battle falters: Anti-AIDS effort, hailed as model
for Asia, loses steam.” July 10, 2004. Washington Post Foreign Service. http://www.msnbc.msn.com/id/5407073/.
--Asma Hussain, MPH, E-mail: Ahussain@nfpmedcenter.org
DIFFERENCES IN MATERNAL AND CHILD/INFANT MORTALITY RATES IN RURAL AND URBAN PAKISTAN
Maternal mortality rates are considered one of the best indicators of women’s health and their quality and accessibility to health services (UNFPA 2005). In Pakistan, this rate is among the worst in the world (ADB 2005).
Pakistan remains a largely rural country, although its urban population is steadily increasing. Approximately 33 percent of the population lives in urban areas (PRC 2004).
Women in urban areas have a literacy rate two times higher than women in rural areas (PRC 2004) and this clearly has an effect on mortality rates. The mother’s education directly affects infant mortality rate — the higher her education, the less chances of infant mortality occurring (Ali 2001). Zahid (2004) also concluded that the mother’s education and her age at the birth of the child are strongly correlated with neonatal and infant mortality. However, a difference occurs when location is considered. Acquisition of primary or less education by urban mothers brings a substantive decrease in the incidence of child mortality; however, rural women with the same level of education do not produce much change in child mortality (Ali 2001). Women in rural areas must acquire higher education in order to bring a visible decrease in child mortality (Ali 2001).
According to Ali’s study of the variables that affect maternal and child mortality, 39 percent of rural women who were married at younger than 16 years of age reported at least one death of her child, whereas 27 percent of urban mothers reported the same. For every age at marriage category (<16, 16-18, 19-21, 22+), rural mothers reported a higher percentage of at least one child death. Despite the fact that women are the same age when they get married, their chances of having at least one child die is greatly affected by whether they reside in an urban or rural area.
The total percentage of women in urban areas who experienced one child death — after calculating age at marriage, current work status, educational status, poverty rate, crowding, and SES — was 21.79 percent, whereas this percentage jumped to 29 percent for women in rural areas (Ali 2001).
In Pakistan, one researcher offered the following account: “I asked a group of health workers in a village how many mothers they would expect to die out of 100 births, and one doctor responded with 10 or 15. I asked if he thought this was too much and he said no, this was to be expected.” (UN-OCHA 2005).
References
Ali, Mubashir Syed. Poverty and Child Mortality in Pakistan( 2001) Pakistan Institute
of Development Economics. http://web.idrc.ca/uploads/user-S/10281438670mimap23.pdf.
Country Assistance Plans-Pakistan (2005) Asian Development Bank.
http://www.adb.org/Documents/CAPs/PAK/0103.asp.
Demographic Profile of Pakistan. Population Resource Center (2004)
http://www.prcdc.org/summaries/pakistan/pakistan.html.
Pakistan: Special Report on Maternal Mortality (2005) Irinnews.org. United Nations
Office for the Coordination of Humanitarian Affairs. http://www.irinnews.org/print.asp?ReportID=35704.
Zahid, Mustafa. Impact of Maternal Education and Health Related Behaviors on
Infant and Child Survival in Pakistan. University of Western Ontario. London, Ontario. www.canpopsoc.org/2004/secure/Zahid.ppt.
--Asma Hussain, MPH, E-mail: Ahussain@nfpmedcenter.org
STRUCTURAL ADJUSTMENT PROGRAMS AND THEIR EFFECTS ON INCREASING POVERTY, HIV/AIDS
In the early 1980s, the International Monetary Fund and World Bank created structural adjustment programs (Werner, Sanders 1997), designed to assist countries during economic hardships. In order to qualify for loans, poor countries had to comply with the requirements of the northern market system (Werner, Sanders 1997). Components of the structural adjustment programs include sharp cuts in public spending on education and health; privatization of public services; and the devaluation of the local currency (Werner, Sanders 1997).
