AIDS and Behavior

, Volume 21, Issue 4, pp 973–981 | Cite as

Against the Odds: Syringe Exchange Policy Implementation in Indiana

  • Beth E. MeyersonEmail author
  • Carrie A. Lawrence
  • Laura Miller
  • Anthony Gillespie
  • Daniel Raymond
  • Kristen Kelley
  • D. J. Shannon
Original Paper


Indiana recently passed legislation allowing local governments to establish syringe exchanges. While the effectiveness of syringe exchange programming is established, there is a dearth of studies about associated policy adoption and implementation. This study documents the experiences of 24 Indiana counties engaged in the process of establishing syringe exchange programming under new state law. A mixed method, qualitative, exploratory case study was conducted from May 2015 to April 2016. We observed rapid and widespread policy adoption interest, and yet counties reported significant policy ambiguity, epidemiologic and resource capacity issues. The emergence of health commons involving information and tangible resource sharing networks allowed institutional rearrangement in the midst of resource scarcity; however, such rearrangement appeared to be a central threat to policy adoption and implementation given state structural barriers. The emerging commons could be a critical policy success factor, as it would achieve efficiencies not possible in the current resource environment, and can help achieve institutional rearrangement for the improvement of population health. Several recommendations for improvement are offered.


Health commons HIV Syringe exchange hepatitis C Local government 



This research was not underwritten by a grant or contract.

Compliance with Ethical Standards

Conflict of interest

The authors do not have any potential conflicts to disclose.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional and/or National Research Committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors. The study was deemed exempt by the Indiana University IRB.


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Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  1. 1.Rural Center for AIDS/STD PreventionIndiana University School of Public Health-BloomingtonBloomingtonUSA
  2. 2.Indiana Minority Health CoalitionIndianapolisUSA
  3. 3.Harm Reduction CoalitionNew YorkUSA
  4. 4.Prescription Drug Abuse Prevention Task ForceOffice of the Indiana Attorney GeneralIndianapolisUSA

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