NEEDLE EXCHANGE USE AMONG A COHORT OF INJECTING DRUG-USERS

Objective: To study prospectively injection behavior of injecting drug users (IDU) who did and did not utilize a local needle exchange in th e Bronx, New York City. Design: Since 1985, IDU attending a methadone maintenance program have been enrolled in a prospective study of HIV-r elated risk behaviors. Since 1989, when a needle exchange opened near the methadone program, data have been collected from study participant s regarding utilization of the exchange. Participants: Study participa nts (n = 904) who injected between 1985 and 1993.Results: Of 904 IDU, 21.9% used the needle exchange. Male gender [adjusted odds ratio (AOR) , 1.57], HIV seropositivity (AOR, 1.39) and younger age (AOR per 10 ye ars of age, 1.66) were independently associated with needle exchange a ttendance. The percentage injecting declined each year, preceding the opening of the needle exchange and concurrent with its operation (from 64.6% in 1985 to 43.6% in 1993). Among the 329 participants who injec ted in the year before the exchange opened, 1988, 53 out of 124 (42.7% ) needle exchange users and 168 out of 205 (81.9%) nonusers reduced or stopped injecting by 1993 (P < 0.001). Exchange users shared needles less than non-users (P < 0.05 in 1993). HIV infection was unrelated to these reductions in injection. Conclusions: Methadone-treated IDU wit h access to a needle exchange reduced injecting and needle-sharing. Th is pattern of harm reduction, which began at least 4 years before the needle exchange opened, occurred in both those who did and did not uti lize the needle exchange. Needle exchange, as a strategy to reduce inj ection-related harm, should not be viewed as discordant with methadone treatment.