ABSTRACT
This study was designed to describe demographic and drug use characteristics, health status, and HIV-related risk behavior among clients attending the San Francisco needle exchange program (NEP), and to assess the relationship between NEP utilization and risk behavior. Randomly selected clients were interviewed when they visited the NEP. Participants were of diverse ethnicity, had a mean age of 38.2, and 72% were male. Many reported being homeless (25%), unemployed (34%), uninsured (52%), and having an episode of infectious disease in the past 2 years (36%). Clients who received a higher proportion of their needles from the exchange were less likely to report sharing of needles or rinse water. Clients who attended the exchange more frequently were more likely to clean their skin prior to injecting and less likely to use the same needle repeatedly. Frequency of visiting the NEP was not associated with the likelihood of sharing needles or rinse water. Efforts to evaluate needle exchange in the United States will benefit from descriptive reports from other NEP programs, and the use of nonexchange comparison groups.
Subject(s)
HIV Infections/etiology , HIV Infections/prevention & control , Health Behavior , Health Status , Needle-Exchange Programs/organization & administration , Patient Acceptance of Health Care/psychology , Risk-Taking , Substance Abuse, Intravenous/complications , Adult , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Patient Acceptance of Health Care/statistics & numerical data , Program Evaluation , San Francisco , Surveys and Questionnaires , Urban Health Services/organization & administrationABSTRACT
OBJECTIVE: We analyzed data on all drug-treatment admissions in San Francisco County over a 4-year period (n = 35,460) to evaluate the potential negative effects of the San Francisco needle-exchange program. METHODS: Admissions in the 2 years preceding implementation of the exchange program (1987-1988) were compared with admissions in the 2 years following implementation (1989-1990). RESULTS: No negative consequences of needle exchange were detected. Specifically, the presence of the exchange program was not associated with (1) increases in injection drug use, (2) increases in needle-sharing behavior, or (3) changing drug-use behavior from non-injection to injection. We also compared high-drug-use neighborhoods with and without local needle-exchange sites. Neighborhoods without needle-exchange sites showed a greater increase in proportion of admissions for injection drug use, and in frequency of injection, over time. CONCLUSIONS: Because of methodological limitations, our findings are preliminary. Longitudinal studies comparing needle-exchange and non-exchange cohorts are needed to further evaluate effects of this intervention.
