95-658: The National Harm Reduction Coalition , previously known as the Harm Reduction Coalition , is an American advocacy organization for people who use drugs. The NHRC emerged from a Harm Reduction Working Group (HRWG) organized in 1993 by Francie and Stephanie Comer, Dan Bigg, George Clark (head of San Francisco's needle exchange), and Dave Purchase. Many of the attendees at the first meeting had worked with (or founded) needle exchanges in different cities, including Los Angeles, San Francisco, Philadelphia and New York. Many were current or former injection drug users . Several of
190-491: A public health emergency of international concern, marking the second such declaration in the last two years due to the virus's transmission. The WHO's Constitution states that its objective "is the attainment by all people of the highest possible level of health". The WHO fulfils this objective through its functions as defined in its Constitution: As of 2012 , the WHO has defined its role in public health as follows: Since
285-405: A "necessity defense" which permits breaking of a law to prevent an imminent harm. In other jurisdictions where syringe possession without a prescription remained illegal, physician-based prescription programmes have shown promise. Epidemiological research demonstrating that syringe access programmes are both effective and cost-effective helped to change state and local NEP-operation laws, as well as
380-430: A 2011 survey, 20% of US NEPs reported training police during the previous year. Covered topics included the public health rationale behind NEPs (71%), police occupational health (67%), needle stick injury (62%), NEPs' legal status (57%), and harm reduction philosophy (67%). On average, training was seen as moderately effective, but only four programmes reported conducting any formal evaluation. Assistance with training police
475-556: A 2013 paper at the International Congress of Psychiatrists that highlighted lack of training for needle exchange workers and also showed the workers performing a range of tasks beyond contractual obligations, for which they had little support or training. It also showed how needle exchange workers were a common first contact for distressed drug users. Perhaps the most concerning finding was that workers were not legally allowed to provide Naloxone should it be needed. According to
570-758: A 2022 study by Vanderbilt University economist Analisa Packham, syringe exchange programs reduce HIV rates by 18.2 percent but lead to greater drug use. Syringe exchange programmes increased drug-related mortality rates by 11.7 percent and opioid-related mortality rates by 21.6 percent. Activist groups claim there is no way to ensure SEP users will be properly disposed of. Peer reviewed studies suggest that there are less improperly disposed of syringes in cities with needle exchange programs than in cities without. Other studies of similar design find that syringe exchange program drop boxes were associated with an overall decrease of improper syringe disposal (over 98% decrease) and going further from said syringe exchange sites increases
665-495: A convention concerning the bubonic plague was signed by sixteen of the nineteen states attending the Venice conference. While Denmark , Sweden-Norway , and the US did not sign this convention, it was unanimously agreed that the work of the prior conferences should be codified for implementation. Subsequent conferences, from 1902 until the final one in 1938, widened the diseases of concern for
760-550: A crime or participation in NEP as evidence of criminal activity. Although most US NEPs operate legally, many report some form of police interference. In a 2009 national survey of 111 US NEP managers, 43% reported at least monthly client harassment, 31% at least monthly unauthorized confiscation of clients' syringes, 12% at least monthly client arrest en route to or from NEP and 26% uninvited police appearances at program sites at least every six months. In multivariate modeling, legal status of
855-523: A leading role in several public health achievements, most notably the eradication of smallpox , the near- eradication of polio , and the development of an Ebola vaccine . Its current priorities include communicable diseases , such as HIV/AIDS , Ebola , malaria and tuberculosis ; non-communicable diseases such as heart disease and cancer ; healthy diet , nutrition, and food security ; occupational health ; and substance abuse . The agency advocates for universal health care coverage, engagement with
950-488: A model called "needs-based" where the syringes are handed out without requiring any to be returned. According to a report published in 1994, Montreal's CACTUS exchange which has a policy of one-for-one, plus one needle with a limit of 15 had a return rate of 75-80% between 1991 and 1993. An exchange in Boulder, Colorado , implemented a one-for-one with four starter needles and reported an exchange rate of 89.1% in 1992. In
1045-399: A much higher degree on the basis of increasing total needles in circulation. Portland residents in areas where syringe acquisition is unlimited claim to be "drowning in needles" and picking up upwards of 100 per week. Opposition groups also argue government action in increasing the amount of syringe disposal boxes is slow. As of 2011, CDC estimated that every HIV infection prevented through
