• Appropriate legislative bodies should repeal laws in the nine states that require a prescription in order to purchase injection equipment.

These recommendations must be viewed in the overall context of the drug epidemic. Comprehensive responses to this threat to public health are critical: most critical is the expansion of drug treatment to make it more available. Needle exchange programs report increased referrals to drug abuse treatment and, in the few studies that examined this issue, no increase in the number of dirty needles discarded in public places (e.g., parks, streets, alleys). 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. Moreover, needle exchange and bleach distribution 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.

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. 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 participants. Indeed, the appropriate legislative bodies should enact legislation (and should appropriate monies) to increase drug treatment capacity. In this context, both needle exchange and bleach distribution programs should be regarded as strategies for public health promotion and disease prevention.



Prevalence denotes the proportion of a population that is currently (or at a specified point in time) infected. Incidence denotes the rate of occurrence of new cases of infection per unit of time.

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