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Part 1

Valente et al. (2001) conducted research whereby the research questions include: What is the influence of the use of Needle Exchange programs (NEP) on syringe circulation times and syringe relay behavior among intravenous drug users? Valente et al. (2001, P.341) state, “This article determines the extent NEP use was associated with exclusive versus secondary exchange and how it was associated with syringe circulation times.” The purpose of this question is to determine the efficacy of NEPs in preventing HIV transmission among IDUs. The sample consists of 2,574 individuals participating in Maryland's Baltimore Needle Exchange Program (BNEP). From August 1994 to February 1997, 30 months were devoted to the study. The primary dependent variable is HIV seroconversion, which refers to the participants' acquisition of HIV during the study period. The principal independent variable is BNEP use. A registration questionnaire was administered to participants upon enrollment in the BNEP to capture the data. The most significant finding is that exclusive NEP users (participants who returned their syringes) had an inferior risk of HIV seroconversion than NEP users who engaged in syringe relays (returning syringes issued to someone else).

Kerr et al. (2010) explored the research question of whether the SEP policy change was linked to variations in syringe sharing and the prevalence of HIV. Kerr et al. (2010, P.1449) state, "We sought to determine if the change in SEP policy was associated with changes in rates of used syringe sharing and HIV incidence among IDU.” The goal of the question was to observe the effect of changes in SEP policy, specifically a shift from an emphasis on syringe exchange to an emphasis on syringe distribution, syringe-sharing behaviors, and the incidence of HIV among IDUs. The sample comprised one thousand two hundred twenty-eight injection drug users (IDUs) in British Columbia, Vancouver, and Canada. Results were tracked longitudinally through baseline and twice a year follow-up visits, including an interviewer directed questionnaire and a blood sample. The investigation was conducted between 1998 and 2003. The incidence of HIV among injection drug users (IDUs) is the dependent variable, while the independent variables include the period preceding and following the variation in SEP policy, age, and gender. Participants completed a questionnaire administered by an interviewer and provided a blood sample during semiannual follow up visits to collect data. The most important finding was that the period after the change in SEP policy, which improved access to sterile syringes, was autonomously allied with significant decreases in syringe lending, syringe borrowing, and HIV incidence among injection drug users.

Target population behavior and definition can significantly affect program evaluation for marginalized or stigmatized populations like NEP/SEP. The target population's views and biases can influence program design, implementation, and evaluation. NEP/SEP target populations, such as injection drug users, typically experience stigma and negative preconceptions due to drug use. Stigmatization can lead policymakers and the public to regard NEP/SEP as encouraging drug use rather than a harm reduction method. Negative impressions may hamper program acceptability and support, making implementation and expansion difficult for marginalized groups, including the LGBTQ community (Lewis et al., 2017). Additionally, they are affected by the public perception of "Otherness." Programs for "other" populations may be resisted by society. NEP/SEP programs may be considered as assisting a marginalized or unworthy demographic. Some groups may oppose these programs, influencing financing, support, and political will.

The success of such programs can be assessed by reducing HIV incidence and other related issues. If the incidence of a setting goes down, it indicates that the programs have been successful. In terms of bias, it can have a significant effect on the outcomes, and therefore, measuring success can only include observing the attitudes and inclusion of populations in studies and the healthcare process. More inclusion and better studies indicate lesser occurrences of biases. In general, Policymakers, researchers, and the general public hold beliefs, attitudes, and prejudices regarding the target population of a program or intervention. In his case, the target population refers to the individual's research aims to understand or help. NEP/SEP programs, for example, target injectable drug users, a stigmatized group. Negative perceptions can affect program evaluation research designs, data collecting, and interpretation. Target population perceptions can skew program evaluations: Society and healthcare providers may stigmatize injectable drug users. This can hinder target population participation in NEP/SEP programs. Selection bias might restrict the generalizability of evaluation findings if particular injection drug user populations are disproportionately excluded or reluctant to participate in the program. Finally, Politicians that see injection drug users negatively may be less likely to sponsor NEP/SEP programs. This is true because social construction has been seen to affect policy agenda (Schneider & Ingram, 1993). Thus, these initiatives may be under-capacitated and lack sufficient support. Insufficient resources can limit program execution and data collecting, affecting program assessments.

References

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Kerr, T., Small, W., Buchner, C., Zhang, R., Li, K., Montaner, J., & Wood, E. (2010). Syringe sharing and HIV incidence among injection drug users and increased access to sterile syringes. American journal of public health, 100(8), 1449-1453.

Lewis, D. C., Flores, A. R., Haider-Markel, D. P., Miller, P. R., Tadlock, B. L., & Taylor, J. K. (2017). Degrees of acceptance: Variation in public attitudes toward segments of the LGBT community. Political Research Quarterly, 70(4), 861–875. https://doi.org/10.1177/1065912917717352

Schneider, A., & Ingram, H. (1993). Social construction of target populations: Implications for politics and policy. American political science review, 87(2), 334–347. https://doi.org/10.2307/2939044

Valente, T. W., Foreman, R. K., Junge, B., & Vlahov, D. (2001). Needle-exchange participation, effectiveness, and policy: syringe relay, gender, and the paradox of public health. Journal of Urban Health, 78, 340-349. https://doi.org/10.1093/jurban/78.2.340