of drug use, it is not surprising that a single risk factor—availability of sterile needles—does not play a crucial role in increasing drug use or initiating noninjectors to injection drug use. This critical point was noted by the University of California researchers (Lurie and Chen, 1993) when they stated that "initiation into drug use is influenced by many social, psychological, and biological factors—and not by the simple availability of syringes" (p. 23).

Because treatment is neither quickly nor universally effective at eliminating drug use, some injection drug use may occur even if a major expansion of drug treatment programs were implemented (Joseph, 1989). Also, even if treatment were made readily available, not all injection drug users would be interested in participating. Recognizing this, the approach adopted by needle exchange and bleach distribution programs is a pragmatic one. These programs acknowledge that not all addicts demonstrate readiness for treatment, that many who enter treatment will not be completely abstinent, and that, once abstinent, relapse is endemic to chemical dependence.

SUMMARY

As with other sensitive issues, communities cannot be categorized as simply either supporting or opposing needle exchange programs. The range of views is far more complex. Members of minority communities ravaged by the effects of drug abuse and HIV infection have articulated both opposition and support for these programs. Law enforcement personnel have been divided on the concept of these programs. Health professionals have debated extensively the pros and cons of needle exchange and bleach distribution. Public opinion polls reflect division and a trend toward more favorable disposition to accept such programs as the issues are debated.

Table 4.3 summarizes the concerns of the individual community groups solicited by the panel. They range from fears of worsening drug abuse and crime to concern about promoting immoral activities. The reactions of these stakeholders are not mutually exclusive. All share the concern that handing out sterile injection equipment or bleach bottles to injection drug users does not address the underlying problems associated with drug abuse and in fact may create more negative outcomes. In sum, the main argument against needle exchange and bleach distribution programs is based on perceptions that they do more harm than good.

CONCLUSIONS

That community responses to needle exchange and bleach distribution programs have varied considerably, not only across but also within subgroups



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