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State laws, syringe exchange, and HIV among persons who inject drugs in the United States: History and effectiveness


In 1981, when acquired immune deficiency syndrome (AIDS) was first observed among persons who inject drugs, almost all US states had laws criminalizing the possession and distribution of needles and syringes for injecting illicit drugs. We reviewed changes to these laws to permit ‘syringe exchanges’ and the provision of public funding for such programs. Most of the changes in law occurred during the 1990s, 5–10 years later than in many other countries. Public funding of syringe exchanges is associated with lower rates of human immunodeficiency virus (HIV) infection, greater numbers of syringes distributed (a possible causal mechanism), and greater numbers of health and social services provided. Experience in the United states may prove useful in other countries: state, provincial, and local governments may need to move ahead of central governments in addressing HIV infection among persons who inject drugs.

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  • Centers for Disease Control and Prevention. (2001) First report of AIDS. MMWR Morbidity and Mortality Weekly Report 50 (21): 429.

  • Gallo, R.C. and Montagnier, L. (2003) The discovery of HIV as the cause of AIDS. New England Journal of Medicine 349 (24): 2283–2285.

    Article  Google Scholar 

  • Normand, J., Vlahov, D. and Moses, L.E. (1995) Preventing HIV Transmission: The Role of Sterile Needles and Bleach. Washington DC: National Academies Press.

    Google Scholar 

  • van Ameijden, E.J., van den Hoek, A.R. and Coutinho, R.A. (1994) Injecting risk behavior among drug users in Amsterdam, 1986 to 1992, and its relationship to AIDS prevention programs. American Journal of Public Health 84 (2): 275–281.

    Article  Google Scholar 

  • Stimson, G.V. (1995) AIDS and injecting drug use in the United Kingdom, 1987–1993: The policy response and the prevention of the epidemic. Social Science & Medicine 41 (5): 699–716.

    Article  Google Scholar 

  • Wodak, A. (1993) Preventing the spread of HIV among Australian injecting drug users. Forensic Science International 62 (1–2): 83–87.

    Article  Google Scholar 

  • Abdul-Quader, A. et al (2013) Effectiveness of structural-level needle/syringe programs to reduce HCV and HIV infection among people who inject drugs: A systematic review. AIDS and Behavior 17 (9): 2878–2892.

    Article  Google Scholar 

  • Wodak, A. and Cooney, A. (2006) Do needle syringe programs reduce HIV infection among injecting drug users: A comprehensive review of the international evidence. Substance Use and Misuse 41 (6–7): 777–813.

    Article  Google Scholar 

  • NIDA. (1990) Drugs and violence: Causes, correlates, and consequences. NIDA Research Monograph 103: 1–275.

  • Coyle, M. (2003) Race and class penalties in crack cocaine sentencing: Sentencing project. Paper presented at the annual meeting of the American Sociological Association, 16 August, Atlanta, GA, Atlanta Hilton Hotel, December.

  • Anderson, W. (1991) The New York needle trial: The politics of public health in the age of AIDS. American Journal of Public Health 81 (11): 1506–1517.

    Article  Google Scholar 

  • Gostin, L. (1998) The legal environment impeding access to sterile syringes and needles: The conflict between law enforcement and public health. Journal of Acquired Immune Deficiency Syndrome Human Retrovirology 18 (1): S60–S70.

    Article  Google Scholar 

  • Bluthenthal, R.N., Kral, A.H., Lorvick, J. and Watters, J.K. (1997) Impact of law enforcement on syringe exchange programs: A look at Oakland and San Francisco. Medical Anthropology 18 (1): 61–83.

    Article  Google Scholar 

  • ONDCP. (1992) Needle Exchange Programs: Are They Effective? Executive Office of the President, Washington DC: Office of National Drug Control Policy July, Report No. 7.

  • Gibson, D.R., Flynn, N.M. and Perales, D. (2001) Effectiveness of syringe exchange programs in reducing HIV risk behavior and HIV seroconversion among injecting drug users. AIDS 15 (11): 1329–1341.

    Article  Google Scholar 

  • Bastos, F.I. and Strathdee, S.A. (2000) Evaluating effectiveness of syringe exchange programmes: Current issues and future prospects. Social Science & Medicine 51 (12): 1771–1782.

