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Public Health
Reports
The impact of a needle exchange's closure Abstract Robert S. Broadhead, Yael van Hulst and Douglas D.
Heckathorn Objective: A wealth of scientific findings demonstrate that unsafe injection practices are the direct or indirect cause of one third of new HIV infections in the United States and that needle exchange programs are effective in reducing drug-related risks. While previous studies have analyzed the impact of needle-exchange programs in operation, we analyzed the impact of an established needle exchange's closure on its clients' risk behaviors, and on the community-at-large. Background: After operating with state-sponsorship for four years, the Windham, Connecticut needle exchange was closed after becoming embroiled in a public controversy in which it was blamed for causing the city's "drug problem," "discarded needle problem," and even the economic decline of the city itself. Methods: From
March 1994 through February 1997, as part of a larger AIDS prevention
research project funded by the National Institute on Drug Abuse,
risk-assessment interviews were administered to 330 injection drug users
in Windham, the majority of whom were clients of the needle exchange.
After the exchange was closed in March 1997, for the next eleven
months, we re-recruited former respondents who remained in the area and
were still active injectors. This
produced 111 "post-closure initial" interviews and 78
"post-closure follow-up" interviews three months later. Based on the interviews administered before and after the
closure of the needle exchange, and surveys of public drug-using sites,
an impact analysis is offered of the exchange's closure. Results: Following the closure of the needle exchange, a statistically significant increase in drug injectors' procurement of syringes from street and other "unreliable sources" was found, as well as in their re-use of syringes and the sharing of injection equipment. Surveys of outdoor drug-use areas found that the closure of the needle exchange did not reduce the volume of discarded syringes and other drug-injection debris, or reduce the robustness of Windham's illicit drug scene. Conclusions: The problems in Windham that led to the closure of the exchange still remain, and the city's drug injectors are engaging in higher levels of HIV risk-behavior. In closing the needle exchange, Windham has deprived itself of one of the few scientifically proven means for reducing the spread of HIV and for reducing other drug-related problems within the community.
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