laws requiring a prescription to purchase needles and syringes (Figure 3.2). Four of these states—California, Illinois, Massachusetts, and New York—have needle exchange programs. In this report, a needle exchange program is defined as legally authorized when it has been specifically authorized by statute, regulation, or case law in the state.

Other laws affecting the operation of needle exchange programs involve drug-free zones and prostitution-free zones. These are city ordinances that prohibit persons convicted of a drug-related crime or prostitution from entering certain areas during certain times of the day. They tend to be areas with high drug trafficking, which are precisely the areas that needle exchange programs target in order to reach the most people. The ordinances impede injection drug users from obtaining sterile injection equipment from needle exchange programs operating in these areas and limit the operating capabilities of the programs (see Chapter 5 for an in-depth discussion of legal issues).

The administrative structures and funding sources of the programs are closely related to whether they are legally authorized. The programs that are not legally authorized tend to be operated by activists and funded by private donations and, occasionally, by foundation grants; however, this is not universal. Although legally authorized needle exchange programs are more likely than those not legally authorized to receive local or state government funding, not all of them do. Activists continue to administer many of the currently operating programs. The remainder are administered by either government agencies or community-based organizations, some with and some without local or state government involvement.

Program Operations

As described by Lurie et al. (1993a), needle exchange sites can be broadly classified into two categories: fixed and mobile. Fixed sites operate at a consistent and predictable location at the same time each week. Mobile sites include deliveries and persons roving either on foot or in a vehicle. Roving sites usually cover a specific geographic area and often follow a consistent route, but they do not stay at any one location for very long. Fixed sites have the advantage of being relatively predictable, whereas mobile sites can cover a greater geographic area and can more readily accommodate changes in local conditions.

In their systematic survey, Lurie et al. (1993a) identified seven types of exchange sites: four types of fixed sites (stationary van, storefront, street, and health facility) and three types of mobile sites (walk route, deliveries, and roving van).

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