| dc.creator | Bastos, Francisco Inácio Pinkusfeld Monteiro | |
| dc.creator | Strathdee, Steffanie Anne | |
| dc.date | 2010-08-23T16:58:31Z | |
| dc.date | 2010-11-04T14:19:50Z | |
| dc.date | 2010-08-23T16:58:31Z | |
| dc.date | 2010-11-04T14:19:50Z | |
| dc.date | 2000 | |
| dc.date.accessioned | 2023-09-26T21:15:18Z | |
| dc.date.available | 2023-09-26T21:15:18Z | |
| dc.identifier | BASTOS, Francisco Inácio Pinkusfeld Monteiro; STRATHDEE, Steffanie Anne. Evaluating e efectiveness of syringe exchange programmes: current issues and future prospects. Social Science & Medicine, v. 51, p. 1771-1782, 2000. | |
| dc.identifier | 0277-9536 | |
| dc.identifier | https://www.arca.fiocruz.br/handle/icict/612 | |
| dc.identifier.uri | https://repositorioslatinoamericanos.uchile.cl/handle/2250/8871572 | |
| dc.description | The authors gratefully acknowledge Dr. T. Valente who provided a critical review of the manuscript and Ms. T.O. Johnson who assisted in manuscript preparation. They thank also Drs. Nick Crofts (Australia)and Fernando Marques (Brazil) for the unpublished
information they kindly provided. FIB is partially supported by a National Research Council (CNPq) salary grant (IIA) and is a recipient of an award scholarship from Rio de Janeiro Research Council (FAPERJ). | |
| dc.description | Although a large body of international literature has found syringe exchange programmes (SEPs) to be associated with reduced incidence of blood borne pathogens among injection drug users, recent studies have fuelled controversy surrounding SEP e ectiveness. Existing studies are observational in nature and have seldom considered ecologic aspects a ecting SEP functioning and evaluation. The authors apply concepts from infectious disease
epidemiology to discuss the direct and indirect e ects of SEP upon the spread of blood borne pathogens in drug users, their social networks and the broader community. Further, the authors discuss social policies, particularly drug control policies, which have directly and/or indirectly limited SEP functioning at local and national levels. A
critical review of the literature suggests that biases common to observational studies can account for higher HIV incidence among SEP attenders relative to non-attenders. Strong selection factors often lead high-risk drug users to be over-represented among SEP attenders. Failure to account for these factors and the indirect e ects of SEPs can
bias interpretations of programme e ectiveness. Future SEP evaluations should consider behavioural data, the local
ethnographic context, the prevalence of infectious disease in the groups under study and the structural components of SEP that are most and least e ective at reducing incidence of blood borne pathogens. Hierarchical models that take into account the ecological dimensions of SEP are recommended as an approach for future studies. Beyond
methodologic concerns, the authors discuss social, legal and programmatic obstacles that must be overcome in order to maximise SEP e ectiveness. | |
| dc.format | application/pdf | |
| dc.language | eng | |
| dc.publisher | Elsevier Science Ltd | |
| dc.rights | open access | |
| dc.subject | Syringe-exchange programmes | |
| dc.subject | Injecting drug users | |
| dc.subject | HIV | |
| dc.subject | Blood borne infections | |
| dc.subject | Epidemiology | |
| dc.subject | Ecological studies | |
| dc.title | Evaluating e ectiveness of syringe exchange programmes: current issues and future prospects | |
| dc.type | Article | |
