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Jefferson County Syringe Exchange Program (SEP)
Annual Report 2014
Jefferson County Public Health has provided a Syringe Exchange Program (SEP) since 2000 as part of a
State effort to reduce the risk of HIV and other blood-borne infections among injection drug users, their
families, and communities. SEP services include access to clean syringes, disposal of used syringes,
prevention supplies, risk reduction education, and referral services. Education includes verbal and printed
information on HIV, hepatitis, STDs, overdose prevention, encouraging one time use of needles, health
alerts (for example, wound botulism and recent heroin overdoses/deaths), and immunizations. Internal
referrals include STD, HIV, and Hepatitis C screening and counseling, tuberculosis screening, family
planning, and immunizations. External referrals include drug and alcohol treatment, medical care, mental
health care, domestic violence, food, clothing, and shelter.
JCPH funded the SEP from 2000 – 2011 with State HIV prevention dollars. The CDC guidelines shifted
in 2011 to focus funding for HIV Prevention Programs on high risk populations based on local HIV
prevalence. Jefferson County is classified as a low prevalence county so it does not qualify for funding.
There has been no State funding available since 2011. There is some discussion at the State level about
finding a way to reinstitute funding for SEPs statewide. The State has provided one bulk order of supplies
for county SEPs once each year since 2012.
Syringe exchange program success is not easily measured in disease prevention numbers but the number
of clients seen and syringes exchanged reflects the disease transmission prevention capacity of this
program. SEP utilization increased significantly in 2014, with 350 visits, up from 185 visits in 2013. The
number of syringes dispensed was 42,809, up from 24,596 in 2013. The number of IDU prevention
materials dispensed increased from 15,984 to 18,373. See tables and graphs on following pages.
The State Public Health Lab provides a limited number of free HIV tests for high risk clients. Though
there is no state funding for staff time for HIV counseling and testing services, JCPH staff continues to
offer this service for low income high risk clients with no medical coverage. Others requesting testing will
be tested through the Quest lab and the cost of the testing will be billed to the client/insurance.
Throughout 2014 staff encouraged uninsured clients to sign up for health insurance through
www.wahealthplanfinder.org and offered appointments to assist clients.
During the last 4 months of 2014, in response to an increase in gonorrhea cases in the community, all SEP
clients were encouraged to be tested for gonorrhea/chlamydia while at SEP. The 2014 Communicable
Disease Program Performance Measures Report contains a discussion of this outbreak.
Funding for State and federal programs for free Hepatitis C testing for high risk clients ended in 2012.
The State piloted a new Hepatitis C testing program in a few counties in 2014. JCPH plans to offer this
testing in 2015. Five doses of State supplied Hepatitis A/B vaccine were administered at no charge in
2014.
Naloxone is a medication used to reverse opioid overdose and provide time for transportation to the ER
for additional overdose treatment. Naloxone is available to injection drug users, their friends, and families
in eight or more Washington counties at SEPs or through partnerships with pharmacies. JCPH staff
contacted local pharmacies to ask about willingness to stock naloxone. This was followed up by a letter
from the Health Officer and Board of Health encouraging pharmacies to stock naloxone and the nasal
atomizers for nasal spray administration. One pharmacy has expressed interest in this program. JCPH will
continue to set up protocols and training needed for this program so that naloxone will be available in
Jefferson County in mid-2015.
