Effectiveness of sterile needle and syringe programmes

This is the first comprehensive international review of the evidence for needle syringe programmes. The major, and now overwhelmingly strong, finding is that needle syringe programmes reduce HIV transmission effectively, safely and cost effectively. The size of the benefit is substantial. There is compelling evidence that needle syringe programmes reduce HIV incidence and HIV prevalence by reducing HIV risk behaviour. The Bradford Hill criteria, generally regarded as the most robust method of assessing public health interventions, were used for the evaluation framework. Conservatively, six of the nine Bradford Hill criteria were fulfilled (strength of association, replication of findings, temporal sequence, biological plausibility, coherence of evidence, and reasoning by analogy). Three of the Bradford Hill criteria were not fulfilled (specificity of association, biological gradient and experimental evidence). Five additional criteria were clearly fulfilled ( a o a d a e c ©