Low-threshold treatment program
[11] Similarly, in many European countries NSP outlets serve as low-threshold primary health care centers targeting primarily IDUs.[19] On the other hand, over half of the countries in Asia, the Middle East, and North Africa retain the death penalty for drug offenses, although some have not carried out executions in recent years.[23] It has also been argued that in fighting disease, needle exchanges take attention away from bigger drug problems, and that, contrary to saving lives, they actually contribute to drug-related deaths.[26] A single 1997 study which showed a correlation between frequent program use and elevated rates of HIV infection among IDUs in Vancouver, Canada,[27] has become widely cited by opponents of NSPs as demonstrating their counter-productiveness.[33][34] Narrower focus studies dealing solely with the needle exchange issue are abundant, however, and generally support the thesis that NSPs reduce the risk of prevalence of HIV, hepatitis and other blood-borne diseases.[21][30][35][36] In Australia, monitoring of drug users participating in NSPs showed the incidence of HIV among NSP clients to be essentially identical to that of the general population.[38] Internationally, support for the effectiveness of low-threshold programs including needle exchange have come from studies conducted in Afghanistan,[39] China,[40] Spain,[41] Taiwan,[42] Estonia,[43] Canada,[44] Iran,[45] and many other countries.