Sir - It could be concluded from the report by Kitty Holland (February 22nd) on the Merchants Quay Project's evaluation of their needle exchange programme that the efficacy of such programmes in reducing the transmission of blood-borne viruses is well established. This is far from the case.
With regard to the Hepatitis-C virus, there is no scientific study which clearly identifies needle exchange programmes as impacting in any significant way on Hep-C rates among injecting drug users. Prevalence rates have remained consistently high across the EU over time (they currently range from 50 to 90 per cent), irrespective of the level of needle provision introduced. In the Netherlands, according to the European Monitoring Committee for Drugs and Drug Addiction, the Hepatitis-C prevalence rate in injecting drug users is well over 70 per cent.
A recent external evaluation of the Eastern Health Board Drugs Service was extremely critical of the lack of needle exchange provision in Dublin, describing the service as "patchy and not very comprehensive", and it called for the establishment of a "network of needle exchange facilities". This call was made despite the conclusion of its own literature review of the issue that, "research evaluation literature on the specific impact of syringe exchange schemes is mixed".
What is really interesting, however, is that, despite this "patchy and not very comprehensive" service, the HIV prevalence rate among injecting drug users in Ireland is 0.9 per cent according to the European Monitoring Committee for Drugs and Drug Addiction. In France, where syringes have been readily available from pharmacies, as the Merchants Quay Project is recommending for Ireland, since 1987 the HIV prevalence rate among injecting drug users is between 15.5 and 18.3 per cent. In the Netherlands, the doyen of "harm reductionists" the world over, the prevalence rate is apparently between 20 and 26 per cent.
The high incidence of HIV among crack cocaine users (generally smoked) in the US indicates that there many aspects of an addict's behaviour which makes them susceptible to blood-borne infections. This, coupled with the fact that risk of infection in injecting drug users cumulates with use (the longer the injecting career the greater the risk), would suggest that greater attempts to tackle the problem of addiction may produce better results in reducing the spread of blood-borne viruses than facilitating self-destructive, and indeed illegal, behaviour - Yours, etc.,
Andre Lyder, Coalition Of Communities Against Drugs, Cork Street, Dublin 8.