Don C. Des Jarlais, Vivian Guardino, Ann Nugent and Alisa Solberg

The Dave Purchase Memorial 2012 National Survey of Syringe Exchange

Programs: Summary of Results

This work was funded by amfAR, The Foundation for AIDS Research with support from the Elton John AIDS Foundation (EJAF).

Characteristics Of SEPs Participating in BIMC/NASEN SurveysUnited States, 1997-2012

Year 1997 1998 2000 2002 2004 2005 2006 2007 2008 2009 2010 2011 2012

Numbers ofSEPs known to NASEN 113 131 154 148 174 166 188 186 184 201 194 197 199**

SEPs Participating in survey (%) 100

(88%)110

(84%)127

(82%)126

(85%)109

(63%)118

(71%)150

(80%)131

(70%)123

(67%)149

(74%)149

(77%)144

(73%)142

(71%)

Cities with SEPs participating 78 77 98 97 88 90 113 100 98 115 119 117 111

States with SEPs participating * 33 33 36 32 32 29 32 31 30 33 33 32 30

Syringes exchanged (millions) 17.5 19.4 22.6 24.9 24.0 22.5 27.6 29.5 29.1 33.1 35.5 36.9 39.2

Total of SEP budgets ($, millions) 8.4 8.6 12.0 13.0 11.6 14.5 17.4 19.6 21.3 21.6 21.7 19.3 19.4

Total of SEP budgets in 2012-adjusted $ (millions) (adjusted using a constant 3% annual inflation rate)

12.2 12.2 16.3 16.9 14.4 17.5 20.5 22.5 23.9 23.5 23.0 19.9 19.4

Public funding as % of total SEP budgets 67% 69% 74% 67% 76% 74% 79% 73% 79% 80% 82% 84% 81%

*This category includes the District of Columbia and/or Puerto Rico.** We attempted to contact 212 programs but 10 programs appeared to be no longer operating and 3 programs were found to have been started in 2013.

Number of Syringes Exchanged and Total SEP Budgets 1997-2012

1997 1998 2000 2002 2004 2005 2006 2007 2008 2009 2010 2011 20120

5

10

15

20

25

30

35

40

45

Syringes exchanged (millions) Total of SEP budgets in 2012-adjusted $ (millions)*

*adjusted using a constant 3% annual inflation rate

1996 1997 1998 2000 2002 2004 2005 2006 2007 2008 2009 2010 2011 20120

50

100

150

200

SEPSs Known to NASEN and Cities with SEPs Participat -ing

SEPs Known to NASEN Cities with SEPs participating

National Survey of Syringe Exchange Programs Methodology

2011 Survey• 197 SEPs contacted in second quarter 2012• 144 SEPs (73%) submitted completed surveys by

late summer.2012 Survey

• 199* SEPs contacted in second quarter 2013 • 142 SEPs (71%) submitted completed surveys by

the fall of 2013

*We attempted to contact 212 programs but 10 programs appeared to be no longer operating and 3 programs were found to have been started in 2013.

SEP Budget Dollars2011 2012

Total $$$ $19,345,206 $19,431,912 City Gov $ $5,157,416 $5,789,118

County Gov $ $1,683,229 $1,538,358

State Gov $ $8,793,482 $8,391,180

Federal Gov $ $637,518 N/A

Foundation $ $2,081,362 $1,966,688

Individual Donations $584,780 $696,947

Out-of-pocket $ $28,145 $50,525

NASEN $ $36,750 $4,150

CBO Donation $ $53,944 $28,740

Corporate Donation $ $82,464 $68,300

Other $ $202,841 $856,406

Budget Status 2011 vs. 2012

Increased Budget

Decreased Budget

Same Budget Did Not Answer0

10

20

30

40

50

60

70

38 37

60

9

32

42

57

11

20112012

Num

ber

of S

EPs

SEPs That Participated in 2011 & 2012 Surveys

Total Budget $$

2011 $15,857,761 (as reported by 104 SEPs)

2012 $17,236,124 (as reported by 104 SEPs)

Types of Areas that SEPs are Located in theUnited States, 2011-2012

Rural Suburban Urban Didn't Answer0

20

40

60

80

100

120

30

14

97

3

2516

99

2

20112012

Num

ber o

f SEP

s

Gender Distribution Of NSEP Participants in 2012*

Male65%

Female34%

Transgender1%

Gender

*Weighted by the number of syringes distributed

Ethnic Distribution of NSEP Participants in 2012* Other

2%Asian/Pacific Islander

2% Native American3% Biracial/Mixed

2%

Hispanic19%

African American15%

Caucasian57%

*Weighted by the number of syringes distributed

Silicone

Steroids

Other amphetamine (uppers/Dexedrine)

