2010 National Survey of Syringe Exchange

Programs: Summary of Results

Don C. Des Jarlais, Vivian Guardino, Ann Nugent, Kamyar Arasteh,

David PurchaseThis work was funded by amfAR, The Foundation for AIDS

Research, with support from the Elton John AIDS Foundation and the Irene Diamond Foundation-Tides Foundation.

Characteristics of SEPs Participating in BIMC/NASEN Surveys

United States, 1994-2010Numbers of 199

4-199

5

1996

1997

1998

2000 2002

2004

2005

2006

2007

2008

2009

2010

SEPs known to NASEN

68 101 113 131 154 148 174 166 188 186 184 201 194

SEPs Participating in survey (%)

60(88%)

87(86%)

100(88%)

110(84%)

127(82%)

126(85%)

109(63%)

118(71%)

150(80%)

131(70%)

123(67%)

149(74%)

147(77%)

Cities with SEPs participating

44 69 78 77 98 97 88 90 113 100 98 115 119

States with SEPs participating *

21 29 33 33 36 32 32 29 32 31 30 33 33

Syringes exchanged (millions)

8.0 13.9 17.5 19.4 22.6 24.9 24.0 22.5 27.6 29.5 29.1 33.1 35.5

Total of SEP budgets ($, millions)

6.3 7.3 8.4 8.6 12.0 13.0 11.6 14.5 17.4 19.6 21.3 21.6 21.7

Total of SEP budgets in 2010-adjusted $ (millions) (adjusted using a constant 3% annual inflation rate)

9.1 10.4 11.7 11.7 15.6 16.1 13.7 16.7 19.5 21.4 22.6 22.2 21.7

Public funding as % of total SEP budgets 62% 62% 67% 69% 74% 67% 76% 74% 79% 73% 79% 80% 82%

* This category includes the District of Columbia and/or Puerto Rico.

Number of syringes exchanged and Total SEP budgets 1994-2010

1994-1995

1996 1997 1998 2000 2002 2004 2005 2006 2007 2008 2009 20100

5

10

15

20

25

30

35

40

Syringes exchanged (millions)

Total of SEP budgets in 2010-adjusted $ (millions)*

*adjusted using a constant 3% annual inflation rate

1994-

1995

1996 1997 1998 2000 2002 2004 2005 2006 2007 2008 2009 20100

50

100

150

200

SEPs known to NASEN and cities with SEPs participating

SEPs Known to NASEN Cities with SEPs participating

National Survey of Syringe Exchange Programs Methodology

2009 Survey• 201 SEPs contacted in first

quarter 2010• 149 SEPs (74%) submitted

completed surveys by early summer.

2010 Survey• 194 SEPs contacted in first

quarter 2010• 149 SEPs (77%) submitted

completed surveys by early summer.

SEP Budget Dollars2009 2010

Total $$$$21,686,7

88$21,674,4

95City Gov $ $5,381,142 $6,021,484

County Gov $ $2,261,688 $2,328,563

State Gov $ $9,768,293 $9,336,118

Foundation $ $3,233,266 $2,127,053

Individual Donations $536,333 $833,686

Out-of-pocket $ $41,959 $29,830

NASEN $ $45,609 $67,116

CBO Donation $ $2,059 $27,410

Corporate Donation $ $38,084 $57,350

Other $ $378,355 $563,906

Budget Status 2009 vs. 2010

Increased Budget

Decreased Budget

Same Budget

Didn't Answer

0

10

20

30

40

50

60

70

26

53

60

10

40

54 47

8

2009

2010

Nu

mb

er

of

SE

Ps

SEPs That Participated in 2009 & 2010 Surveys

Total Budget $$

2009 $20,045,912

(as reported

by 115 SEPs)

2010 $18,889,998

(as reported by 115 SEPs)

Types of Areas SEPs Are Located In

United States, 2009-2010

Rural

Subu

rban

Urb

an

On a

Reser

vatio

n

Didn'

t Ans

wer

0

20

40

60

80

100

120

3117

98

0 3

33

13

97

1 5

20092010

Nu

mb

er

of

SE

Ps

Gender Distribution of NSEP Participants in 2010*

Male64%

Female35%

Transgender1%

Gender

*Weighted by the number of syringes distributed

Ethnic Distribution of NSEP Participants in 2010*

Other 1%

Asian/Pacific Islander2%

Native American2% Biracial/Mixed

5%

Hispanic17%

African American19%

Caucasian55%

*Weighted by the number of syringes distributed

Silicone

Steroids

Other amphetamine (uppers/Dexedrine)

HIV medications and/or insulin

Cocaine mixed w/other drug NOT heroin

Other

Heroin mixed w/other drug (not cocaine)

Downers (benzodiazepines, tranquilizers)

Other opiates (OxyContin, Percodan, etc)

Methamphetamine (crystal meth/ice/crank)

