dirty syringes and may be inconvenient for injection drug users who have to travel long distances to use the needle exchange program.

A minimum age requirement for exchanging is generally imposed in response to the concern that the needle exchange program may encourage young people to start injecting illicit drugs. A countervailing concern is that young injection drug users may have difficulties gaining access to sterile needles.

Requiring a participant to show needle ''track" marks (visibly scarred veins due to repeated injection) in order to use the needle exchange program is intended to limit clientele to active users. This rule is, in part, a response to the concern that needle exchange programs may encourage noninjection drug users to start injecting drugs, but it can also be used to prevent noninjection drug users from selling syringes for a profit. However, some programs note that participants who do not have tracks may be neither new injectors nor profiteers, but may instead be surrogates exchanging syringes for friends or family members. Some programs actively encourage surrogate exchangers, believing that they act as important sources of sterile needles and, perhaps, of education for otherwise hidden injection drug user populations.

Hours of Operation

Of the surveyed programs (Lurie et al., 1993a), the number of operating hours per week, not including deliveries, typically ranged from 8 to 168, with a median of 10. Hours of operation was also found to be related to whether programs are legally authorized: legally authorized exchanges are open more hours per week.

On-Site Services Offered

The range of services offered by needle exchange programs includes

  • education,

  • HIV testing and counseling,

  • tuberculosis screening,

  • screening for sexually transmitted diseases,

  • primary medical care,

  • substance abuse treatment, and

  • case management.

Services to educate and inform injection drug users regarding injection practices, safety steps, nonsharing behavior, and other risk reduction methods are an important part of a needle exchange program. The ability and



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