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#17328767278241140-552: A needle exchange program saves an estimated US$ 178,000+. Separately it reported an overall 30 percent or more reduction in HIV cases among IDUs. Proponents of harm reduction argue that the provision of a needle exchange provides a social benefit in reducing health costs and also provides a safe means to dispose of used syringes. For example, in the United Kingdom, proponents of SEPs assert that, along with other programmes, they have reduced
1235-457: A prescription and police arrest people who possess syringes without a prescription. Boulder County health department reports between January 2012 and March 2012, the group received over 45,000 dirty needles and distributed around 45,200 sterile syringes. As of 2017, NSPs are illegal in 15 states. NSPs are prohibited by local regulations in cities in Orange County, California , even though it
1330-528: A resolution on disability prevention and rehabilitation , with a focus on community-driven care. 1977 and 1978: The first list of essential medicines was drawn up, and a year later the ambitious goal of " Health For All " was declared. 1986: The WHO began its global programme on HIV/AIDS . Two years later preventing discrimination against patients was attended to and in 1996 the Joint United Nations Programme on HIV/AIDS (UNAIDS)
1425-429: A resolution passed on the subject, Alger Hiss , the secretary general of the conference, recommended using a declaration to establish such an organization. Sze and other delegates lobbied and a declaration passed calling for an international conference on health. The use of the word "world", rather than "international", emphasized the truly global nature of what the organization was seeking to achieve. The constitution of
1520-501: A series of conferences that took place until 1938, about 87 years. The first conference, in Paris, was almost solely concerned with cholera , which would remain the disease of major concern for the ISC for most of the 19th century. With the cause , origin, and communicability of many epidemic diseases still uncertain and a matter of scientific argument, international agreement on appropriate measures
1615-550: A significant infusion of financial and technical resources. The WHO's official mandate is to promote health and safety while helping the vulnerable worldwide. It provides technical assistance to countries, sets international health standards, collects data on global health issues, and serves as a forum for scientific or policy discussions related to health. Its official publication, the World Health Report , provides assessments of worldwide health topics. The WHO has played
1710-477: A state of emergency to address the HIV epidemic, allowed SEPs to provide sterile syringes, take back used devices, and operate as a service for health education to support individuals struggling with substance use disorders . Since then, it was approximated that from July 1, 2017, to December 31, 2017, only 1,672,000 out of the 3,030,000 distributed needles (60%) were returned to the designated sites. In April 2018, acting Mayor Mark Farrell allocated $ 750,000 towards
1805-513: A stationary site. More generally, US NEPs distribute syringes through a variety of methods including mobile vans, delivery services and backpack/pedestrian routes that include secondary (peer-to-peer) exchange. In the United States, a ban on federal funding for needle exchange programs began in 1988, when republican North Carolina Senator Jesse Helms led Congress to enact a prohibition on the use of federal funds to encourage drug abuse. The ban
1900-663: A way to address problematic substance use. Police also reported anxiety about accidental needle sticks and acquiring communicable diseases from IDUs, but were not trained or equipped to deal with this occupational risk; this anxiety was intertwined with negative attitudes towards syringe access initiatives. US NEPs have successfully trained police, especially when framed as addressing police occupational safety and human resources concerns. Preliminary evidence also suggests that training can shift police knowledge and attitudes regarding NEPs specifically and public health-based approaches towards problematic drug use in general. According to
1995-409: Is a social service that allows injection drug users (IDUs) to obtain clean and unused hypodermic needles and associated paraphernalia at little or no cost. It is based on the philosophy of harm reduction that attempts to reduce the risk factors for blood-borne diseases such as HIV/AIDS and hepatitis . Needle-exchange programmes can be traced back to informal activities undertaken during
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#17328767278242090-510: Is a specialized agency of the United Nations responsible for global public health . It is headquartered in Geneva , Switzerland, and has six regional offices and 150 field offices worldwide. Only sovereign States can participate, and it is the largest intergovernmental health organization at the international level. The WHO's purpose is to achieve the highest possible level of health for all
2185-590: Is frequent in the area and injecting paraphernalia has been found in carparks, parks, footpaths, and drives. Furthermore, people who inject drugs have broken into syringe disposal bins to reuse discarded equipment. A study commissioned by the Australian Government revealed that for every A$ 1 invested in NSPs in Australia, $ 4 was saved in direct healthcare costs, and if productivity and economic benefits are included,
