be based. The importance of flexibility and community control is strongly emphasized.

  • Appropriate health agencies should make available technical assistance and relevant epidemiologic data to local organizations and groups within the communities to assist them in making informed decisions about needle exchange and bleach distribution programs.

  • Needle exchange programs should promote HIV prevention not only by providing sterile equipment, but also by means of education, drug treatment referral, and materials, including bleach, alcohol pads, and condoms.

  • Needle exchange programs should make special efforts to reach and retain hard-to reach subgroups of injection drug users, such as young injection drug users and women.

  • The National Institutes of Health, the Centers for Disease Control and Prevention, and the Agency for Health Care Policy and Research should support evaluation research examining the programs and the key outcomes, including HIV risk behavior and reduced HIV transmission.

The panel further recommends that in meeting the need for increasing the treatment capacity, as described above,

  • Incremental funds for needle exchange programs and other AIDS prevention strategies should be appropriated but should not be taken from resources now supporting drug treatment programs.

In addition, such a diversion of funds would be unwise because drug treatment programs have been shown to be effective in treating the underlying disorder of drug abuse and can be effective in curtailing HIV risk behaviors. Moreover, for many program participants, needle exchange and bleach distribution programs have been found to serve as a bridge to drug treatment for many needle exchange program clients. Indeed, the panel further recommends that:

  • The appropriate legislative bodies should enact legislation (and should appropriate monies) to increase drug treatment capacity and establish better links between treatment and AIDS prevention programs that target injection drug users.

Finally, the panel recommends that:

  • The National Institutes of Health (e.g., National Institute on Drug Abuse) and the Centers for Disease Control and Prevention should support research that evaluates the effect of needle exchange and bleach distribution



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