The University of California report reviewed data on reported needle-sharing frequency in studies of needle exchange programs. Of the 26 evaluations addressing behavior change associated with the use of needle exchange programs that were identified, 16 were deemed of acceptable quality (rating 3 or higher). Of the 16 studies, 14 presented data on the frequency of needle sharing; 9 of these had comparison groups reported. As Table 7.4 indicates, 10 of the 14 studies showed a beneficial effect of the needle exchange programs on reported frequency of needle sharing; 4 showed a mixed or neutral effect; and none showed an increased frequency of needle sharing. Regarding sexual risk behavior change, the report concluded that the findings were neutral. That is, four studies reported beneficial effects of needle exchange programs relating to sexual risk associated with number of partners and two reported mixed or neutral effects. When reviewing studies that addressed risk associated with partner choice, three showed beneficial effects and two reported mixed or neutral effects. Finally, beneficial effects of needle exchange programs relating to condom use were observed in one study, mixed or neutral results in another, and adverse effects in three studies.
The University of California report noted that 17 of 18 U.S. and Canadian programs visited stated that they provide referrals to drug treatment. Of 33 U.S. programs surveyed, 3 reported treatment services on site. The extent to which referrals enter treatment and are retained was described—the 6 programs that collect data on referrals reported 2,208—but was not studied. The report noted (Lurie et al., 1993:236) that the paucity of drug abuse treatment slots in many cities limits the usefulness of needle exchange program referrals to drug abuse treatment. This affects the likelihood that a needle exchange program will refer and that a referral will link a client with treatment.
The University of California report identified 21 studies that were relevant to the issue of whether needle exchange programs impact rates of HIV infection: 2 case studies, 7 serial community cross-sectional studies, 6 serial needle exchange program cross-sectional studies, 1 case-control study,