that the conclusions and recommendations in this chapter are based not only on the findings presented in this chapter, but also on the findings and conclusions presented in the earlier chapters. This presentation reflects the cumulative development of the panel's understanding about the issues inherent in the establishment of needle exchange and bleach distribution programs and, ultimately, their anticipated effects, based on the pattern of evidence the panel discerned from its collection of descriptive and analytic materials, community views, and reviews of pertinent studies.

Chapter 8 identifies issues that need to be studied further.

The report includes three appendixes. Appendix A is a detailed description and review of some unpublished research findings, which came to the panel's attention as we were completing our review of the available evidence on needle exchange and bleach distribution programs (see the Preface). These studies are significant because their results appear to conflict with the findings of the body of literature reviewed in this report and have the potential of being misinterpreted. Appendix B presents a detailed summary of the views of various professional associations on needle exchange and bleach distribution programs. Appendix C gives biographical information about panel members and the study director.



Prevalence denotes the proportion of a population that is currently (or at a specified point in time) infected. Incidence denotes the rate of occurrence of new cases of infection per unit of time.


These statutes include the Comprehensive Alcohol Abuse, Drug Abuse, and Mental Health Amendments Act of 1988, the Health Omnibus Programs Extension of 1988, the Ryan White Comprehensive AIDS Resources Emergency Act of 1990, and the Departments of Labor, Health and Human Services, and Education, and Related Agencies Appropriations Acts of 1990 and 1991.


Angarano, G., G. Pastore, L. Monno, T. Santantonio, N. Luchena, and O. Schiraldi 1985 Rapid spread of HTLV-III infection among drug addicts in Italy. Lancet 2(8467):1302.

Berkelman, R.L., W.L. Heyward, J.K. Stehr-Green, and J.W. Curran 1989 Epidemiology of human immunodeficiency virus infection and acquired immunodeficiency syndrome. American Journal of Medicine 86:761-770.

Centers for Disease Control 1982 Pneumocystis pneumonia. Morbidity and Mortality Weekly Report 30:250-252.

Centers for Disease Control and Prevention, Centers for Substance Abuse Treatment, National Institute on Drug Abuse 1993 HIV/AIDS Prevention Bulletin April 19.

Des Jarlais, D.C., S.R. Friedman, D. Novick, J.L. Sotheran, P. Thomas, et al. 1989 HIV-1 infection among intravenous drug users in Manhattan, from 1977 through 1987. Journal of the American Medical Association 261:1008-1012.

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