I refer to the letter entitled Syringes: A Public Health Hazard by Mario Saliba (August 23).

Needle exchange programmes have been the subject of much debate. Needle and syringe programmes are public health measures aimed at reducing the transmission of blood-borne infections through a reduction in needle sharing among injecting drug users. It has been found that such programmes are effective in preventing the spread of Hepatitis B and C and HIV, without encouraging illicit drug use. In fact, Malta has a low prevalence of Hepatitis B and C and HIV among injecting drug users in comparison to other countries. It is very likely that a major factor contributing to this is the early introduction of the syringe distribution scheme to ensure accessibility to sterile injecting equipment.

In February 2002, sedqa, the National Agency Against Drug and Alcohol Abuse, initiated a needle exchange programme, in collaboration with the Department of Primary Health Care, after studying even foreign programmes and seeing how they can be adapted to the Maltese cohort of injecting drug users. This consisted of a system of safe-disposal bins given out with a number of syringes from health centres. The system entailed users throwing these safe receptacles into metal disposal bins at the health centres once they are full of used syringes in order to be properly disposed of.

Despite the very low risk of accidental needle-stick injury, the agency devised this project to address the issue of the safe disposal of used syringes. In fact, to date, in Malta there have been no reported cases of Hepatitis or HIV resulting from a needle-stick injury from syringes discarded by drug users.

The aims of the needle-exchange project, which was also piloted in three health centres before it was adapted in all local health centres, were mainly to discourage the sharing of needles and equipment and thus prevent the spread of blood-borne diseases, encourage drug users to make contact with a counselling/treatment service, and promote changes in the disposal patterns of drug abuse by offering a safe method to do this. An on-going campaign, both on the media and with drug users already in contact with sedqa's services, supported the project.

We also found the co-operation of other entities while staff at health centres were purposely trained. Collaboration also included the police and the drug squad in particular. This was important because of the legal implications involved. Unfortunately, the suspicion of drug addicts that they might be prosecuted if found in possession of a safe bin with used syringes was enough to seriously limit the success of the scheme.

This situation reinforces the behaviour whereby drug abusers get syringes and discard them immediately after use. Eventually, this resistance and widespread attitude of the drug users against the use of the safe bins led to the project being discontinued.

However, harm minimisation is still widely promoted among sedqa's clients and also between the injecting drug users themselves. In fact, they have several safe methods that they adopt, and most of them would dispose of used syringes where they cannot be reached by other persons, especially children. This information came to light during a focus group that the agency held with injecting drug users during an evaluation of the needle exchange programme.

Sedqa believes that the emphasis on harm minimisation procedures and the promotion existing, accepted safe methods of disposing of used syringes among injecting drug users, would leave more positive results. To complement this, sedqa also collaborates with the police, local councils and also with employees of the Works Department, who are provided with special tools to collect used syringes should they encounter any disposed of unsafely in public places. This apart from the fact that sedqa still seeks possible initiatives to counteract this issue.

Finally one has to point out that our Detox outpatient centre is one of the centres in Europe that is highly accessible and therefore enjoys a high activity rate. This means that our centre is more in touch with the greater part of the heroin-abusing population as opposed to other European centres where services are more limited and therefore more clients are out on the streets without care and not accounted for in the statistics of the centres. Therefore, the sheer numbers and comparisons may be deceiving unless interpreted correctly.

Sedqa offers its care services both within the community and in residential settings. People requiring help regarding problems related to substance abuse can be referred, refer themselves to these services or access more information by calling Helpline 151, or by visiting the Agency's website www.sedqa.gov.mt