Needles and syringes distributed per person who injects drugs

Export Indicator

Number of needles and syringes distributed per person who injects drugs per year by needle and syringe programmes
What it measures

Progress in improving the coverage of needles and syringes provided, an essential HIV prevention service for people who inject drugs

Rationale

Injecting drug use is the main route of transmission for about 10% of the people acquiring HIV globally and 30% of those outside sub-Saharan Africa. Preventing HIV transmission caused by injecting drug use is one of the key challenges in reducing the burden of HIV.

Needle and syringe programmes are one of nine interventions in the WHO, UNODC and UNAIDS comprehensive package for the prevention, treatment and care of HIV among people who inject drugs.

Needle and syringe programmes greatly enhance HIV prevention for people who inject drugs, and a wealth of scientific evidence supports its efficacy in preventing the spread of HIV.

Numerator

Number of needles and syringes distributed in the past 12 months by needle and syringe programmes

Denominator

Number of people who inject drugs in the country

Calculation

Numerator/denominator

Method of measurement

Programme data used to count the number of needles and syringes distributed (numerator)

Estimation of the number of people who inject drugs in the country (denominator)

Measurement frequency

Every two years

Disaggregation

Cities and other administrative areas of importance

Additional information requested

If there are subnational data available, please provide the disaggregation by administrative area, city, or site in the space provided. Submit the digital version of any available survey reports using the upload tool.

Strengths and weaknesses

Some difficulties in counting needles and syringes are reported. Some commonly used syringes are 1-ml or 2-ml needle and syringe units; others are syringes to which needles need to be fitted. In most cases, only data on the number of syringes distributed by needle and syringe programmes but not pharmacy sales are available.

Estimating the number of people who inject drugs at the country level presents challenges. People who inject drugs are defined in many ways, and the estimates have ranges. The UNODC publishes estimates of the number of people who inject drugs in the World drug report. These estimates may be used. If there is a reason not to use them, please provide the rationale in the comment field.

Countries that have legalized sales of needles and syringes without a prescription may appear to have artificially low coverage with this indicator.

Countries can monitor this indicator against the following coverage levels: 

  • Low: <100 syringes per person who injects drugs per year. 
  • Medium: 100–200 syringes per person who injects drugs per year. 
  • High: >200 syringes per person who injects drugs per year.

These levels are based on studies in low- and middle-income countries investigating the levels of syringe distribution and how these affect HIV transmission. The levels required for preventing hepatitis C are likely to be much higher than those presented here.

Further information

The following fully describes this indicator: WHO, UNODC and UNAIDS. Technical guide for countries to set targets for universal access to HIV prevention, treatment and care for injecting drug users. Geneva: World Health Organization; 2012 (http://www.who.int/hiv/pub/idu/targets_universal_ access/en/index.html).

Needle and syringe programmes [website]. Geneva: World Health Organization; 2016 (http://www.who.int/hiv/topics/idu/needles/en/index.html).

Effectiveness of sterile needle and syringe programming in reducing HIV/AIDS among injecting drug users. Geneva: World Health Organization; 2004 (http://www.who.int/hiv/pub/idu/e4a-needle/en/index.html).

UNODC Global Assessment Programme on Drug Abuse. Estimating prevalence: indirect methods for estimating the size of the drug problem. Vienna: UNODC; 2003 (https://www.unodc.org/documents/GAP/GAP%20Toolkit%20Module%202%20Final%2...). 

Hickman M, Taylor C, Chatterjee A, Degenhardt L, Frischer M, Hay G et al. Estimating the prevalence of problematic drug use: a review of methods and their application. Bull Narcotics. 2002;54:15–32.

Most-at-risk populations: sampling strategies and design tool [website]. Atlanta: United States Department of Health and Human Services, Centers for Disease Control and Prevention, GAP Surveillance Team; 2009 (http://globalhealthsciences.ucsf.edu/sites/default/files/content/pphg/su... CDC-MARPs/index.html).

For details on the Injecting Drug Users Reference Group and to access reported country-level and global-level estimates of injecting drug use and HIV among people who inject drugs, please visit: https://ndarc.med.unsw.edu.au/project/injecting-drug-users-reference-gro....

WHO/UNAIDS Working Group on Global HIV/AIDS and STI Surveillance. Guidelines on estimating the size of populations most at risk to HIV. Geneva: World Health Organization and UNAIDS, 2010 (http://www.unaids.org/en/media/unaids/contentassets/documents/epidemiolo... Estimating_Populations_en.pdf).

WHO/UNAIDS Working Group on Global HIV/AIDS and STI Surveillance. Guidelines on surveillance among populations most at risk for HIV. Geneva: World Health Organization; 2011 (http://www.unaids.org/en/media/unaids/contentassets/documents/epidemiolo... among_most_at_risk.pdf).