Delaware

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Delawares Needle Exchange Program

• Presented by Chris Zebley, A.P.N.
• Brandywine Counseling, Inc. and
• Christiana Care Health Services
• June 13, 2009

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HIV/AIDS Trends in Delaware 3,400
living cases of HIV/AIDS
Delaware infected 1 out of every 254 (n 3,400)
--AA 1/83 (n 2,147) --White 1/636 (n
999) --Hispanic 1/233 (n 231) (ratios based
on latest available U.S. Census Estimates and
reported Living HIV/AIDS cases)
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TRENDS IN HIV/AIDS IN DE

• Gender
• --Males - 49 of Delawares population, yet
• 71 of new infections through
  2007
• --Females - 51 of Delawares population, yet
  20 of new infections through late 1980s,
  compared to 33 of new infections from 2000
  to 2007

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New Infections in Delaware by gender 1997 - 2007
Note Data perspective change from number of HIV
cases and number AIDS cases to the number of New
Infections
HIV Reporting Began 07/01
Year

242
252
229
198
165
178
214
221
153
225
300
Total
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TRENDS IN DE (Cont)

• Ethnicity
• -- African Americans (disproportionately
  highHIV/AIDS rate)
• 44 cases attributed to African-Americans
  in the late 80s---jumped to 67 by the end of
  2007 despite being 20 of Delawares population

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New Infections Diagnosed in Delaware
Race/Ethnic Groups, 1997-2007
NOTE Other Am Indian, Native Alaskan Asian,
Native Hawiian and Multi Race
HIV Reporting Began 07/01
Year
242
252
229
198
165
178
214
221
153
225
300
Total
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TRENDS IN DE (Cont)

• Age
• --70 of reported HIV/AIDS cases in DE
• through 2007 is within the 30-49 age group
  
• -- Teen groups not infected at rates seen in
  many other states

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2007 Estimated Delaware Pop. 864,764 Source
US Census
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20
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TRENDS IN DE (Cont)

• Behavioral Risk Groups
• --Through 1999, the highest risk group in
  cases
• reported was
• IDU 44 (n 987)
• MSM 33 (n 748)
• Heterosexual transmission 14 (n 305)
• --From 2000 to 2007, we are seeing a shift in
  
• Delawares risk group population.
• Heterosexual 36 (n 941)
• IDU 30 (n 798)
• MSM 27 (n 698)

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Roughly 60 of all HIV/AIDS cases in Delaware
are directly or indirectly related to needle
sharing.
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Brandywine Counseling, Inc.

• Opioid and drug-free outpatient treatment
• Specialized case management and medical care for
  pregnant women, the homeless, and persons with
  HIV/AIDS
• Residential treatment for women with children
• Drug Court
• Needle Exchange and other HIV Prevention
  Activities
• HIV Primary Care- Christiana Care Health Services

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We believe that everyone--no matter who they are
or what they dohas a fundamental right to health
and safety.
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OBJECTIVES

• To understand the philosophy and practice of Harm
  Reduction
• To understand how Brandywine Counseling, Inc.
  implements a harm reduction approach to address
  the health and safety of drug users, sex workers
  and other people at high risk
• To envision how you may incorporate this
  approach in your work with at-risk clients

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Harm Reduction- The Philosophy

• A set of practical strategies designed to reduce
  negative consequences of drug use.
• Strategies range along a spectrum from safer use,
  to managed use, to abstinence.
• A client-centered approach that presents
  realistic options based on a clients needs as
  identified by the client.
• Empowers and affirms users as the primary agents
  for improving their lives.

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Harm Reduction

• Prioritizes the right to health and safety for
  all people as its core value.
• Offers options to those most marginalized
• Recognizes obstacles and aims to assist their
  removal.

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Harm Reduction In Practice

• Provides options in a non-coercive and
  non-judgmental way.
• Shows unconditional respect and caring.
• Reinforces successes avoids condemning clients
  that experience challenges.
• Does not remove a coping mechanism until another
  is in place.

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How do we Incorporate Harm Reduction into
Practice at Brandywine?

• Sterile Syringe Exchange
• HIV Testing and Counseling
• Delivery of HIV Primary Care
• Acknowledge and work to remove barriers to
  treatment and healthcare.

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Common Health Issues Among Drug Users

• HIV and Hepatitis C
• Overdose
• Sexually Transmitted Diseases
• Endocarditis
• Abscesses and Cellulitis
• Upper Respiratory Infections
• Malnutrition
• Depression
• Chronic Pain/Pain Management

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History of Sterile Syringe Access

• Senate Bill 60, first introduced by Senator Henry
  in 1996
• The bill was re-written every year only to be
  ignored and unheard by the house until . . .
• June 30th, 2006
• at the eleventh hour

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Before the New Law

• Access to Sterile Syringes was unlawful without a
  prescription
• Access was limited to black market sales on the
  street- often repackaged used syringes
• Orwithout access, a necessary evil, to share a
  syringe/needle with another person

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Why Needle Exchange?