2280-616: Is not disallowed by state law in California. Removal of legal barriers to the operation of NEPs and other syringe access initiatives has been identified as an important part of a comprehensive approach to reducing HIV transmission among IDUs. Legal barriers include both "law on the books" and "law on the streets", i.e., the actual practices of law enforcement officers, which may or may not reflect relevant law. Changes in syringe and drug control policy can be ineffective in reducing such barriers if police continue to treat syringe possession as
2375-557: Is now on the verge of extinction, thanks to a Global Vaccination Drive. The World Health Organization (WHO) stated the eradication programme has saved millions from deadly disease. Between 1990 and 2010, WHO's help has contributed to a 40% decline in the number of deaths from tuberculosis, and since 2005, over 46 million people have been treated and an estimated 7 million lives saved through practices advocated by WHO. These include engaging national governments and their financing, early diagnosis, standardising treatment, monitoring of
2470-496: The American Medical Association (AMA), which in 2000 adopted a position strongly supporting NSPs when combined with addiction counseling. The Melbourne, Australia, inner-city suburbs of Richmond, and Abbotsford are locations in which the use and dealing of heroin has been concentrated. The Burnet Institute research organisation completed the 2013 'North Richmond Public Injecting Impact Study' in collaboration with
2565-565: The US Centers for Disease Control and Prevention (CDC), the United Nations Children's Fund (UNICEF), and smaller organizations. As of 2011 , it has been working to immunize young children and prevent the re-emergence of cases in countries declared "polio-free". In 2017, a study was conducted as to why Polio Vaccines may not be enough to eradicate the Virus & conduct new technology. Polio
2660-815: The USSR , called on the World Health Assembly to undertake a global initiative to eradicate smallpox, resulting in Resolution WHA11.54. 1965: The first report on diabetes mellitus and the creation of the International Agency for Research on Cancer . 1966: The WHO moved its headquarters from the Ariana wing at the Palace of Nations to a newly constructed headquarters elsewhere in Geneva. 1967: The WHO intensified
2755-998: The United Nations Development Programme (UNDP), and the World Bank . 1975: The WHO launched the Special Programme for Research and Training in Tropical diseases (the TDR). Co-sponsored by UNICEF , UNDP, and the World Bank, it was established in response to a 1974 request from the WHA for an intensive effort to develop improved control of tropical diseases. The TDR's goals are, firstly, to support and coordinate international research into diagnosis, treatment and control of tropical diseases; and, secondly, to strengthen research capabilities within endemic countries. 1976: The WHA enacted
2850-572: The World Health Assembly finished on 24 July 1948, having secured a budget of US$ 5 million (then £1,250,000 ) for the 1949 year. G. Brock Chisholm was appointed director-general of the WHO, having served as executive secretary and a founding member during the planning stages, while Andrija Štampar was the assembly's first president. Its first priorities were to control the spread of malaria , tuberculosis and sexually transmitted infections , and to improve maternal and child health , nutrition and environmental hygiene. Its first legislative act
2945-509: The 1970s. The idea is likely to have been rediscovered in multiple locations. The first government-approved initiative (Netherlands) was undertaken in the early to mid-1980s, followed closely by initiatives in the United Kingdom and Australia by 1986. While the initial programme was motivated by an outbreak of hepatitis B , the AIDS pandemic motivated the rapid adoption of these programmes around
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3040-669: The 1980s, Maggie Telfer from the Bristol Drugs Project advocated for needle exchanges to be established in the United Kingdom. The British public body, the National Institute for Health and Care Excellence (NICE), introduced a recommendation in April 2014 due to an increase in the number of young people who inject steroids at UK needle exchanges. NICE previously published needle exchange guidelines in 2009, in which needle and syringe services were not advised for people under 18, but
3135-715: The HRWG's original participants had also been involved with ACT UP . The HRC itself was founded in San Francisco in 1994, moving to New York City soon after. 700 people attended the HRC's first conference, held in Oakland in 1996. The HRC was initially led by George Clark. Allan Clear was the NHRC's executive director from 1995 until 2016, when he left to take a job in the New York State government. Clear
3230-544: The Health Organization of the League of Nations. After World War II , the United Nations absorbed all the other health organizations, to form the WHO. During the 1945 United Nations Conference on International Organization, Szeming Sze , a delegate from China, conferred with Norwegian and Brazilian delegates on creating an international health organization under the auspices of the new United Nations. After failing to get
3325-655: The ISC, and included discussions of responses to yellow fever , brucellosis , leprosy , tuberculosis , and typhoid . In part as a result of the successes of the Conferences, the Pan-American Sanitary Bureau (1902), and the Office International d'Hygiène Publique or " International office of Public Hygiene " in english(1907) were soon founded. When the League of Nations was formed in 1920, it established
