Courtesy of The Lindesmith Center, New York City

Needle exchange programs (NEPs) are a simple, cost-effective way to reduce needle sharing, curtail the transmission of HIV/AIDS, increase the safe disposal of used needles, provide information to injecting drug users (IDUs), and help users obtain drug treatment, detox, and primary health care. Yet the U.S. government prohibits federal funding of NEPs, and many state governments criminalize them. By contrast, national and local governments in Western Europe and Australia have made sterile syringes widely accessible through needle exchanges and pharmacies.

Scientific communities support needle exchanges.

• Virtually every scientific body supports needle exchanges: the United States Centers for Disease Control, the National Commission on AIDS, the General Accounting Office, the National Academy of Sciences.
• The National Commission on AIDS concluded "Legal sanctions on injection equipment do not reduce illicit drug use, but they do increase the sharing of injection equipment and hence the spread of AIDS."

Needle exchanges reduce the spread of HIV/AIDS.

• As the use of needle exchanges increases, the use of shared needles decreases.
• A 1994 study of New York City IDUs concluded that "regular participation in these syringe exchange programs would reduce the risk of HIV infection by approximately half."
• In one month in 1992, the Prevention Point NEP in San Francisco disposed of approximately 8600 HIV-contaminated syringes.
• In a 1992 study of needle exchange clients in New Haven, Connecticut, new HIV infections were cut by one-third.
• Diabetic IDUs with legal access to clean needles had significantly lower rates of HIV than non-diabetic IDUs -- 9.8% versus 24.3% -- even though the duration and intensity of drug use were similar.

The costs of AIDS are rapidly rising in both human and economic terms.

• By 1994, 125,000 people had developed AIDS as a result of injecting drugs with unsterile syringes.
• Over a third of new AIDS cases stem from injection drug use.
• AIDS is the leading cause of death among all Americans aged 25 to 44.
• As more and more people contract HIV through dirty needles, the proportion of all AIDS patients who are injecting drug users (IDUs), their sex partners, or their children is growing.
• The cumulative cost in the United States of treating all people with HIV or AIDS will be $15.2 billion in 1995.
• NEPs have a median annual budget of $169,000. Since the yearly cost of treating one person with AIDS is $38,300, each needle exchange program would more than pay for itself by preventing the transmission of HIV/AIDS to just five people.

Drug paraphernalia and prescription laws impede the establishment of needle exchanges.

• NEPs in the United States are either legal, decriminalized, or illegal. The legal status of NEPs depend on individual states' drug paraphernalia and prescription laws, and on local laws.
• All but six U.S. states have drug paraphernalia laws that criminalize the possession or distribution of syringes except for "legitimate medical purposes."
• Nine states and Washington, D.C. prohibit the purchase of syringes without a prescription. These laws -- in states like New York, California, and Illinois which have large IDU and HIV/AIDS populations -- affect the vast majority of illicit drug injectors.
• Local governments, which understand the need for NEPs, sometimes grant exemptions to state laws against them.
• By the late 1980s, virtually all developed countries other than the U.S. had made legal access to sterile injection equipment a primary component of AIDS prevention for IDUs. NEPs are now commonplace throughout the Netherlands, Britain, Switzerland, Australia, and dozens of other European cities.

Needle exchanges in action: How they work, whom they affect.

• There are approximately 77 needle exchange programs, more than double the number in 1993, when the existing 33 NEPs administered a total of 102 exchange sites. The number continues to grow.
• Most NEPs operate on the principle of a one-for-one exchange: the user receives one clean needle for every used needle he brings.
• The vast majority of needle exchange sites are storefronts, scheduled mobile van stops at designated street corners, or street exchanges by outreach workers.
• In addition to providing needles, programs distribute alcohol swabs to clean the skin before injection, medicative ointments for infections, sterile water, vials of bleach to disinfect used needles when new ones are not available, health pamphlets, condoms, and sharpsafe containers where users can safely dispose of dirty needles.
• People who use needle exchanges are not new users who start injecting because they can get clean needles. One year after a San Francisco needle exchange opened, only 3% of the clients had used drugs for less than a year. 3 years later, only 1.1% had.
• The 1988 opening of Prevention Point, an active NEP in San Francisco, did not draw people to start using drugs. The minimum age of IDUs in San Francisco remained virtually the same from 1987 to 1992, and the mean age increased by almost five years from 35.8 years to 41.6 years. Since NEPs operate on a one-for-one exchange, they provide an incentive against discarding needles on the street. A study conducted by Portland's NEP Outside-In found that the number of needles discarded in the neighborhood with the needle exchange dropped after the NEP opened.

Other needle distribution methods can augment the effectiveness of needle exchanges.

• Different options for obtaining syringes should be available to meet the different needs of different users. The 1988 UK Advisory Council on the Misuse of Drugs declared "a combination of syringe exchange schemes and over- the-counter sales from community pharmacies offers the best solution [to IDUs' lack of access to sterile injection equipment]."
• Pharmacies sell syringes in almost all countries in Europe and Australia. Pharmacies make needles readily available to most people since they are located virtually everywhere and are open at all hours. In addition, pharmacies do not carry the stigma some associate with NEPs.
• In over a dozen European and Australian cities, needles are available from vending machines which deliver a clean needle when a used one is deposited. They make sense especially in high-use drug areas where users need clean syringes late at night, and in rural areas or smaller cities where the IDU population isn't big enough to support needle exchanges.

The government should make specific policy changes to curtail the spread of AIDS.

• State governments should repeal their drug paraphernalia laws so that possession of syringes is legal.
• The nine state governments with prescription laws should repeal those laws so that pharmacies and NEPs can legally sell or distribute syringes.
• Local governments should seek exemptions to the prescription laws until these laws are repealed.
• The federal government should repeal the ban on federal funding of NEPs.
• The federal government should begin funding NEPs to expand the network of needle exchanges and increase their hours of operation, both of which would make sterile syringes more accessible. The funding would also enable NEPs to provide services like primary health care and testing for tuberculosis.

For further information or source citations, contact Dan Weiller at (212) 887-0695 or via e-mail at [email protected].