• Needle Exchange allows regular contact with
  active drug users and increases the opportunities
  to provide risk reduction counseling and connect
  addicts with drug abuse and/or HIV treatment
  services.
• Providing someone with safe injection equipment
  and preventing an HIV infection is far more cost
  effective than treating the same person for HIV
  over his or her lifetime (approximately 119,000
  per person over his/her lifetime).
• An increased rate of HIV among injection drug
  users means an increased risk for everyone their
  sexual partners (and their sexual partners),
  police officers encountering needles on the job,
  etc it is much easier to stop an infection chain
  before it starts than after.
• It is not just about HIV. Needle exchange lowers
  risk for transmission of Hepatitis B C.

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SB60 The Law

• The Program must be mobile
• BCI (the Provider) used their expertise to choose
  the site locations and times
• Oversight Committee Ex. Sterile Syringe Marking
• One for - One exchange pros and cons
• Must operate in the city of Wilmington

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The First day was February 1st, 2007
They enrolled 1 client ! ! !They danced around
him, he thought we were nuts!
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Sites and Locations

• We have a total of 8 sites
• 19801, 19802, 19805 and 19806
• Riverside
• Southbridge
• Eastside
• West Center City
• Hilltop
• Browntown
• Northside

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Program EnrollmentEach member is
assigned a client ID and Given a membership
card. The card offers immunization from the
possession of paraphernalia law
Program Wilmington Needle Exchange Provider
Brandywine Counseling, Inc Authority Division of
Public Health Participation in this program
provides immunity from prosecution for possession
of needles, as established in Senate Bill 60. For
info call 302-655-9880 ext. 22
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First Aid Supplies
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Additional Services

• Unigold Fingerstick Rapid test for Preliminary
  HIV Testing
• Referrals to Substance Abuse Treatment and
  Detoxification
• Housing
• Food/Clothing
• Domestic Violence

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Referrals to Substance Abuse Tx

• Simple and streamlined access since we offer
  assessments, services, programs, and referrals to
  higher levels of care.
• Relationship with Detox to hold an emergency
  slot/bed for the NEP participants
• Referral Form with consent is completed for
  follow up and tracking purposes

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Numbers

• From February 1st 2007 to Today
• ? 559 clients enrolled
• ? over 20,000 needles exchanged
• ? 4265 First Aid Kits
• ? 2854 Safe Sex Kits
• ? 13 are 19-24
• ? 52 are 25-34
• ? 28 are 35-49

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More Numbers

• ? 7 are 50
• ? 73 are White
• ? 13 are Hispanic
• ? 13.4 are Black (up 3 points)
• ? 1193 Rapid HIV tests on the van
• ? 294 of them are NEP participants
• ? 11 new positives were identified
• ? 28 confirmed Substance Abuse Treatment or Detox
  admissions

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LINK Project

• Social Networking Strategy-
• started Feb
  2009
• 48 people now on the LINK program
• Membership referrals are incentivized
• Connectors 19
• Crew Members 39
• Increased Membership
• Increased HIV testing

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Successes

• Ability to perform Confirmatory Testing
• Identification of 11 new Positive people
• Outreach workers to canvas site locations
• Partnership with Christiana Care Health Services
• Went from 4 to 8 sites in the first year
• Link Project
• Positive Relationship with Police Department
• Pregnancy Screening
• Possible Hep A B vaccinations

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The Vans
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Visions for the Future

• Narcan Prescriptions with Overdose Prevention
  Program
• More weekend sites
• Starter Kit
• Get Approval to expand beyond city limits
• Medical Van that also includes Methadone and
  Suboxone Distribution
• Other services vaccinations, wound care, and
  other screenings

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The Outreach Team
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Providers Working with Drug Users can

• Refer clients to syringe exchanged if injecting
• Refer/provide HIV Testing
• Be sensitive to the issues of women and sex
  workers
• Discuss overdose prevention
• Promote overall health, watching for abscesses,
  weight loss and upper respiratory infections

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Providers Working with Drug Users can

• Collaborate with substance abuse treatment sites
• Collaborate with local HIV Prevention and Harm
  Reduction agencies
• Open, clear lines of communication can help
  minimize unexpected interactions between
  methadone and medications being used to treat
  other conditions
• Foster open, non-judgmental working relationships
  with drug using clients

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For More Information

• Brandywine Counseling, Inc.
• [phone] Main Office
• Basha Silverman, Director of HIV Prevention
  Services, Outreach, and NEP (302)-655-9880 ext
  23, bashasilverman_at_gmail.com
• Chris Zebley, Nurse Practitioner, [phone],
  czebley_at_christianacare.org