3420-681: The National District Attorneys Association (NDAA), Drug Watch International, The Heritage Foundation , Drug Free Australia, and so forth and religious organizations such as the Catholic Church . In the United States NEP programmes have proliferated, despite lack of public acceptance. Internationally, needle exchange is widely accepted. Two 2010 'reviews of reviews' by a team originally led by Norah Palmateer that examined systematic reviews and meta-analyses on
3515-635: The United Nations together with the exchange of letters related thereto, and taking into account the respective co-ordinating responsibilities of both organizations, it is recognized by the World Health Organization that the International Atomic Energy Agency has the primary responsibility for encouraging, assisting and co-ordinating research and development and practical application of atomic energy for peaceful uses throughout
3610-660: The United States to be operated at public expenses was established in Tacoma, Washington in November 1988. The Centers for Disease Control and Prevention and the National Institutes of Health confirm that needle exchange is an effective strategy for the prevention of HIV. The NIH estimated in 2002 that in the United States, 15–20% of injection drug users have HIV and at least 70% have hepatitis C. The Centers for Disease Control (CDC) reports one-fifth of all new HIV infections and
3705-586: The United States, where the One-for-one system still dominates, some 25% of injecting drug users are living positive with HIV; in Australia, which hands out equipment for free to anyone needing it (only charging a small fee for some more expensive equipment, like wheel filters and higher-quality tourniquets), only 1% of the IDU population is HIV-positive as of 2015, compared to over 20% in the late 1980s when NSP programs began to spread nationally and became accessible to most of
3800-480: The WHO over the organization's unwillingness to share the penicillin recipe. They would not return until 1956. 1950: A mass tuberculosis inoculation drive using the BCG vaccine gets under way. 1955: The malaria eradication programme was launched, although objectives were later modified. (In most areas, the programme goals became control instead of eradication.) 1958: Viktor Zhdanov , Deputy Minister of Health for
3895-590: The WHO was to report as to whether RTS,S /AS01, were a viable malaria vaccine . For the time being, insecticide -treated mosquito nets and insecticide sprays are used to prevent the spread of malaria, as are antimalarial drugs – particularly to vulnerable people such as pregnant women and young children. In 1988, WHO launched the Global Polio Eradication Initiative to eradicate polio . It has also been successful in helping to reduce cases by 99% since WHO partnered with Rotary International ,
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3990-425: The WHO's role and priorities in public health, ranging from narrowing its mandate to strengthening its independence and authority. During the 1970s, WHO had dropped its commitment to a global malaria eradication campaign as too ambitious, it retained a strong commitment to malaria control. WHO's Global Malaria Programme works to keep track of malaria cases, and future problems in malaria control schemes. As of 2012,
4085-498: The World Health Organization was signed by all 51 countries of the United Nations, and by 10 other countries, on 22 July 1946. It thus became the first specialized agency of the United Nations to which every member subscribed. Its constitution formally came into force on the first World Health Day on 7 April 1948, when it was ratified by the 26th member state. The WHO formally began its work in September 1, 1948. The first meeting of
4180-506: The Yarra Drug and Health Forum and North Richmond Community Health Centre and recommended 24-hour access to sterile injecting equipment due to the ongoing "widespread, frequent and highly visible" nature of illicit drug use in the areas. Between 2010 and 2012 a four-fold increase in the levels of inappropriately discarded injecting equipment was documented for the two suburbs. In the surrounding City of Yarra, an average of 1,550 syringes per month
4275-488: The amount of improperly disposed needles. Other ethnographic studies find evidence that criminal related drug possession laws further serve to increase improperly disposed of needles, and decreasing the severity of possession laws may positively impact proper syringe disposal, this corroborates the CDC's own guidelines on syringe disposal, which claim "Studies have found that syringe litter is more likely in areas without SSPs". On
4370-565: The basis for global prevention, treatment, and support the plan to fight the AIDS pandemic . 2006: The WHO launches the Global action plan for influenza vaccines 2016: The Global action plan for influenza vaccines ends with a report which concludes that while substantial progress has been made over the 10 years of the Plan, the world is still not ready to respond to an influenza pandemic. 2016: Following
4465-424: The budget and activities. The WHO is funded primarily by contributions from member states (both assessed and voluntary), followed by private donors. Its total approved budget for 2020–2021 is over $ 7.2 billion, while the approved budget for 2022–2023 is over $ 6.2 billion. The budget is $ 6.83 billion for 2024–2025. The International Sanitary Conferences (ISC), the first of which was held on 23 June 1851, were
4560-563: The client how many they brought back. The volume-based method left potential for gaming the system and an exchange agency in Vancouver devoted significant effort to game the system. Some, such as the Columbus Public Health in Ohio weigh the returned sharps rather than counting. The practices and policies vary between needle and syringe program sites. In addition to exchange, there is
