Needle exchange curbs spread of Aids

Around 150 addicts use Bern's needle exchange every day Keystone

Switzerland’s policy of providing clean needles and safe injecting rooms for drug addicts is being seen as a success in reducing the spread of HIV and Aids.

There are now needle exchanges and injecting rooms in most Swiss cities, despite opposition from at home and abroad.

In the late 1980s and early 1990s Switzerland had one of the highest rates of heroin addiction in Europe and a faster than average spread of HIV.

Many addicts were sharing needles at the notorious open drug scenes in cities such as Zurich and Bern.

In a bid to prevent needle sharing, the Swiss health authorities introduced some controversial programmes, including needle exchanges, vending machines with needles and syringes, and injecting rooms.

While critics say these policies simply encourage drug abuse, those working with Aids sufferers claim the needle exchanges have proved their worth.

“This is an extremely important programme,” said Franciska Oswald of the Swiss Aids Foundation. “The fact is the number of drug users who are HIV positive has declined.”

According to Federal Health Office figures, the number of new HIV cases among intravenous drug users fell from over 400 in 1991 to around 100 in 1997.

Injection room

Bern’s needle exchange centre sees about 150 addicts every day – and many of them attend more than once.

The figures are staggering: 9,000 syringes and 15,000 needles are handed out to addicts every single week.

Such a service may seem shocking, but the programme is in line with the Federal Health Office’s policy of harm reduction. This includes establishing nationwide facilities for supervised drug use, improving the availability of sterile injection kits, and improving drug users’ injection techniques.

“People come here so they can consume in a clean and safe way,” said Gabrielle Bucher, who is a social worker at the needle exchange.

The centre also provides other services: addicts can get a meal or a soft drink; they can have a shower or wash their clothes; and most important of all, there are medical staff and social workers to provide treatment and counselling.

“We have people here they can talk to,” explained Bucher. “If they are thinking they want to try to come off drugs, we can get help for them to do this.”

Heroin addiction

Steven, who has been a heroin addict for ten years, is a regular user of the centre.

“For me, this is one of the most important places in Bern,” he said. “Before, we were on the open scene, and that is never good.

“Here, everything is clean: the needles, the syringes, and you can get information about HIV.”

Staff at the centre don’t know exactly how many of their clients are HIV positive, but they estimate the figure is probably around 15 per cent.

Statistics show that 20 per cent of the patients on Switzerland’s heroin prescription programme are infected with HIV.

Safe sex

Among the addicts who come to the needle exchange are women who work as prostitutes. Here again, HIV prevention is a top priority.

“Monday night is only for women,” said Bucher. “We give out condoms and we give advice about safe sex.”

Franciska Oswald agrees that this is a very important part of the programme: “When we are working on HIV prevention among drug users, it’s crucial that we talk about sexual activity, too.”

“So, it’s not just about exchanging needles; we have to tell them not to forget about safe sex.”

Difference of opinion

Needle exchanges and injecting rooms are widely accepted in the German-speaking part of Switzerland, but there is widespread resistance in Italian- and French-speaking areas, even though the government’s policy of harm reduction was approved in a nationwide vote.

Needle exchanges are available in French-speaking Geneva and Lausanne, but there are no centres in Italian-speaking Ticino.

These policies remain highly controversial in other European countries where most emphasis is placed on stamping out drug abuse.

Switzerland also devotes much time and effort to drug prevention, but its harm reduction policy means it is also committed to protecting the health of those who do become addicts.

Both Oswald and Bucher dismiss the idea that providing clean needles or safe places to inject encourages drug abuse.

“There are studies which show that there has been no increase in drug use in Switzerland since this policy started,” said Oswald. “The fact is that it does not increase the number of drug users.”

“There will never be a world without drugs,” added Bucher. “And in the countries which only practice a policy of repression there are still drug addicts. Those drug addicts will get infected, they will get sick, and they will die.”

swissinfo, Imogen Foulkes

Key facts

It’s estimated there are around 30,000 intravenous drug users in Switzerland
Ten years ago many consumed their drugs on the open scenes of Zurich and Bern; needle sharing was common.
The rate of HIV infection among Swiss drug users was high.
Now almost every large Swiss town and city has a needle exchange and a safe injection room, and rates of HIV among drug users has decreased.