Enough sterile syringes to prevent HIV transmission among injection drug users in Montreal?

The HIV epidemic among injection drugs users in Montreal continues unabated. We wished to know whether sufficient syringes were being distributed to provide for the needs of injection drug users (IDUs) in Montreal. Using data from several sources, including the estimated number of active IDUs in 1994 and the injection frequency according to the drug consumed, we calculated the number of syringes required by IDUs. The number of syringes estimated was compared with the number of syringes distributed by needle exchange programs or sold in private pharmacies. Overall, we estimated that in 1994 about 10,683,000 syringes were required by the 10,000 IDUs in Montreal. Because about 338,000 syringes were distributed, <5% of the need was being met. The parameters in our analysis, particularly the number of IDUs in Montreal, drug use, and the frequency of injection, are subject to uncertainty. Nevertheless, because of the disparity between the small proportion of syringes distributed and the number required, it is unlikely that sufficient syringes are available to ensure access to clean needles and prevent HIV transmission. Measures should be taken to expand syringe distribution to Montreal IDUs.