4655-611: The continuing effects of nuclear disasters in Chernobyl and Fukushima . They believe WHO must regain what they see as independence. Independent WHO held a weekly vigil from 2007 to 2017 in front of WHO headquarters. However, as pointed out by Foreman in clause 2 it states: In particular, and in accordance with the Constitution of the World Health Organization and the Statute of the International Atomic Energy Agency and its agreement with
4750-417: The decriminalization of syringe purchase and possession in the US state of Rhode Island suggested that up to a third of police officers were not aware that the law had changed. This knowledge gap parallels other areas of public health law, underscoring pervasive gaps in dissemination. Even police officers with accurate knowledge of the law, however, reported intention to confiscate syringes from drug users as
4845-555: The effect of needle and syringe exchange alone on HIV incidence was limited and inconclusive, given "myriad design and methodological issues noted in the majority of studies." Four studies that associated needle exchange with reduced HIV prevalence failed to establish a causal link, because they were designed as population studies rather than assessing individuals. NEPs successfully serve as one component of HIV prevention strategies. Multi-component HIV prevention programmes that include NSE reduce drug-related HIV risk behaviors and enhance
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#17328767278244940-595: The effectiveness of NSPs in preventing HIV, 3 that were negative and 2 inconclusive. However a review by Käll et al. disagreed with the Wodak and Cooney review, reclassifying the studies on NSP effectiveness to 3 positive, 3 negative and 5 inconclusive. The US Institute of Medicine evaluated the conflicting evidence of both Drs Wodak and Käll in their Geneva session and concluded that although multicomponent HIV prevention programmes that include needle and syringe exchange reduced intermediate HIV risk behavior, evidence regarding
5035-829: The encounters detailed by respondents involved private security personnel, rather than local police. Similar findings have emerged internationally. For example, despite instituting laws protecting syringe access and possession and adopting NEPs, IDUs and sex workers in Mexico's Northern Border regions report frequent syringe confiscation by law enforcement personnel. In this region as well as elsewhere, reports of syringe confiscation are correlated with increases in risky behaviors, such as groin injecting, public injection and utilization of pharmacies. These practices translate to risk for HIV and other blood-borne diseases. NEPs serving predominantly IDUs of color may be almost four times more likely to report frequent client arrest en route to or from
5130-589: The establishment of international standards for biological products. The WHO was established on April 7, 1948, and formally began its work on September 1, 1948. It incorporated the assets, personnel, and duties of the League of Nations ' Health Organization and the Paris-based Office International d'Hygiène Publique , including the International Classification of Diseases (ICD). The agency's work began in earnest in 1951 after
5225-586: The fiftieth anniversary of WHO's founding. He, did, however, accept that more had to be done to assist maternal health and that progress in this area had been slow. 2000: The Stop TB Partnership was created along with the UN's formulation of the Millennium Development Goals . 2001: The measles initiative was formed, and credited with reducing global deaths from the disease by 68% by 2007. 2002: The Global Fund to Fight AIDS, Tuberculosis and Malaria
5320-505: The funding ban was in effect, it "may have led to HIV infection among thousands of IDUs, their sexual partners, and their children." US NEPs continue to be funded through a mixture of state and local government funds, supplemented by private donations. The funding ban was effectively lifted for every aspect of the exchanges except the needles themselves in the omnibus spending bill passed in December 2015 and signed by President Obama. This change
5415-449: The global smallpox eradication campaign by contributing $ 2.4 million annually to the effort and adopted a new disease surveillance method, at a time when 2 million people were dying from smallpox per year. The initial problem the WHO team faced was inadequate reporting of smallpox cases. WHO established a network of consultants who assisted countries in setting up surveillance and containment activities. The WHO also helped contain
5510-462: The impact of harm reduction services. Tilson (2007) concluded that only comprehensive packages of services in multi-component prevention programmes can be effective in reducing drug-related HIV risks. In such packages, it is unclear what the relative contribution of needle exchange may be to reductions in risk behavior and HIV incidence. Multiple examples can be cited showing the relative ineffectiveness of needle exchange programmes alone in stopping
5605-429: The inclusion criteria. Those were done by the teams of Gibson (2001), Wodak and Cooney (2004), Tilson (2007) and Käll (2007). The Palmateer team judged that their conclusion in favour of NSP effectiveness was not consistent with the results from the HIV studies they reviewed. The Wodak and Cooney review had, from 11 studies of what they determined as demonstrating acceptable rigour, found 6 that were positive regarding