Structural adjustment programs have serious consequences. In countries with these policies, the majority of citizens have seen their real earnings cut in half, while the consumption of the wealthiest citizens has increased (Samir 1993). The World Bank and the IMF claim that an increase in poverty in most of the countries that have adopted structural adjustment programs could have just as easily occurred without these programs (Werner, Sanders 1997). Werner and Sanders (1997) compare this claim to one made by the tobacco industry that there is no proof that smokers who die of heart disease would not have otherwise perished if they had not consumed the tobacco products.
In 1995, a controversial article titled “Socioeconomic Obstacles to HIV Prevention and Treatment in Developing Countries: The Roles of the International Monetary Fund and the World Bank” was published in the British journal AIDS (James 1995).
The article focused on four main consequences of structural adjustment programs that the authors believed to be central to the increasing rates of HIV/AIDS (James 1995). First, rural farmers are forced to leave their families in search of work in cities due to the decline of the rural subsistence economy. There, they are more likely to contract HIV and have a worse nutritional status, which then increases vulnerability to HIV (James 1995). Second, the development of a transportation infrastructure increases the chances of infection, for HIV is easily spread along truck routes (James 1995). Next, migration and urbanization result in increased chances of men having multiple sex partners and since women are generally financially dependent on their husbands, they are less likely to negotiate safe sex when their partners return (James 1995). Lastly, structural adjustment programs decrease spending on health (James 1995). Such programs have been responsible for a 56 percent increase of maternal mortality deaths in northern Nigeria (James 1995).
Clearly, even with the negative consequences of structural adjustment programs, these programs are implemented. The World Bank and IMF require a profound transformation of their policies and vision.
References
James, John, World Bank in AIDS Prevention Controversy (1995) AIDS.ORG. http://www.aids.org/atn/a-225-14.html.
Samir, Amin. “Don’t Adjust—Delink!” April/May 1993. Toward Freedom.
Werner, David and David Sanders. Questioning the Solution: The Politics of Primary Health Care and Child Survival with an In-Depth Critique of Oral Rehydration Therapy. 1997. HealthWrights. Palo Alto, CA.
--Asma Hussain, MPH, E-mail: Ahussain@nfpmedcenter.org
TEACH OR SELL THE KNOWLEDGE? THE BATTLE BETWEEN COMMERCIAL AND HOME ORAL REHYDRATION THERAPY
The field of international health experienced a revolutionary breakthrough in the early seventies with the advent of oral rehydration therapy (ORT), a simple mixture of water, salt, and sugar that enabled families to replenish their dehydrated children. ORT decreased the number of children younger than five dying of diarrhea by 60 percent between 1980 and 2000 (JHBSPH). Despite its success, financial considerations have played a crucial role in its administration.
There continues to be a battle between those who advocate a bottom-up approach that ORT should be taught to the poor to enable them to treat diarrhea on their own. Strongly opposing them is the top-down belief held by international agencies that ORT packets are “developed and tested by highly qualified doctors, chemists, and physiologists” and that poor families do not have the knowledge to carefully mix the correct amount of sugar and salt.
Despite the research supporting ORT, this method only received wider recognition for its potential when the information in the reports was put to practical use. In 1962, Bangladesh was hit by a cholera epidemic, and desperate doctors in one hospital began administering the same solutions that were in the drip by mouth (Werner 35). They received stunning results by being able to rehydrate a greater number of people and reported a death rate of near zero, as compared to 27 percent and 47 percent in other hospitals (Werner 35).
In the early years of campaigns, packets of ORT were manufactured in industrialized countries and distributed free of charge in developing countries. However, with cutbacks in budgets, distribution became commercialized. Erroneous marketing also led mothers to believe that the ORT packets are a medicine. Thus, mothers administered the solution in small portions, preventing the dehydrated child from receiving adequate amounts of fluids. There is a lack of ORT packets even in areas where they are aggressively marketed.
Apart from the lack of access, cost is another issue. In its 1994 State of the World’s Children Report, UNICEF commented, “A quarter of a century has now passed since its discovery…the technique is virtually cost free” (Werner 49). On the contrary, a study in rural Bangladesh found that the cost of a commercially produced ORT packet was seven times greater than that of a liter of a home ORT solution (Islam). Seven times greater. The cost difference here undoubtedly equals the difference between life and death.