Cocaine by itself

Heroin and cocaine

Heroin by itself

0% 10% 20% 30% 40% 50% 60% 70%

1%

1%

2%

2%

3%

6%

7%

8%

17%

19%

19%

21%

65%

Percent of NSEP Participants Injecting the following Drugs in 2010*

Percent of SEP Participants*Weighted by number of syringes distributed

Type of Heroin Used in 2010As Reported by SEPs

Primarily White Powder: 52

35%

Both White Powder & Black Tar: 37

25%

Primarily Black Tar: 52

35%

Don't Know: 32%

Didn't Answer: 53%

Type of Exchange Conducted by SEPs in 2010

Variation No. (%)

Allowed receipt of more syringes than brought in 123 (83%)

Used Start-up Packs 90 (60 %)Used A Minimum 39 (26%)Used A Distribution Model 76 (51%)

Had a Limit on Syringes Exchanged 36 (24%)

Weekly Exchange Hours @ Regular, Scheduled Times &

Places • 2009 Total of 4,063 hours per

week averaging 27.8 hours per

SEP (n = 146)• 2010

Total of 4,370 hours per week

averaging 30.8 hours per SEP

(n=142)

Number of Syringes Distributed by Syringe Exchange Programs (SEPs), by

Program Size: 2009 & 2010

SEP Size(Syringes

Distributed)

No. of SEP

s2009

Total syringes exchanged

2009

No. of SEP

s2010

Total syringes exchanged

2010

Small(< 10,000)

25 94,611(0.3%) 22

92,316(0.3%)

Medium(10,000-55,000)

39 1,129,493(3.4%) 25

714,320(2.0%)

Large(55,001-499,999)

70 13,011,703(39.3%) 75

12,576,461(35.4%)

Very Large(500,000)

14 18,879,383(57.0%) 18

22,127,202(62.3%)

Total148

* 33,115,190 140 35,510,299* In 2009, one program responding to the survey did not track the number of syringes exchanged, in 2010 nine programs did not indicate the number of syringes they distributed.

Returned/Collected Syringes

2009 2010

30,569,003

29,549,258

Disposal Methods of Collected /Used Syringes in 2010

Private Sani-tation

Arrangement with Local Facilities

Other Syringe Exchanges

Private Doc-tors Or Clinics

Other Places Of Syringe Disposal

95

39

9 6 8

Nu

mb

er

of

SE

P P

rog

ram

s

Syringes Exchanged By Programs That

Participated in Both 2009 & 2010 Surveys2009

(n=117*)• 33,178,581 syringes distributed

• 26,953,212 syringes collected

2010 (n=117*)

• 32,650,380 syringes distributed

• 27,114,420 syringes collected

*Only programs which reported the number of syringes distributed in both 2009 and 2010 are included in the calculations above . In 2009, five programs in this group did not report the number of syringes they collected , the number was seven in 2010.

SEP Usage of Unique Identifiers for Tracking

Individuals in 2010

Used Unique Identi-fier: 88 SEPs59%

Did Not Use

Unique Identi-fier: 60 SEPs41%

Secondary Exchange & Methods of Encouragement Used by SEPs in

2010Secondary Exchange No. (%)

SEPs allowing secondary exchange 133 ( 89%) SEPs encouraging secondary exchange 114 (77%)Methods of Encouragement

Talked about it 104 (70%) Had no limit on syringes exchanged 91 (61%) Gave extra supplies 108 (72%) Provided sharps containers 100 (67%) Enrolled people receiving syringes from secondary exchange

30 (20%)

Peer education 78 (52%) Gift certificates/Other incentives 13 (9%)

OD Prevention with Narcan

Safer Crack Use

OD Prevention without Narcan

Use of Bleach

Dental Dam/Female Condom Use

Abscess/Wound and/or Vein Care

STD and HIV Prevention (other than condom use)

Condom Use

Safer Injection Techniques

Hepatitis (A,B,C) Prevention

0% 20% 40% 60% 80% 100%

51%

54%

52%

65%

70%

90%

93%

98%

94%

95%

54%

56%

57%

63%

71%

91%

95%

96%

96%

97%

Risk Reduction Education Provided by SEPs in 2009 & 2010

2010 2009

Percent of SEPs

Weekly On-Site Medical Services

•2009Total of 1,360 hours per week, averaging 29.6 hours per SEP offering on-site medical services (n=46)•2010Total of 1,089 hours per week, averaging 16.8 hours per SEP offering on-site medical services (n=65)