5700-526: The last European outbreak in Yugoslavia in 1972 . After over two decades of fighting smallpox, a Global Commission declared in 1979 that the disease had been eradicated – the first disease in history to be eliminated by human effort. 1974: The Expanded Programme on Immunization and the control programme of onchocerciasis was started, an important partnership between the Food and Agriculture Organization (FAO),
5795-449: The late 20th century, the rise of new actors engaged in global health—such as the World Bank , the Bill & Melinda Gates Foundation, the U.S. President's Emergency Plan for AIDS Relief ( PEPFAR ) and dozens of public-private partnerships for global health—have weakened the WHO's role as a coordinator and policy leader in the field; subsequently, there are various proposals to reform or reorient
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#17328767278245890-446: The legal changes, gaps between the formal law and environment mean that many programmes continue to face law enforcement interference and covert programmes continue to exist within the U.S. Colorado allows covert syringe exchange programmes to operate. Current Colorado laws leave room for interpretation over the requirement of a prescription to purchase syringes. Based on such laws, the majority of pharmacies do not sell syringes without
5985-477: The monitoring of public health risks, coordinating responses to health emergencies, and promoting health and well-being generally. The WHO is governed by the World Health Assembly (WHA), which is composed of its 194 member states. The WHA elects and advises an executive board made up of 34 health specialists; selects the WHO's chief administrator, the director-general (currently Tedros Adhanom Ghebreyesus of Ethiopia ); sets goals and priorities; and approves
6080-457: The organisation's director Professor Mike Kelly explained that a "completely different group" of people were presenting at programmes. In the updated guidance, NICE recommended the provision of specialist services for "rapidly increasing numbers of steroid users", and that needles should be provided to people under the age of 18—a first for NICE—following reports of 15-year-old steroid injectors seeking to develop their muscles. The first program in
6175-513: The other hand, there is data to suggest SEPs do increase improper syringe disposal. Opposition groups contribute their own proof through photographic evidence of increased needle litter, additionally, opponents argue that programs which do not mandate a 1:1 needle exchange encourage the more convenient improper discarding of needles when the programs are not open or are not accepting needle returns. Additionally, many programs allow for unlimited access to needles, which opponents argue increases litter to
6270-470: The other organization has or may have a substantial interest, the first party shall consult the other with a view to adjusting the matter by mutual agreement. The nature of this statement has led some groups and activists including Women in Europe for a Common Future to claim that the WHO is restricted in its ability to investigate the effects on human health of radiation caused by the use of nuclear power and
6365-546: The perceived failure of the response to the West Africa Ebola outbreak , the World Health Emergencies programme was formed, changing the WHO from just being a "normative" agency to one that responds operationally to health emergencies. 2020: the World Health Organization announced that it had classified the novel coronavirus outbreak as a public health emergency of international concern. The novel coronavirus
6460-512: The population. Programs providing sterile needles and syringes currently operate in 87 countries around the world. IA comprehensive 2004 study by the World Health Organization (WHO) found a "compelling case that NSPs substantially and cost effectively reduce the spread of HIV among IDUs and do so without evidence of exacerbating injecting drug use at either the individual or societal level." WHO's findings have also been supported by
6555-696: The program (operating legally vs illegally) and jurisdiction's syringe regulation environment were not associated with frequency of police interference. A detailed 2011 analysis of NEP client experiences in Los Angeles suggested that as many as 7% of clients report negative encounters with security officers in any given month. Given that syringes are not prohibited in the jurisdiction and their confiscation can only occur as part of an otherwise authorized arrest, almost 40% of those who reported syringe confiscation were not arrested. This raises concerns about extrajudicial confiscation of personal property. Approximately 25% of
6650-976: The program and almost four times more likely to report unauthorized syringe confiscation. A 2005 study in Philadelphia found that African-Americans accessing the city's legally operated exchange decreased at more than twice the rate of white individuals after the initiation of a police anti-drug operation. These and other findings illustrate a possible mechanism by which racial disparities in law enforcement can translate into disparities in HIV transmission. The majority (56%) of respondents reported not documenting adverse police events; those who did were 2.92 times more likely to report unauthorized syringe confiscation. These findings suggest that systematic surveillance and interventions are needed to address police interference. Police interference with legal NEP operations may be partially explained by training defects. A study of police officers in an urban police department four years after
