HIV and Needle Exchange Programs

How Effective Are They in Preventing HIV and Hepatitis?

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What Are Needle Exchange Programs?

More than a million people in the U.S. are injecting drug users (IDUs), the impact of which costs society more than $50 billion per year in health care costs, lost productivity, accidents, and crime. Not only do IDUs imperil their health and well being, they are at greater risk of getting or passing HIV to persons with whom they share needles or have sex.

If fact, one-third of all AIDS diagnoses are linked to injecting drug use, while rates are as high as 64 percent in women who either share needles and/or have sex with an IDU.

Furthermore, injecting drug use is seen to be the primary route of infection in more than 50% of children born to HIV positive mothers in the U.S.

In response, many states and communities have instituted needle exchange programs (NEPs) to discourage the shared use of needles among IDUs. The aims of these programs include:

The Politics of Needle Exchange

Needle sharing is a common practice for persons unable to access ample needle supplies. Fear of arrest and prosecution keep many from accessing NEPs that might otherwise be legal in their state. In such cases, users will rely upon bleach and other substances to sterilize their "works." Under the influence of drugs, judgment can be clouded and even these preventive measures are ignored or forgotten.

Most U.S. states have laws that make it a crime to possess or distribute drug paraphernalia not used for a legitimate medical purpose, while ten states and the District of Columbia have enacted legislation that requires a prescription in order to buy a needle and syringe. Even where over-the-counter sales of syringes are permitted by law, pharmacists are often unwilling to sell to IDUs.

In July 1992, the state of Connecticut passed a law permitting the purchase and possession of up to ten syringes without a prescription. After the new law went into effect, the sharing of needles among IDUs was seen to drop dramatically.

By contrast, when public protests forced the closure of one Connecticut NEP in 1999, risk practices were reported in increase dramatically, with one study suggesting that rate of needle sharing rose from 16% before the closure of the NEP to 34% after the closure. Furthermore, re-use of needles also spiked following the closures, with an average of 7.7 re-uses prior to discarding.

How Can Injection Risks Be Reduced?

Getting drug users into treatment centers remains the best means to prevent transmittable blood-borne infections. Unfortunately, not all user are ready or able to quit. Even those who are highly motivated may find few drug treatment services available in their area, or have to place themselves on long waiting lists. As a result, fewer than 15 percent of IDUs are in treatment at any given time.

For those who cannot stop injecting drugs, the best way to avoid spreading HIV is to use a sterile needle for each injection, or at the very least not to share needles.

Users who share should disinfect their injection equipment thoroughly with bleach, although this should not be considered a safe practice but rather a less risky option if no other realistic options are available.

Does Needle Exchange Encourage Drug Use?

There is no evidence that needle exchange programs increase or encourages injecting drug use. In fact, one study of a San Francisco-based NEP found that, from 1987 to 1992, frequency of injecting drug use among clients actually decreased from 1.9 to 0.7 injections per day. Moreover, the percentage of first-time IDUs dropped from three percent to just one percent within the same period..

Does Needle Exchange Reduce the Spread of HIV?

Simply put, the answer is yes. Needle exchange programs are based on a sound public health principle; to eliminate the means by which to pass an infection from one person to the next.

Needle exchange programs have also achieved reductions in the rate of hepatitis infection, which can also be spread through shared needles. In Tacoma, Washington, clients of a regional NEP were reported to be up to eight times less likely to contract hepatitis B or C than IDUs who have not accessed the program.

Needle exchange programs can, therefore, act as a bridge to numerous preventive health interventions, including:

  • Drug treatment
  • HIV testing and counseling
  • Primary medical care
  • STD screening
  • Social work and psychologist referrals

Today, there are over 220 NEP in the U.S. distributing over 36 million needles annually.

Learn more about how to find a needle exchange program nearest you.


Bassler, S. "The history of needle exchange programs in the United States." University of Toledo, 2007:1-32.

Green, T.; Bowman, M.; Mann, S.; et al "Life After the Ban: An Assessment of US Syringe Exchange Programs’ Attitudes About and Early Experiences with Federal Funding". American Journal of Public Health. 2012; 102(5) e9-e16.