HIV medications and/or insulin

Other

Cocaine mixed w/other drug NOT heroin

Downers (benzodiazepines, tranquilizers)

Heroin mixed w/other drug (not cocaine)

Other opiates (OxyContin, Percodan, etc)

Heroin and cocaine

Cocaine by itself

Methamphetamine (crystal meth/ice/crank)

Heroin by itself

0% 10% 20% 30% 40% 50% 60% 70%0%

2%

2%

4%

4%

4%

6%

9%

16%

17%

18%

18%

60%

Percent of NSEP Participants Injecting the Following Drugs in 2012*

Percent of SEP Participants*Weighted by number of syringes distributed

Type of Exchange Conducted by SEPs in 2012

Variation No. (%)

Allowed receipt of more syringes than brought in 114 (80%)

Used Start-up Packs 77 (54 %)

Used A Distribution Model 73 (51%)

Had a Limit on Syringes Exchanged 48 (34%)

Used A Minimum 46 (32%)

Exchange Hours @ Regular, Scheduled Times & Places

• 2011 Total of 4,144 hours per week averaging 29.4 hours per SEP• 2012

Total of 3,317 hours per weekAveraging 24.2 hours per SEP

Number of Syringes Distributed by Syringe Exchange Programs (SEPs), by Program Size:

2011 & 2012

SEP Size(Syringes

Distributed)

No. of

SEPs2011

Total syringes exchanged

2011

No. of

SEPs2012

Total syringes exchanged

2012

Small(< 10,000) 19

54,709(<1%) 18

57,938(<1%)

Medium(10,000-55,000) 33

965,472(3%) 33

735,911(2%)

Large(55,001-499,999) 72

13,472,727(37%) 71

12,820,837(33%)

Very Large(500,000) 18

22,383,837(61%) 18

25,535,971(65%)

Total 142 36,876,745 140 39,150,657

*In 2011, two programs did not indicate the number of syringes they distributed. In 2012, one program did not indicate the number of syringes they distributed and one program indicated that they did not distribute any syringes.

Returned/Collected Syringes in 2011 and 2012

2011 2012

30,837,933 33,903,012

Disposal Methods of Collected/Used Syringes in 2012

Private Sanitation Arrangement with Local Facilities

Other Syringe Exchanges

Private Doctors/Clinics Other Places of Syringe Disposal

95

30

93

9

Num

ber

of S

EP P

rogr

ams

2011 (n=108*)• 31,662,789

syringes distributed• 27,078,225

syringes collected

2012 (n=108*)• 36,919,542

syringes distributed• 31,987,385

syringes collected

Syringes Exchanged by Programs ThatParticipated in Both 2011 & 2012 Surveys

*Only programs that reported the number of syringes distributed in both 2011 and 2012 are included in the calculations above. In 2011, eight programs in this group did not report the number of syringes they collected, the number was also eight in 2012.

Used Unique

Identifier: 81 SEPs

57%

Did Not Use

Unique Identifier:

61 SEPs43%

SEP Usage of Unique Identifiers for Tracking Individuals in 2012

Secondary Exchange & Methods of Encouragement Used by SEPs In 2012

Secondary Exchange No. (%) SEPs allowing secondary exchange 119 ( 84%) SEPs encouraging secondary exchange 92 (65%)Methods of Encouragement Talked about it 83 (58%) Gave extra supplies 71 (50%) Provided sharps containers 71 (50%) Had no limit on syringes exchanged 59 (42%) Peer education 44 (31%) Enrolled people receiving syringes from secondary exchange

18 (13%)

Gift certificates/Other incentives 12 ( 8%)

OD Prevention without Narcan

Safer Crack Use

OD Prevention with Narcan

Use of Bleach

Dental Dam/Female Condom Use

Abscess/Wound and/or Vein Care

STD and HIV Prevention (other than condom use)

Safer Injection Techniques

Condom Use

Hepatitis (A,B,C) Prevention

0% 20% 40% 60% 80% 100%

51%

58%

58%

62%

61%

91%

88%

94%

95%

97%

55%

56%

59%

65%

73%

87%

92%

94%

96%

97%

Risk Reduction Education Provided by SEPs in 2011 & 2012 2012 2011

Percent of SEPs

SEPs Providing On-site Medical Services

•2011

Number of SEPs=75

•2012

Number of SEPs=71

Safer Injection Supplies Provided by SEPs in 2011 & 2012

Crack Kits

Bleach

Wound Kits

Water bottles

Antibiotic Ointment

Containers for carrying syringes

Band-aids

Cookers

Ties

Cotton

Alcohol Pads

0% 20% 40% 60% 80% 100%44%

49%

60%

72%

78%

88%

81%

94%

91%

98%

99%

39%

51%

59%

68%

76%

83%

87%

92%

94%

95%

99%

20122011

Percent of SEPs

Overdose Rescue & Drug Treatment Medications Provided by SEPs in 2011 & 2012

Buprenorphine

Suboxone

Naloxone

0% 10% 20% 30% 40% 50%

8%

10%

47%

6%

8%

49%

20122011

Percent of SEPs

Naloxone Services and Fundingat SEPs in 2012

# of SEP’s

%

Program distributes Naloxone 71 50%Funding source for programs providing Naloxone