6745-475: The programme name, the Portland needle exchange operated by Multnomah County hands out syringes to addicts who do not present any to exchange. The exchange programme reports 70% of their users are transients who experience "homelessness or unstable housing" It was reported that during the fiscal year 2015–2016, the county dispensed 2,478,362 syringes and received 2,394,460, a shortage of 83,902 needles. In 2016, it
6840-459: The programmes' disease prevention effectiveness is due to inherent design limitations of the reviewed primary studies and should not be interpreted as the programmes lacking preventive effects. The second of the Palmateer team's 'review of reviews' scrutinised 10 previous formal reviews of needle exchange studies, and after critical appraisal only four reviews were considered rigorous enough to meet
6935-427: The programs returned a staggering $ 27 for every $ 1 invested. The study notes that over a longer time horizon than that considered (10 years) the cost-benefit ratio grows even further. In terms of infections averted and lives saved, the study finds that, between 2000 and 2009, 32,000 HIV infections and 96,667 hepatitis C infections were averted, and approximately 140,000 disability-adjusted life years were gained. From
7030-482: The removal of abandoned needles littering the streets of San Francisco. As of 2011, at least 221 programmes operated in the US. Most (91%) were legally authorized to operate; 38.2% were managed by their local health authorities. The CDC reported in 1993 that the most significant expenses for the NSPs is personnel cost, which reports it represents 66% of the budget. More than 36 million syringes were distributed annually, mostly through large urban programmes operating
7125-448: The same number of syringes must be returned. According to Santa Cruz County, California , exchange staff interviewed by Santa Cruz Local in 2019, it is a common practice not to count the number of exchanged needles exactly, but rather to estimate the number based on a container's volume. Holyoke, Massachusetts , also uses the volume system. United Nations Office on Drugs and Crime for South Asia suggests visual estimation or asking
7220-404: The spread of HIV among intravenous drug users. These supposed benefits have led to an expansion of these programmes in most jurisdictions that have introduced them, increasing geographical coverage and operating hours. Vending machines that automatically dispense injecting equipment have been successfully introduced. World Health Organization The World Health Organization ( WHO )
7315-481: The spread of blood-borne disease. Many needle exchange programmes do not make any serious effort to treat drug addiction. For example, David Noffs of the Life Education Center wrote, "I have visited sites around Chicago where people who request info on quitting their habit are given a single sheet on how to go cold turkey—hardly effective treatment or counseling." A 2013 systematic review found support for
7410-522: The status of syringe possession more broadly. For example, between 1989 and 1992, three exchanges in New York City tagged syringes to help demonstrate rates of return prior to the legalization of the approach. By 2012, legal syringe exchange programmes existed in at least 35 states. In some settings, syringe possession and purchase is decriminalized, while in others, authorized NEP clients are exempt from certain drug paraphernalia laws. However, despite
7505-450: The topic found insufficient evidence that NSP prevents transmission of the hepatitis C virus , tentative evidence that it prevents transmission of HIV , and sufficient evidence that it reduces self-reported risky injecting behaviour. In a comment Palmateer warned politicians not to use her team's review of reviews as a justification to close existing programmes or to hinder the introduction of new needle-exchange schemes. The weak evidence on
7600-426: The use of NEPs to prevent and treat HIV and HCV infection. A 2014 systematic review and meta-analysis found evidence that NEPs were effective in reducing HIV transmission among injection drug users, but that other harm reduction programmes have probably also contributed to the decrease in HIV incidence. NEPs appear to be as effective in low- and middle-income countries as in high-income ones. Lemon and Shah presented
7695-417: The vast majority of hepatitis C infections are the result of injection drug use. United States Department of Health and Human Services reports 7%, or 2,400 cases of HIV infections in 2018 were among drug users. Portland, Oregon , was the first city in nation to expend public funds on a NSP which opened in 1989. It is also one of the longest running programme in the country. Despite the word "exchange" in
7790-488: The world without prejudice to the right of the World Health Organization to concern itself with promoting, developing, assisting and co-ordinating international health work, including research, in all its aspects. The key text is highlighted in bold, the agreement in clause 2 states that the WHO is free to perform any health-related work. 1947: The WHO established an epidemiological information service via telex . 1949: The Soviet Union and its constituent republics quit
7885-407: The world's people, defining health as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." The main functions of the World Health Organization include: to promote the control of epidemic and endemic diseases; to provide and improve the teaching and training in public health, the medical treatment of disease and related matters; and to promote
