Harm reduction and HIV-prevention among injecting drug users in Australia: an international comparison.

In response to the threat of HIV transmission via drug injection with shared needles, Australia developed a needle and syringe exchange program that became one of the most comprehensive in the world. Originally health professionals and pharmacists were given the responsibility of implementing the program. However, community-based AIDS organizations were soon also funded to distribute sterile injecting equipment, alcohol swabs, puncture-proof disposable containers, condoms, and safe sex information. Nearly all of the programs operated on a no-need-for-exchange basis, during hours and from outlets (both fixed and mobile) that were convenient for users. Their success in preventing the widespread transmission of HIV among injecting drug users was demonstrated in international studies that found a large discrepancy between the rates of HIV infection in cities with, and without, needle and syringe exchange programs, and was reflected in the continued low level of HIV infection among injecting drug users in Australia. Australia's success in preventing HIV transmission among drug users suggests the merits of the "harm reduction" approach to controlling drug use as well as funding community-based needle and syringe exchange programs.