Jefferson County SEP Clinics/Demographics
SEP
Visits1
New
Clients
Returning
Client
Visits1
Secondary
Exchange
Visits1
Female
Client
Visits1
Male
Client
Visits1
2014 350 50 300 227 199 145
2013 185 28 157 126 115 70
2012 150 18 132 96 NA NA
2011 142 19 123 110 NA NA
2010 81 13 68 40 NA NA
2009 65 12 53 35 NA NA
2008 68 6 64 67 NA NA
2007 65 9 56 58 NA NA
2006 54 8 50 49 NA NA
2005 36 6 30 29 NA NA
2004 64 12 48 45 NA NA
2003 63 9 55 53 NA NA
2002 41 11 29 25 NA NA
2001 16 6 9 5 NA NA
2000 14 3 7 3 NA NA
Note: 1Represents duplicate clients
New Client Visits by Age
Total
Female
Total
Male
Female
< 20 yr
Female
20 -29 yr
Female
30+ yr
Male
< 20 yr
Male
20 -29 yr
Male
30+ yr
2014 20 29 2 7 11 3 8 18
2013 13 15 6 4 3 2 6 7
Total Client Visits by Age
< 20 years 20 -29 years 30+ years
2014 53 (15%) 100 (29%) 191 (56%)
2013 23 (12%) 77 (42%) 84 (46%)
14 16
41 63 64
36
58 65 70 65
81
142 150
185
350
506 2,076
4,206
9,222
18,060
13,716
17,905
24,585
21,133
14,044
9,156
17,726 17,405
24,596
42,809
-
5,000
10,000
15,000
20,000
25,000
30,000
35,000
40,000
45,000
-
50
100
150
200
250
300
350
400
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
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Syringe Exchange Utilization, 2000-2014
Jefferson County Washington
Number of client visits
Number of syringes
exchanged
2011 – 2014 SEP Clinic Participant Visits by Zip Code
2011 – 2014 SEP Clinic Participant Reported Syringe Use
2011 – 2014 SEP Clinic Participant Secondary Exchange
59%
29%
11%
60%
34%
5%
59%
38%
3%
57%
41%
2%
0%
10%
20%
30%
40%
50%
60%
70%
98368 Other within Jefferson Cty Outside Jefferson Cty
2011
2012
2013
2014
49%
22%
3%
26%
64%
12%
2%
22%
64%
21%
1%
14%
67%
25%
1%
7%
0%
10%
20%
30%
40%
50%
60%
70%
80%
Each syringe used
once
Each syringe used 2-
5 times
Each syringe used
6+ times
Unknown
2011
2012
2013
2014
17%18%
38%
22%
5%
32%
9%
49%
6%4%
31%
11%
47%
10%
1%
35%
17%
39%
8%
1%
0%
10%
20%
30%
40%
50%
60%
No secondary
exchange
Exchanging for
one other
person
Exchanging for
2-5 other
people
Exchanging for
6+ other people
Unknown
2011
2012
2013
2014
Materials Distributed by Jefferson County SEP
Syringes
Exchanged
IDU
Prevention
Materials1
Condoms/
Latex
Barriers2
HIV Tests
Offered
Educational
Materials3
Provided
Referral
Information4
Outreach
Education5
2014 42,809 18,373 625 114 52 139 177
2013 24,596 15,984 377 90 18 129 105
2012 17,405 11,535 406 49 28 128 90
2011 17,726 16,512 319 41 10 142 86
2010 9,156 11,024 102 36 7 67 29
2009 14,044 7,098 271 31 26 51 33
2008 21,330 7,941 140 27 32 35 32
2007 24,585 9,988 20 22 18 23 N/R7
2006 17,905 9,000 0 2 3 2 N/R
2005 13,716 7,611 20 0 6 11 N/R
2004 18,060 7,265 228 N/O6 48 11 N/R
2003 9,222 1424 800 N/O 42 18 N/R
2002 4,206 1,026 427 N/O 50 NA N/R
2001 2,076 3 14 N/O 9 5 N/R
2000 506 11 33 N/O 10 2 N/R
Notes
1 IDU Prevention Materials include: Tourniquets, cookers, cottons, sterile water, sharps containers, alcohol preps, antibiotic
ointment, band aids and sterile pads for wounds, tape. Individual items are given on an as needed basis.
2 This number is for condoms dispensed in SEP only, condoms may also be picked up in the lobby.
3 Educational Materials include information on hepatitis, HIV, STDs, health alerts (ex. wound botulism, overdose), care of
abscesses, street drugs, tattoo safety, needle reuse, IDU safety, domestic violence, immunizations.
4 Referrals: Internal referrals include STD, HIV and Hepatitis C screening and counseling, tuberculosis screening, family
planning and immunizations. External referrals include drug treatment, medical care, mental health care, domestic violence,
food, clothing and shelter.
5 Outreach education is defined as face-to-face education on blood borne pathogens, risk reduction methods, safe injecting
practices, vein care, and other as needed.
6 N/O: Not offered
7 N/R: Not reported
2015 Goals
Continue anonymous, safe services to reduce the risk of HIV infection in our communities by promoting
revisits by clients and to encourage clients to tell others about SEP.
Continue to educate clients on the importance and rational of using each syringe one time only.
Continue development of program for overdose prevention and naloxone availability.
Continue to inform clients at each visit of resources available at JCPH and in the community.
Continue to offer free HIV testing and counseling at each visit through the State laboratory for high risk
clients without medical coverage.
Encourage uninsured clients to sign up for health insurance through www.wahealthplanfinder.org
Resume offering free Hepatitis C testing when State has new program in place; continue offering Hepatitis
A & B vaccine.
Continue dialog with clients regarding improvement of SEP services.
Prioritize supplies to be stocked, keeping only those deemed necessary to maintain safe practices among
IDU clients. Inform clients of alternative safe materials, such as using soda bottles for the collection of
used needles in lieu of sharps containers.
3/20/2015