The effectiveness of needle exchange programs: A review of the science and policy

eedle exchange programs (NEPs) permit injection drug users (IDUs) to exchange potentially contaminated syringes for sterile ones, with the aim of decreasing the circulation of contaminated injection equipment and reducing the spread of blood-borne pathogens in the community. Since the first NEP was introduced in Amsterdam in 1984, at least 46 regions, countries, and territories reported having at least one NEP by December 2000. Surprisingly, only one-third of countries where HIV has been reported among IDUs and only 40% of countries where injection drug use is known to occur have introduced at least one NEP. There are also considerable variations in NEP availability and coverage within and between countries, and sometimes within states or cities. This review discusses the history, science, and politics surrounding the implementation and evaluation of NEPs in both developed and developing countries, and suggests alternative mechanisms to increase coverage of sterile syringes among IDUs. We also suggest areas for further research to guide future attempts at interventions that aim to reduce the global spread of blood-borne infections.