NDARC Technical Report No. 102 (2001)
The first Needle and Syringe Program started illegally in New South Wales in 1986 after two years of discussion (Wodak, et al., 1987). It was largely implemented as a community health measure to prevent the spread of HIV between injecting drug users and the wider community (Feachem, 1995). It is generally agreed that NSPs have fundamentally altered the course of Australia’s AIDS epidemic (UNAIDS, 1999). For example, Needle and Syringe Programs were estimated to have prevented around 2,900 infections of HIV in 1991. In that year, $10 million was spent on Needle and Syringe Programs nationally, producing an estimated saving of $266 million in treatment costs (Hurley, et al., 1996).
Despite this, many misconceptions exist surrounding the rationale and role of Needle and Syringe Programs. As a response, a Needle and Syringe Information Kit was produced. This report provides an evaluation of that Needle and Syringe Information Kit.
The Information Kit contained four documents. An introductory letter from Mr Chris Puplick, chairman of the Australian National Council on AIDS, Hepatitis C and Related Diseases (ANCAHRD), gave a brief outline of the aims and purpose of the Information Kit (Appendix A).
A 28-page booklet entitled Needle and Syringe Programs: A Review of the Evidence (Dolan, et al., 1999) provided a detailed review of the scientific evidence for and against Needle and Syringe Programs. It was presented in a question and answer format and addressed crucial questions regarding the value and effectiveness of NSPs (Appendix B).
An 18-page booklet entitled Needle and Syringe Programs: Your Questions Answered (Dillon & Dolan, 1999) addressed frequently asked questions about Needle and Syringe Programs and provided a summary of scientific evidence in a non-technical, quick-reference format. It also addressed issues relevant toprofessionals who may receive inquiries from the media and the general public.These included how best to dispose of discarded syringes, how to deal with a needle-stick injury, how to respond to media questions about NSPs, and advice and referral contact details related to injecting drug use (Appendix C).
A questionnaire used to evaluate the Kit’s utility in communicating relevant information about NSPs, Evaluation of Needle and Syringe Program Information Kit was also included (Appendix D).
Just over 12,000 Needle and Syringe Program Information Kits were mailed to key stakeholders and potentially interested individuals. Recipients included all Australian federal and state parliamentarians and local councillors, as well as public servants, environmental health officers, needle and syringe workers, alcohol and other drug workers, and pharmacists.
The response rate for the ‘fax-back’ questionnaire was 0.9%, with 107 forms returned by the specified date. Generally, all targeted occupations and locations were represented. The majority of respondents reported finding the information in the Kit to be “useful”, “easy to understand”, “comprehensive”, “valid and accurate” and to “improve their knowledge” about NSPs.
Looking at attitudes towards Needle and Syringe Programs, eighty percent of respondents stated that they still supported needle and syringe programs after reading the Kit. Seven percent indicated that they still opposed such programs and 5% of respondents reported still being undecided. Of the respondents who indicated a change in attitude towards NSPs, 5% stated that they now support NSPs, and 1% (one person) stated that they now oppose them. No one reported that after reading the Information Kit they had become undecided about their position on NSPs. This result may indicate that the Information Kit did not confuse respondents about NSPs.
Respondents were also given an opportunity to make comments. Overall, 57% of respondents (n = 58) made some comment about the booklet or NSPs. Of these, 54% were considered positive or supportive, 23% were considered negative or critical and 23% were neutral. A complete list of comments can be found in Appendix E.
A major limitation of this study was the very low Evaluation Form response rate. As stated, the response rate was 0.9%. In contrast, the average response rate for postal surveys is typically around 50%. Reasons for this low response rate and possible methodological improvements are discussed.
The small sample size of this evaluation dictates that caution must be exercised when drawing conclusions due to the possibility of a response bias. Generally however, the results of this evaluation do offer qualified support for the utility of the Needle and Syringe Information Kit consistent with its stated aims and objectives.