Journal of Urban Health

, Volume 77, Issue 3, pp 346–358 | Cite as

Characteristics and utilization patterns of needle-exchange attendees in Chicago: 1994–1998

  • Heena Brahmbhatt
  • Dan Bigg
  • Steffanie A. Strathdee
Original Articles: Substance Use and HIV Prevention


The objectives of this study were to describe characteristics and utilization patterns of participants attending a needle-exchange program (NEP) in Chicago, Illinois. Since 1994, demographics of NEP attendees and program utilization data were collected systematically at 22 sites operated by the Chicago Recovery Alliance (CRA). Descriptive statistics were used to assess time trends, site variations, and characteristics of attendees in day sites versus evening sites. A total of 11,855 injection drug users (IDUs) visited the NEP at least once from 1994 to 1998. Median age was 41 years, and 74% were male. Overall race distribution was African-American 50%, Caucasian 38%, Puerto Rican 10%, other 2%. Over time, there was a proportional decrease in African-American users (55.4% to 39.9%,P<.001), a significant increase in Puerto Rican users (1.4% to 14.1%,P<.001), and a stable proportion of Caucasian users (42%). Each year, 15–20% of all clients were first-time attenders. Overall, participants attending evening versus day sites were younger (median age 39 years vs. 42 years,P<.001) and more ethnically diverse. Over a 4-year period, this NEP reached a diverse population of IDUs and recruited a stable proportion of first-time users. Compared to daytime NEP venues, evening NEP sites attracted younger clients and those who were more diverse ethnically. To maximize coverage of sterile syringes, NEPs should strive for diversification in terms of hours of operation and location.

