hypotheses and delineate the most appropriate methodologies for testing such hypotheses. The panel is authorized, but not committed, to asses the potential risks and benefits associated with the implementation of such programs if it judges the data adequate to make such an assessment.

The charge gives special attention to the first three of the five tasks specified in the congressional mandate. The panel addressed tasks 4 and 5 as specified in the mandate by relying primarily on the research findings of two large-scale studies, undertaken with support from the federal government, that devoted a substantial amount of attention to these issues (U.S. General Accounting Office, 1993; Lurie et al., 1993).

The panel's charge refers to both needle exchange and bleach distribution programs, and a brief characterization of these programs will shed some light on the panel's scope of work. Diverse AIDS prevention programs have been implemented in attempts to reduce the spread of HIV among injection drug users, their sexual partners, and their offspring. These include, but are not limited to, educational, testing and counseling, needle exchange, and bleach distribution programs. A review of the services and devices delivered by needle exchange and bleach distribution programs (see Chapter 3) makes it clear that these programs do have many common elements and are not mutually exclusive. That is, the majority of the needle exchange programs distribute bleach, educational material, and condoms and make referrals to drug treatment and other services. Bleach programs typically dispense bleach, condoms, and educational materials and provide treatment and other referrals (e.g., primary care, public services). Both types of AIDS prevention programs attempt to prevent the transmission of the virus through the use of infected equipment and sexual risk behaviors. Both types of programs adopt multiple strategies in an attempt to reduce high-risk behaviors (e.g., injection and sexual behaviors). The primary distinguishing characteristic between them is that needle exchange programs provide as one of their main services the exchange of sterile needles for the return of used ones, whereas bleach distribution programs provide a readily available disinfectant (i.e., household bleach) to clean needles not meant to be reused.

A recent public health bulletin (Centers for Disease Control and Prevention, 1993), which was issued jointly by the National Institute on Drug Abuse of the National Institutes of Health, the Center for Substance Abuse Treatment of the Substance Abuse and Mental Health Services Administration, and the Centers for Disease Control and Prevention, makes it clear that the use of bleach can play a role in reducing risk of HIV transmission, but it does not always sterilize the injection equipment. Specifically, the bulletin states that sterile, never-used needles and syringes are safer than bleach-disinfected,



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