7980-405: The world. Needle and syringe programs operate differently in different parts of the world; the first NSPs in Europe and Australia gave out sterile equipment to drug users, having begun in the context of the early AIDS epidemic. The United States took a far more reluctant approach, typically requiring IDUs to already have used needles to exchange for sterile ones - this "One-for-one" system is where
8075-500: Was a new strain of coronavirus that had never been detected in humans before. The WHO named this new coronavirus " COVID-19 " or "2019-nCov". 2022: The WHO suggests formation of a Global Health Emergency Council, with a new global health emergency workforce, and recommends revision of the International Health Regulations. 2024: WHO has declared the spread of mpox (formerly monkeypox) in several African countries
8170-557: Was briefly lifted in 2009, reinstated in 2010, and partially lifted again in 2015. Currently, federal funds can still not be used for the purchase of needles and syringes or other injecting paraphernalia by needle exchange programs, though can be used for training and other program support in the case of a declared public health emergency. In the time between 2010 and 2011 when no ban was in place, at least three programmes were able to obtain federal funds and two-thirds reported planning to pursue such funding. A 1997 study estimated that while
8265-614: Was collected from public syringe disposal bins in 2012. Paul Dietze stated, "We have tried different measures and the problem persists, so it's time to change our approach". On 28 May 2013, the Burnet Institute stated that it recommended 24-hour access to sterile injecting equipment in the Melbourne suburb of Footscray after the area's drug culture continued to grow after more than ten years of intense law enforcement efforts. The institute's research concluded that public injecting behaviour
8360-526: Was concerning the compilation of accurate statistics on the spread and morbidity of disease. The logo of the World Health Organization features the Rod of Asclepius as a symbol for healing. In 1959, the WHO signed Agreement WHA 12–40 with the International Atomic Energy Agency (IAEA), which says: whenever either organization proposes to initiate a programme or activity on a subject in which
8455-469: Was difficult to reach. Seven of these international conferences, spanning 41 years, were convened before any resulted in a multi-state international agreement. The seventh conference, in Venice in 1892, finally resulted in a convention. It was concerned only with the sanitary control of shipping traversing the Suez Canal , and was an effort to guard against importation of cholera. Five years later, in 1897,
8550-416: Was drawn up to improve the resources available. 2005: The WHO revises International Health Regulations (IHR) in light of emerging health threats and the experience of the 2002/3 SARS epidemic , authorizing WHO, among other things, to declare a health threat a Public Health Emergency of International Concern . 2006: The WHO endorsed the world's first official HIV/AIDS Toolkit for Zimbabwe, which formed
8645-403: Was first suggested by Kentucky Republicans Hal Rogers and Mitch McConnell , according to their spokespeople. Many states criminalized needle possession without a prescription, arresting people as they left underground needle exchange efforts. In some jurisdictions, such as New York, needle exchange activists challenged the laws in court, with judges ruling that their actions were justified by
8740-698: Was formed. 1988: The Global Polio Eradication Initiative was established. 1995: The WHO established an independent International Commission for the Certification of Dracunculiasis Eradication (Guinea worm disease eradication; ICCDE). The ICCDE recommends to the WHO which countries fulfil requirements for certification. It also has role in advising on progress made towards elimination of transmission and processes for verification. 1998: The WHO's director-general highlighted gains in child survival, reduced infant mortality , increased life expectancy and reduced rates of "scourges" such as smallpox and polio on
8835-649: Was identified by 72% of respondents as the key to improving police relations. Organizations ranging from the NIH, CDC, the American Bar Association , the American Medical Association , the American Psychological Association , the World Health Organization and many others endorsed low-threshold programmes including needle exchange. Needle exchange programmes have faced opposition on both political and moral grounds. Advocacy groups including
8930-496: Was replaced by Monique Tula, formerly Vice President of Programs at AIDS United . Laura Guzman, an Argentinian-American lawyer who had worked for the HRC since 1995, became the executive director in 2023. In 2020 the HRC rebranded as the National Harm Reduction Coalition and revamped its website. Needle exchange A needle and syringe programme ( NSP ), also known as needle exchange program ( NEP ),
9025-532: Was reported that the Cleveland needle exchange program sees "mostly white suburban kids ages 18 to 25". Since the full sanction of syringe exchange programs (SEP) by then-Mayor Frank Jordan in 1993, the San Francisco Department of Public Health has been responsible for the management of syringe access and the proposed disposal of these devices in the city. This sanction, which was originally executed as
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