Termination of an established needle-exchange: A study of claims and theirimpact

Despite the wealth of scientific findings showing thar needle-exchange prog rams reduce unsafe injection practices, and that these practices are the di rect or indirect cause of one third of new HIV infections in the United Sta tes, the figure of needle-exchange in this country remains uncertain, The f ederal government continues to ban the use of federal funds to support need le-exchange programs. In many cities with large numbers of HIV-positive dru g injectors, local and state officials continue to oppose the implementatio n of exchange services. Needle-exchange staff members also continue to risk arrest, prosecution and imprisonment. Whereas previous studies have focuse d on the effectiveness of needle-exchange programs, we offer an analysis of a unique event, the closure of a well-established needle-exchange. The stu dy consists of two parts. The first analysis examines the claimsmaking that succeeded in defining the needle-exchange as a public health hazard and a social problem, causing it to be closed after several years of operation. I n the second part, based on initial and follow-up interviews with needle-ex change clients, surveys of public drug-using sites, and ethnographic interv iews, we present off impact analysis of the exchange's closure. The analysi s provides a case study showing how a community's demonstrably effective HI V prevention efforts can be quickly eroded by the termination of a key harm -induction service.