Des Jarlais, 1989). Two of these planned locations were to offer needle exchange services, and two were not. Subjects were to be recruited from the waiting lists of drug treatment programs in order to better compare rates of actual entry into treatment and to place a prearranged limit on length of needle exchange participation (which was to end as soon as a treatment slot became available for the subject.)

When the scheduled opening of the needle exchange program was announced, however, the ensuing controversy led to a political compromise that no needle exchange would be located "within 1,000 feet of a school." This, however, precluded all four of the originally planned sites. Indeed, the only site that both 9a) met the school distance criterion and (b) was under the control of the City Health Department was in the Health Department's own Lower Manhattan headquarters, which happened to be in an area that was not only inconvenient for injection drug users, but also conspicuously near police headquarters and the Manhattan criminal courts. Moreover, the registration procedures themselves lasted several hours and included tuberculosis screening, administration of a detailed questionnaire on risk behavior, and issuance of a photo ID card. A strict one-for-one exchange rule was in effect, whereby only one syringe at a time could be exchanged.

In a little over a year of operation, 317 injection drug users participated in the program. Many were placed into treatment programs quickly, and too few participated long enough to enable researchers to make pre-and post-program comparisons of risk behavior. Plans were being made to expand the exchange operations into areas more convenient to drug users but, at the end of 1989, a decision was made by a new mayor to close the exchange.

Washington, D.C. The Washington, D.C., program had many similarities to the first legally authorized New York City exchange program. First, the program design itself was actually the product of a delicate compromise with political opponents of needle exchange on the District of Columbia City Council. In addition, as in New York: (1) the program was obliged to operate out of a single site, a drug abuse treatment program, (2) participant eligibility was restricted to those already on a waiting list for drug abuse treatment, and (3) the cumbersome entry procedure required hours of participant and staff time (Vlahov et al., 1994). Also, as in Dundee-Wishart, some of the treatment program staff at the designated site were adamantly opposed to any distribution of needles in a treatment setting. Moreover, the Washington, D.C., needle exchange program was permitted to operate for only 60 days, during which time it was able to enroll a total of 31 injection drug users in the first month and 2 in the second month from the District's estimated 16,000 injection drug users. It was then closed, in keeping with the original agreement, while public health officials assessed the experience.



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