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Preventing HIV Transmission: The Role of Sterile Needles and Bleach
Increase in New Initiates to Injection Drug Use
The University of California report reviewed a variety of studies and used focus groups to understand whether needle exchange programs could encourage persons to initiate injection drug use. In reviewing the demographic data from the programs, the report noted that the median age of participants across programs ranged from 33 to 41, and the median duration of injection drug use from 7 to 20 years. This suggests that most participants initiated injection drug use prior to using the needle exchange program.
A review of serial cross-sectional studies of injection drug users in San Francisco noted an increase in the mean age of the samples over time from 34 in 1986 to 40 in 1990, suggesting that there was not an increase in young new injectors over time. Researchers in Amsterdam used a capture-recapture method to estimate the number of injection drug users between 1983 and 1988. Despite initiation of a needle exchange program in 1984, no change in the number of injection drug users was reported, and the average age of drug users increased over time. Furthermore, the number of drug users under age 22 decreased from 14 percent in 1983 to 3 percent in 1988. The authors concluded that there was no increase in the number of new initiates into injection drug use.
The report concluded, on the basis of evidence from surveys, that (Lurie et al., 1993:357) "needle exchange programs are not associated with an increase in community levels of injecting."
Focus groups were consulted. Of 10 focus groups from needle exchange programs, comprising 65 injection drug users, 2 individuals thought needle exchange programs could encourage nonparenteral drug users to start injecting. Among seven nonprogram focus groups comprising 47 injection drug users, 2 individuals thought needle exchange programs could encourage nonparenteral drug users to start injecting. The focus group data were viewed as corroborating evidence for the data available from surveys arguing against an effect of needle exchange programs on increasing the community levels of injection drug use.
Increased Drug Use in the Community
The University of California report addressed the potential for increased drug use in the community by reviewing the studies noted in the previous section. Researchers searched for additional data by examining established data sets of drug abuse indicators and answers to additional questions asked of focus groups of injection drug users.
The University of California researchers attempted to relate the presence (or absence) of needle exchange programs to ongoing statistical series