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Preventing HIV Transmission: The Role of Sterile Needles and Bleach
THE PANEL'S CHARGE
At the request of Congress, the Panel on Needle Exchange and Bleach Distribution Programs was established by the National Research Council/Institute of Medicine, with support from the National Institute on Drug Abuse. The panel was asked to undertake a study to determine the effectiveness of needle exchange and bleach distribution programs. The panel's charge is as follows:
The panel will gather and analyze the relevant research regarding the effect of such programs on rates of drug use, the behavior of drug users, and the spread of AIDS and other diseases, such as hepatitis, among intravenous drug users and their partners. In addition, the panel will examine closely related issues of importance to the research and service communities, such as the characteristics associated with effective exchange programs, and will provide recommendations for future research directions and methods applicable to the evaluation of syringe exchange and bleach programs. In the latter task, the study will identify the relevant evaluation hypotheses and delineate the most appropriate methodologies for testing such hypotheses. The panel is authorized, but not committed, to assess the potential risks and benefits associated with the implementation of such programs if it judges the data adequate to make such an assessment.
SCIENTIFIC ASSESSMENT OF PROGRAM EFFECTIVENESS
To examine the context that frames needle exchange and bleach distribution programs, the panel assessed a wide range of studies concerning the magnitude and severity of injection drug use; HIV infection among injection drug users and their partners; and the effects of needle exchange and bleach distribution programs on drug use, HIV risk behaviors, and the spread of HIV/AIDS.
The studies that examine needle exchange and bleach distribution programs have various limitations, including inadequate samples, sample attrition, improper controls, problematic measures, and incomplete analyses. Nevertheless, the limitations of individual studies do not necessarily preclude us from being able to reach scientifically valid conclusions based on the entire body of literature available . The situation resembles the exploration of the relationship between cigarette smoking and lung cancer; virtually every individual study was vulnerable to some particular objection, yet collectively those studies justified a compelling conclusion.
It was essential for the panel first to distinguish between studies of high