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Increase in clean needle and syringe provision essential for hepatitis C elimination

Keith Alcorn
12 February 2020
Image: funnyangel/

Elimination of hepatitis C will not be achievable without substantial improvements in provision of sterile injecting equipment, Dr Magdalena Harris of London School of Hygiene and Tropical Medicine told a conference on hepatitis C elimination in London last month.

Current estimates of 'high' coverage don’t reflect the realities of drug users’ lives and statistics on needle exchange services in London have not been updated since 2007, meaning that funders and policy makers have no idea whether services in London are providing adequate numbers of needles and syringes to people who inject drugs in the capital, she warned.

Needle and syringe programmes have been shown to reduce hepatitis C transmission among people who inject drugs. Provision of sterile injecting equipment through needle and syringe programmes is recommended as a core intervention for prevention of hepatitis C by the World Health Organization (WHO).

WHO has set a target for distribution of sterile injecting equipment to people who inject drugs. By 2020, every person who injects drugs should receive at least 200 needle and syringe sets per year, and this should rise to 300 sets per year by 2030. WHO estimated that on average, just 20 sets of needles and syringes reached each person who injected drugs in 2014.

But are these targets adequate? Dr Harris pointed out that 200 needles and syringes per year is the equivalent of 3.85 per week. According to Public Health England, only three in five people who injected drugs in England and Wales reported having sterile injecting equipment for each injection in 2018, and 80% in Scotland.

Dr Harris said there is a disconnect between policy on needle and syringe provision and the realities of drug users’ lives.

Research carried out in London by Dr Harris’s Care and Prevent research team shows that for many drug users, injecting may require multiple attempts to find a vein and that re-use of injecting equipment is common. A survey of 279 drug users in London carried out by the research group found that the majority (58%) made more than one attempt to inject on a recent occasion and one in four reported at least four attempts before achieving a successful injection. Sixty-five per cent reported re-use of injecting equipment sometimes or always. Levels of needle and syringe provision don’t reflect the need for re-use that is prompted by injecting difficulties, especially in older drug users and those who have suffered serious soft tissue infections.

Restrictions on access to needles and syringes were also reported by drug users interviewed by Lambeth Service User Council in a peer survey carried out in 2019. For example, a hostel in Vauxhall, South London, stipulated that drug users must be on opioid substitution therapy to obtain needles and syringes, could not have more than three allocations per week, could not take away an unlimited number and could only access them after 6pm.

Under-provision and rationing of needles and syringes undermine harm reduction and efforts to eliminate hepatitis C, especially among the most marginalised drug users, Dr Harris explained. Needle and syringe programmes remain at the core of reducing drug-related harm for people who use drugs.

Overdose prevention, health care for soft tissue and skin infections, safer injecting advice and engagement with services that can help drug users obtain stable housing, welfare benefits, psychiatric care and support to navigate services are all likely to be higher priorities for people who use drugs than hepatitis C testing and treatment, she said.


Harris M. Harm reduction: a crucial element of elimination. London Joint Working Group on Substance and Hepatitis C conference, 'Your Role in Eliminating Hepatitis C in London', 27 January 2020.