Regular budget item 31 44%Special funding 41 58%

Type of Naloxone Provided by SEPs in 2012

14%

60%

26%

Intranasal NaloxoneInjectable NaloxoneBoth

Safer Sex Items Provided by SEPs in 2011 & 2012

Dental Dams

Female Condoms

Lubricant

Condoms

0% 20% 40% 60% 80% 100%

71%

80%

91%

99%

65%

81%

90%

98%

20122011

Miscellaneous Supplies Provided by SEPs in 2011 & 2012

Other

Gift Certificates/Vouchers/Travel

Clothes

Food

Hygiene Items

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

20%

47%

61%

63%

83%

26%

39%

53%

60%

74%

20122011

Percent of SEPs

HIV and Hepatitis C Related On-site Services Provided by SEPs 2009-2012

Hepatitis C treatment

Hepatitis C testing

HIV counseling and testing

Hepatitis C education and counseling

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

6%

68%

80%

88%

4%

62%

81%

85%

7%

67%

87%

91%

9%

62%

87%

91%

2009201020112012

Percent of SEPs

Screening Related On-site Services Provided by SEPs in 2011 & 2012

Tuberculosis Screening

STD Screening

Substance Abuse Treatment Referrals

0% 20% 40% 60% 80% 100%

26%

47%

94%

27%

42%

94%

20122011

Percent of SEPs

Additional Program Characteristics in 2011 & 2012

2011 No. (%)

2012 No. (%)

Did not operate for two months or more 8 (6%) 15 (11%)

Any full-time (paid) staff 83 (58%) 78 (55%)

Operated by city, county or state health department

34 (24%) 34 (24%)

501-C3 Status 100 (69%) 100 (70%)

Additional Program Characteristics in 2011 & 2012

2011 No. (%)

2012 No. (%)

Operated a Delivery Service 77 (53%) 63 (44%)

Was involved in a formal external

evaluation20 (14%) 18 (13%)

Problems SEPs Encountered in 2011 & 2012

Police harassment of staff / program

Retaining participants

Any type of problem due to gentrification?

Other

Legal status

Operations disrupted by government or law enforcement

Police harassment of participants (at/near site)

Lack of community support

Lack of outreach/publicity

Reaching or recruiting participants

Lack of political support

Staff burnout

Staff shortage

Lack of resources/Lack of funding

0% 20% 40% 60% 80%

6%

13%

9%

6%

15%

13%

19%

22%

24%

22%

30%

28%

56%

75%

8%

11%

11%

12%

15%

18%

19%

20%

23%

25%

27%

30%

46%

72%

2012 2011

Percentage of SEPs

Quality of Relationship 2011No. (%)

2012No. (%)

Very Good 29 (20%) 36 (25%)

Somewhat good 42 (29%) 43 (30%)Neutral 50 (35%) 37 (26%)

Somewhat poor 5 (3%) 7 (5%)

Very poor 1 (1%) 2 (1%)

Non-existent 17 (12%) 13 (9%)

Quality Of Relationship Between SEPs and Police as Reported by SEPs in 2011 & 2012

Quality Of Relationship Between SEPs and Local Health Officials as Reported by SEPs in 2011 & 2012

Quality of Relationship

2011No. (%)

2012No. (%)

Very Good 87(60%) 77(54%)Somewhat good 29(20%) 33(23%)Neutral 16(11%) 13(9%)Somewhat poor 3(2%) 1(1%)Very poor 0(0%) 2(1%)Non-existent 9(6%) 10(7%)Did not answer 0 (--) 6 (4%)

Strategies SEPs Used in 2012 to Gain Law Enforcement Support

Strategy # of SEP’s %

Meetings 66 46%Trainings 37 26%Officer Liaisons 30 21%Coalition work w/other public health activists 36 25%

None 31 22%Invitation to exchange 29 20%Didn’t have capacity/resources for strategy 19 13%Other 16 11%Street demonstrations 1 1%

Does the Affordable Care Act Present Your Program with Any New Opportunities for Revenue?

70%

14%

16%

NoYesDid not answer

Any Favorable or Unfavorable Media Attention in 2012

• YES • 29 programs (20%)

• NO • 105 programs (74%)

• Did not answer• 8 programs (6%)

Very Special Thanks to:

• Jill Westermark

• Shantel Davis

for their generous help contacting SEPs and encouraging survey submissions.