SYRINGE AND NEEDLE EXCHANGE AS HIV AIDS-PREVENTION FOR INJECTION-DRUGUSERS

Objective.-To evaluate an all-volunteer syringe exchange program in Sa n Francisco, Calif. Data Sources.-Syringe exchange program records and 11 semiannual surveys administered during a 5.5-year period, using st andard questionnaires. Interviews (N=5644) were conducted with injecti on drug users recruited in two 21-day drug detoxification clinics and three street settings. Main Outcome Measures.-Use of the syringe excha nge program and self-reported data regarding sources of syringes, freq uency of injection, initiation into drug injection, and frequency of s yringe sharing. Results.-In spring 1992, 45% reported ''usually'' obta ining injection equipment from the syringe exchange, and 61% reported using the program within the past year. During the period from Decembe r 1986 through June 1992, the median reported frequency of injection d eclined from 1.9 injections per day to 0.7 injection per day, the mean age increased from 36 to 42 years, and the percentage of new initiate s into injection drug use decreased from 3% to 1%. In logistic regress ion analysis (of fall 1991 through spring 1992 interviews; n=752), we found six independent factors associated with syringe sharing. Protect ive from syringe sharing were use of the syringe exchange program, hav ing received human immunodeficiency virus (HIV) testing and counseling , condom use, older age, and African-American race. Injection of cocai ne was a predictor for syringe sharing. The strength of association be tween use of the syringe exchange program and not sharing syringes was greatest in injection drug users younger than the median age of 40 ye ars. Conclusions.-The syringe exchange program was rapidly adopted by injection drug users. Health interventions associated with not sharing needles included use of the syringe exchange program and voluntary, c onfidential HIV testing and counseling. Our data did not support the h ypothesis that a syringe exchange program would stimulate increased dr ug abuse in terms of frequency of injection or recruitment of new and/ or younger users.