Safer Injection Supplies Provided by SEPs in 2009 & 2010

Crack Kits

Bleach

Wound Kits

Water bottles

Antibiotic Ointment

Band-aids

Containers for carrying syringes

Ties

Cookers

Cotton

Alcohol Pads

0% 20% 40% 60% 80% 100%

41%

56%

58%

78%

79%

83%

91%

91%

97%

98%

99%

42%

54%

63%

75%

79%

83%

87%

93%

97%

99%

99%

20102009

Percent of SEPs

Overdose Rescue & Drug Treatment Medications Provided by SEPs in 2009 & 2010

Buprenorphine

Suboxone

Narcan

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%

7%

7%

44%

5%

9%

44%

20102009

Percent of SEPs

Safer Sex Items Provided by SEPs in 2009 & 2010

Dental Dams

Female Condoms

Lubricant

Condoms

0% 20% 40% 60% 80% 100%

66%

87%

96%

99%

78%

87%

96%

98%

20102009

Miscellaneous Supplies Provided by SEPs in 2009 & 2010

Other

Gift Certificates/Vouchers/Travel

Clothes

Food

Hygiene Items

0% 10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

19%

36%

59%

69%

83%

15%

46%

58%

68%

83%

20102009

Percent of SEPs

HIV and Hepatitis Related On-Site Services Provided by SEPs in 2009 & 2010

Hepatitis C treatment

Hepatitis A testing

Hepatitis B testing

Hepatitis A vaccine

Hepatitis B vaccine

Hepatitis C testing

Hepatitis A education and counseling

Hepatitis B education and counseling

HIV counseling and testing

Hepatitis C education and counseling

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

9%

15%

19%

38%

38%

62%

68%

76%

87%

91%

7%

12%

18%

40%

41%

67%

74%

77%

87%

91%

20102009

Percent of SEPs

Screening Related On-Site Services Provided by SEPs in 2009 & 2010

Tuberculosis Screening

STD Screening

Substance Abuse Treatment Referrals

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

26%

46%

86%

28%

42%

81%

20102009

Percent of SEPs

Additional Program Characteristics in 2009 & 2010

2009 No. (%)

2010 No. (%)

Did not operate for two months or more

13 (9%) 6 (4%)

Any full-time (paid) staff 97 (65%) 95 (64%)

Operated by city, county or state health department

35 (23%)

35 (23%)

501-C3 Status 117 (79%)

116 (78%)

Additional Program Characteristics in 2009 & 2010

2009 No. %)

2010 No. (%)

Operated a Delivery Service

78 (52%)

69 (46%)

Was involved in formal external evaluation

28 (19%)

23 (15%)

Problems SEPs Encountered in 2009 & 2010

Police harassment of staff / program

Other

Legal status

Operations disrupted by government or law enforcement

Any type of problem due to gentrification?

Retaining participants

Police harassment of participants (at/near site)

Lack of community support

Lack of outreach

Lack of political support

Staff burnout

Reaching or recruiting participants

Staff shortage

Lack of resources/Lack of funding

0% 10% 20% 30% 40% 50% 60% 70% 80%

5%

10%

8%

12%

10%

13%

20%

19%

21%

19%

30%

26%

52%

69%

5%

6%

8%

9%

9%

11%

14%

15%

20%

21%

24%

24%

44%

69%

2010 2009

Percentage of SEPs

Quality of Relationship Between SEPs and Police as Reported by SEPs in 2009

& 2010Quality of Relationship

2009No. (%)

2010No. (%)

Very Good 33 (22%) 35 (23%)

Somewhat good

45 (30%)

55 (37%)

Neutral45

(30%)44 (30%)

Somewhat poor 7 (5%) 6 (4%)

Very poor 4 (3%) 1 (1%)

Non-existent 12 (8%)

8 (5%)

Quality of Relationship Between SEPs and Local Health Officials as Reported

by SEPs in 2009 & 2010Quality of Relationship

2009No. (%)

2010No. (%)

Very Good 103 (69%)

95 (64%)

Somewhat good

28 (19%)

34 (23%)

Neutral 8 (5%) 13 (9%)

Somewhat poor

2 (1%) 1 (1%)

Very poor 2 (1%) 0 (0%)

Non-existent 4 (3%) 4 (3%)

Strategies SEPs Used in 2010 to Gain

Law Enforcement SupportStrategy # of

SEP’s%

None 36 24%Meetings 72 48%Trainings 42 28%Invitation to exchange 24 16%Street demonstrations 6 4%Coalition work w/other public health activists 39 26%

Officer Liasons 41 28%Didn’t have capacity/resources for strategy 19 13%

Other 13 9%

• Any favorable or unfavorable media attention in 2010–YES

•37 programs (25%)–NO

•110 programs (75%)

Federal Funding in 2010SEPs … Yes No Don’t

KnowDidn’tAnsw

er

Applied for federal funding

20

(13%)

117

(79%)

8

(5%)

4

(3%)

Received federal funding

20

(13%)

119

(80%)

5

(3%)

5

(3%)

Programs Used Federal Funding in 2010 to

Maintai

n Present Services Only

Expand Present Service

s

Add New

Services

Maintain/

Expand

Present

Services

Didn’t Answe

r

9

(45%)

7

(35%)

2

(10%)

1

(5%)

1

(5%)