Key words

Harm Reduction HIV/AIDS Injection Drug Use Needle-Exchange Programs Youth 


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  1. 1.
    Schwartz RH. Syringe and needle exchange programs: Part I.South Med. J. 1993;86(3): 318–322.PubMedGoogle Scholar
  2. 2.
    Des Jarlais DC, Friedman SR, Hopkins W. Risk reduction for the acquired immunodeficiency syndrome among intravenous drug users.Ann Intern Med. 1985;103(5):755–759.PubMedGoogle Scholar
  3. 3.
    Normand J, Vlahov D, Moses LE.Preventing HIV Transmission: the Role of Sterile Needles and Bleach. Washington, DC: National Academy Press; 1995.Google Scholar
  4. 4.
    Strathdee SA, van Ameijden EJ, Mesquita F, Wodak A, Rana S, Vlahov D. Can HIV epidemics among injection drug users be prevented?AIDS. 1998;12(suppl A):S71-S79.PubMedGoogle Scholar
  5. 5.
    Holmberg SD. The estimated prevalence and incidence of HIV in 96 large US metropolitan areas.Am J Public Health. 1996;86(5):642–654.PubMedGoogle Scholar
  6. 6.
    van Ameijden EJC, Watters JK, van den Hoek JAR, Coutinho RA. Interventions among injecting drug users: do they work?AIDS. 1995;9(suppl A):S75-S84.PubMedGoogle Scholar
  7. 7.
    Des Jarlais DC, Hagan H, Friedman SR, et al. Maintaining low HIV seroprevalence in populations of injecting drug users.JAMA. 1995;274(15):1226–1231.PubMedGoogle Scholar
  8. 8.
    Des Jarlais DC, Friedman SR, Friedmann P, et al. HIV/AIDS-related behavior change among injecting drug users in different national settings.AIDS. 1995;9(6):611–617.PubMedGoogle Scholar
  9. 9.
    Des Jarlais DC, Marmor M, Paone D, et al. HIV incidence among injecting drug users in New York City syringe-exchange programmes.Lancet. 1996;348(9033):987–991.CrossRefPubMedGoogle Scholar
  10. 10.
    Vlahov D, Junge B. The role of needle exchange programs in HIV prevention.Public Health Rep. 1998;113(suppl 1):75–80.PubMedGoogle Scholar
  11. 11.
    Hagan H, Jarlais DC, Friedman SR, Purchase D, Alter MJ. Reduced risk of hepatitis B and hepatitis C among injection drug users in the Tacoma syringe exchange program.Am J Public Health. 1995;85(11):1531–1537.PubMedGoogle Scholar
  12. 12.
    Broadhead RS, van Hulst Y, Heckathorn DD. The impact of a needle exchange's closure.Public Health Rep. 1999;114(5):439–447.CrossRefPubMedGoogle Scholar
  13. 13.
    Lurie P, Drucker E. An opportunity lost: HIV infections associated with lack of a national needle-exchange programme in the USA.Lancet. 1997;349(9052):604–608.CrossRefPubMedGoogle Scholar
  14. 14.
    Guydish J, Bucardo J, Young M, Woods W, Grinstead O, Clark W. Evaluating needle exchange: are there negative effects?AIDS. 1993;7(6):871–876.PubMedGoogle Scholar
  15. 15.
    Schoenbaum EE, Hartel DM, Gourevitch MN. Needle exchange use among a cohort of injecting drug users.AIDS. 1996;10(14):1729–1734.PubMedGoogle Scholar
  16. 16.
    Bluthenthal RN, Kral AH, Gee L, Erringer EA, Edlin BR. The effect of syringe exchange use on high-risk injection drug users: a cohort study.AIDS. 2000;14(5):605–611.PubMedGoogle Scholar
  17. 17.
    Vlahov D, Junge B, Brookmeyer R, et al. Reductions in high-risk drug use behaviors among participants in the Baltimore needle exchange program.J Acquir Immune Defic Syndr Hum Retrovirol. 1997;16(5):400–406.PubMedGoogle Scholar
  18. 18.
    Heimer R, Khoshnood K, Bigg D, Guydish J, Junge B. Syringe use and reuse: effects of syringe exchange programs in four cities.J Acquir Immune Defic Syndr Hum Retrovirol. 1998;18(suppl 1):S37-S44.PubMedGoogle Scholar
  19. 19.
    Paone D, Clark J, Shi Q Purchase D, Des Jarlais DC. Syringe exchange in the United States, 1996: a national profile.Am J Public Health. 1999;89(1):43–46.PubMedGoogle Scholar
  20. 20.
    Strathdee SA, Celentano DD, Shah N, et al. Needle-exchange attendance and health care utilization promote entry into detoxification.J Urban Health. 1999;76(4):448–460.CrossRefPubMedGoogle Scholar
  21. 21.
    Heimer R. Can syringe exchange serve as a conduit to substance abuse treatment?J Subst Abuse Treat. 1998;15(3):183–191.CrossRefPubMedGoogle Scholar
  22. 22.
    Somlai AM, Kelly JA, Otto-Salaj L, Nelson D. “Lifepoint”: a case study in using social science community identification data to guide the implementation of a needle exchange program.AIDS Educ Prev. 1999;11(3):187–202.PubMedGoogle Scholar
  23. 23.
    Centers for Disease Control and Prevention, Health Resources and Services Administration, National Institute on Drug Abuse, Substance Abuse and Mental Health Services Administration.HIV Prevention Bulletin: Medical Advice for Persons Who Inject Illicit Drugs. Baltimore, MD: US Department of Health and Human Services; 1997.Google Scholar
  24. 24.
    Drucker E, Lurie P, Wodak A, Alcabes P. Measuring harm reduction: the effects of needle and syringe exchange programs and methadone maintenance on the ecology of HIV.AIDS. 1998;12(suppl A):S217-S230.PubMedGoogle Scholar
  25. 25.
    Rockwell R, Des Jarlais DC, Friedman SR, Perlis TE, Paone D. Geographic proximity, policy and utilization of syringe exchange programmes.AIDS Care. 1999;11(4):437–442.CrossRefPubMedGoogle Scholar
  26. 26.