References
Islam, M.R. Common Salt and Brown Sugar: Oral Rehydration Solution in the Treatment of Diarrhea in Adults.
New Formula for Oral Rehydration Salts Will Save Millions of Lives (2002) World Health Organization http://www.who.int/inf/en/pr-2002-35.html.
Prologues of Public Health.” John Hopkins Public Health (2003) http://www.jhsph.edu/Magazine/prologue/page3.html.
Werner, David, David Sanders, Jason Weston, Steve Babb, Bill Rodriguez (1977) Questioning the Solution: The Politics of Primary Health Care and Child Survival with an In-Depth Critique of Oral Rehydration Therapy. California: Healthwrights
--Asma Hussain, MPH, E-mail: Ahussain@nfpmedcenter.org
THE EFFICACY OF NEEDLE EXCHANGE PROGRAMS: IMPLEMENTING LESSONS LEARNED FROM AUSTRALIA
Injecting drug-users are a high-risk population who face the possibility of contracting blood-borne illnesses. In order to help reduce their harm, needle exchange programs (NEPs) are on the rise — programs in which drug users can exchange a dirty needle for a clean one. Although such programs cause much controversy, they are evidence-based reduction strategies.
The major argument against the development of NEPs is that providing needles to drug users “undercuts the credibility of society’s message that drug use is illegal and morally wrong” (Bertram 1996). NEPs are viewed as a temporary solution to a social crisis that demands a permanent end.
These allegations have been countered with strong evidence for the efficacy of NEPs. The premise of such programs lies on the notion of harm reduction or minimization (CAPS 1993). In a study conducted in the Netherlands and Australia in the mid-1980s, health officials found that NEPs were an effective means of reducing the incidence of blood-borne diseases (Martin 2005). In 2002, health officials from Australia released a report assessing the 10-year investment of NEPs, titled “Return on Investment in Needle Exchange and Syringe Programs.” The report — in which researchers examined a total of 778 combined years worth of data from 103 cities worldwide — estimated that NEPs resulted in the avoidance of 25,000 HIV cases in Australia (Martin 2005). Researchers used the data from the Australia report and found that state and federal governments spent $72 million to implement NEPs but they saved $1 billion in long term HIV and Hepatitis C costs alone (JTO 2002).
Opponents of NEPs also argue that these programs will result in an increase of discarded needles which could subsequently harm others (CAPS 1993). According to CAPS (1993), NEPs in the United States have not been shown to increase the total number of discarded syringes.
Despite all the evidence supporting needle exchange programs, the fact that only one legal needle exchange program exists in the state of Ohio demonstrates that public opinion still may be a far more powerful force in shaping policies.
References
Bertram, E, Blachman, M, Sharpe, K, Andreas, P. “Drug War Politics—The Price of Denial (1996) Berkeley, University of California Press. Retrieved April 10, 2005 from http://www.bakerinstitute.org/Pubs/wp_needles.pdf.
Center for AIDS Prevention Studies (CAPS). The Public Health Impact of Needle Exchange Programs in the United States and Abroad (1993) School of Public Health, University of California, Berkeley; Institute for Health Policy Studies, University of California, San Francisco. Retrieved April 8, 2005 from http://www.caps.ucsf.edu/publications/needlereport.html.
Martin, William. Needle Exchange Programs: Sending the Right Message (2005) James A. Baker III Institute for Public Policy, Rice University. Retrieved April 8, 2005 from http://www.bakerinstitute.org/Pubs/wp_needles.pdf.
25,000 New HIV Cases Prevented Via Australia’s Needle Program (2002) Join Together Online (JTO), Boston University School of Public Health.
http://www.jointogether.org/sa/news/summaries/reader/0,1854,554927,00.html.
--Asma Hussain, MPH, E-mail: Ahussain@nfpmedcenter.org