Should Cities Fund Needle Exchange Programs?

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By 1990, injecting drug users aware of the risks of their behavior, AIDS activists, and public health officials had begun needle exchange programs in several cities in the United States—Tacoma and Seattle, Washington; Portland, Oregon; San Francisco, New York City, and the best known and most carefully studied, New Haven, Connecticut.

The New Haven NEP, begun in 1990, cut HIV transmission by an estimated 33 percent in the first two years of the program, with a similar reduction in hepatitis infection. Like most NEPs, the New Haven program did more than simply distribute new syringes. Addicts were given instructions about safe injection practices, offered drug treatment if they wanted it, and provided with minimal health care such as flu shots and checkups. At the time of the 1993 assessment, almost 20 percent of participants in the program had begun drug treatment and hundreds of others, including many users who were not injectors, had come to the program for referral to an appropriate treatment facility.

A Johns Hopkins study of the Baltimore City Needle Exchange, launched in 1994 at the urging of Mayor Kurt Schmoke, concluded that, after six years in operation, the incidence of HIV in that city decreased by 35 percent overall and 70 percent among the approximately 10,000 participants in the program. In both cities, about 20 percent of participants voluntarily entered drug treatment, and in Baltimore the number of used needles collected in the trash fell by almost half, reducing the threat of injury or infection to children and others who might come in contact with them accidentally. Overall drug usage dropped by about 20 percent, 1500 clients had entered treatment—staffers told of having to tell at least 20-30 people every day that no slot was available for them—and the number of used needles collected in the trash fell by almost half. Unlike programs that must operate under the radar in some cities, the Baltimore City Needle Exchange has a website that lets users know when its vans will appear at various locations during the week. In winter, when heavy snow makes it impossible for the vans to travel, local radio and TV stations include the Exchange in their listings of school and government-agency closings.