    Keene J, Stimson GV, Jones S, Parry-Langdon N. Evaluation of syringe-exchange for HIV prevention among injecting drug users in rural and urban areas of Wales.Addiction. 1993;88(8):1063–1070.CrossRefPubMedGoogle Scholar
  27. 27.
    Khoshnood K, Kaplan EH, Heimer R. “Dropouts” or “drop-ins”? Client retention and participation in New Haven's needle exchange program.Public Health Rep. 1995;110(4): 462–466.PubMedGoogle Scholar
  28. 28.
    Kipke MD, Unger JB, Palmer RF, Edgington R. Drug use, needle sharing, and HIV risk among injection drug-using street youth.Subst Use Missue. 1996;31(9):1167–1187.Google Scholar
  29. 29.
    Anderson JE, Cheney R, Clatts M, et al. HIV risk behavior, street outreach, and condom use in eight high-risk populations.AIDS Educ Prev. 1996;8(3):191–204.PubMedGoogle Scholar
  30. 30.
    Cassin S, Geoghegan T, Cox G. Young injectors: a comparative analysis of risk behaviour.Ir J Med Sci. 1998;167(4):234–237.PubMedGoogle Scholar
  31. 31.
    Battjes RJ, Leukefeld CG, Pickens RW. Age at first injection and HIV risk among intravenous drug users.Am J Drug Alcohol Abuse. 1992;18(3):263–273.PubMedGoogle Scholar
  32. 32.
    Vlahov D, Munoz A, Anthony JC, Cohn S, Celentano DD, Nelson KE. Association of drug injection patterns with antibody to human immunodeficiency virus type 1 among intravenous drug users in Baltimore, Maryland.Am J Epidemiol. 1990;132(5):847–856.PubMedGoogle Scholar
  33. 33.
    Rich JD, Strong L, Towe CW, McKenzie M. Obstacles to needle exchange participation in Rhode Island.J Acquir Immune Defic Syndr Hum Retrovirol. 1999;21(5):396–400.Google Scholar
  34. 34.
    Guydish J, Bucardo J, Clark G, Bernheim S. Evaluating needle exchange: a description of client characteristics, health status, program utilization, and HIV risk behavior.Subst Use Misuse. 1998;33(5):1173–1196.PubMedGoogle Scholar
  35. 35.
    Garfein RS, Doherty MC, Monterroso ER, Thomas DL, Nelson KE, Vlahov D. Prevalence and incidence of hepatitis C virus infection among young adult injection drug users.J Acquir Immune Defic Syndr Hum Retrovirol. 1998;18(suppl 1):S11-S19.PubMedGoogle Scholar
  36. 36.
    Centers for Disease Control and Prevention.HIV Surveillance Reports: 1994–1998. Atlanta, GA: Centers for Disease Control and Prevention; 1999;6–11.Google Scholar
  37. 37.
    Junge B, Vlahov D, Riley E, Huettner S, Brown M, Beilenson P. Pharmacy access to sterile syringes for injection drug users: attitudes of participants in a syringe exchange program.J Am Pharm Assoc (Wash). 1999;39(1):17–22.Google Scholar
  38. 38.
    Riley E, Safaeian M, Strathdee SA, et al. Comparing new participants of a mobile versus pharmacy-based needle exchange program.J Acquir Immune Defic Syndr Hum Retrovirol. In press.Google Scholar
  39. 39.
    Friedman SR, Curtis R, Jose B, Flom PL, Neaigus A, Des J. The message not heard: myth and reality in discussions about syringe exchange.AIDS. 1999;13(6):738–739.CrossRefPubMedGoogle Scholar
  40. 40.
    Heimer R, Bluthenthal RN, Singer M, Khoshnood K. Structural impediments to operational syringe-exchange programs.AIDS Public Policy J. 1996;11(4):169–184.PubMedGoogle Scholar
  41. 41.
    Schwartz RH. Syringe and needle exchange programs worldwide: Part II.South Med J. 1993;86(3):323–327.PubMedGoogle Scholar
  42. 42.
    Bluthenthal RN, Kral AH, Erringer EA, Edlin BR. Use of an illegal syringe exchange and injection-related risk behaviors among street-recruited injection drug users in Oakland, California, 1992 to 1995.J Acquir Immune Defic Syndr Hum Retrovirol. 1998; 18(5):505–511.PubMedGoogle Scholar
  43. 43.
    Bluthenthal RN, Kral AH, Lorvick J, Watters JK. Impact of law enforcement on syringe exchange programs: a look at Oakland and San Francisco.Med Anthropol. 1997;18(1): 61–83.PubMedGoogle Scholar
  44. 44.
    Wiebel WW, Jimenez A, Johnson W, et al. Risk behavior and HIV seroincidence among out-of-treatment injection drug users: a four-year prospective study.J Acquir Immune Defic Syndr Hum Retrovirol. 1996;12(3):282–289.PubMedGoogle Scholar
  45. 45.
    Burris S, Finucane D, Gallagher H, Grace J. The legal strategies used in operating syringe exchange programs in the United States.Am J Public Health. 1996;86(8, pt 1): 1161–1166.PubMedGoogle Scholar
  46. 46.
    Des J, Hagan H, Friedman SR, et al. Maintaingng low HIV seroprevalence in populations of injecting drug users.JAMA. 1995;274(15):1226–1231.Google Scholar
  47. 47.
    Vlahov D, Ryan C, Solomon L, Cohn S, Holt MR, Akhter MN. A pilot syringe exchange program in Washington, DC.Am J Public Health. 1994;84(2):303–304.PubMedGoogle Scholar
  48. 48.
    Obadia Y, Feroni I, Perrin V, Vlahov D, Moatti JP. Syringe vending machines for injection drug users: an experiment in Marseille, France.Am J Public Health. 1999;89(12): 1852–1854.PubMedGoogle Scholar

Copyright information

© The New York Academy of Medicine 2000

Authors and Affiliations

  • Heena Brahmbhatt
    • 1
  • Dan Bigg
    • 2
  • Steffanie A. Strathdee
    • 1
  1. 1.Johns Hopkins University School of Hygiene and Public HealthBaltimore
  2. 2.Chicago Recovery AllianceChicago

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