    Article  Google Scholar 

  • Hellinger, F.J. (1993) The lifetime cost of treating a person with HIV. JAMA 270 (4): 474–478.

    Article  Google Scholar 

  • Tempalski, B., Lieb, S., Cleland, C.M., Cooper, H., Brady, J.E. and Friedman, S.R. (2009) HIV prevalence rates among injection drug users in 96 large US metropolitan areas, 1992–2002. Journal of Urban Health 86 (1): 132–154.

    Article  Google Scholar 

  • Centers for Disease Control and Prevention. (2012) CDC Fact sheet of New HIV Infections in the United States Atlanta, GA.

  • Mathers, B. et al (2008) Global epidemiology of injecting drug use and HIV among people who inject drugs: A systematic review. Lancet 372 (9651): 1733–1745.

    Article  Google Scholar 

  • Rothman, K.J. and Greenland, S. (eds.) (1998) Precision and Validity in Epidemiologic Studies. In: Modern Epidemiology. 2nd edn. Philadelphia: Lippincott-Raven, pp. 115–134.

  • Brady, J., Friedman, S., Cooper, H., Flom, P., Tempalski, B. and Gostnell, K. (2008) Estimating the prevalence of injection drug users in the U.S. and in large U.S. metropolitan areas from 1992–2002. Journal of Urban Health 85 (3): 323–351.

    Article  Google Scholar 

  • Des Jarlais, D.C. et al (2005) HIV incidence among injection drug users in New York City, 1990 to 2002: Use of serologic test algorithm to assess expansion of HIV prevention services. American Journal of Public Health 95 (8): 1439–1444.

    Article  Google Scholar 

  • WHO, UNAIDS. WHO, UNODC. (2012) UNAIDS Technical Guide For Countries to Set Targets for Universal Access to HIV Prevention, Treatment and Care for Injecting Drug Users. Geneva, Switzerland: WHO.

  • Degenhardt, L., Mathers, B., Vickerman, P., Rhodes, T., Latkin, C. and Hickman, M. (2010) Prevention of HIV infection for people who inject drugs: Why individual, structural, and combination approaches are needed. Lancet 376 (9737): 285–301.

    Article  Google Scholar 

  • Des Jarlais, D. et al (2014) Combined HIV prevention, the New York City condom distribution program, and the evolution of safer sex behavior among persons who inject drugs in New York city. AIDS and Behavior 18 (3): 443–451.

    Article  Google Scholar 

  • Sullivan, S.G. and Wu, Z. (2007) Rapid scale up of harm reduction in China. International Journal of Drug Policy 18 (2): 118–128.

    Article  Google Scholar 

  • UNAIDS, World Bank. (2010) Evaluation of the Epidemiological Impact of Harm Reduction Programs on HIV in Vietnam. Washington DC: World Bank.

  • Hathaway, A.D. and Tousaw, K.I. (2008) Harm reduction headway and continuing resistance: Insights from safe injection in the city of Vancouver. International Journal of Drug Policy 19 (1): 11–16.

    Article  Google Scholar 

  • Dano, E., An-Tac, I., Belimac, G. and Zhao, P. (2014) Policy breakthrough in needle and syringe program (NSP) for people who inject drugs (PWID) in Cebu city, Philippines. 20th international AIDS Conference, Melbourne Australia. Frado 102.

  • Jolley, E. et al (2012) HIV among people who inject drugs in central and Eastern Europe and central Asia: A systematic review with implications for policy. BMJ Open 2 (5): 1–20.

    Article  Google Scholar 

  • Sharma, M., Oppenheimer, E., Saidel, T., Loo, V. and Garg, R. (2009) A situation update on HIV epidemics among people who inject drugs and national responses in South-East Asia region. AIDS 23 (11): 1405–1413.

    Article  Google Scholar 

  • Krisberg, K. (2010) Funding ban repeal a step forward for needle exchange: Support could bolster HIV prevention. The Nation’s Health 40 (2): 1–13.

    Google Scholar 

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By comparing differences among US state laws, the authors found association of public funding of syringe exchanges with lower rates of HIV infection, greater numbers of syringes distributed, and greater numbers of health and social services.

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Bramson, H., Des Jarlais, D., Arasteh, K. et al. State laws, syringe exchange, and HIV among persons who inject drugs in the United States: History and effectiveness. J Public Health Pol 36, 212–230 (2015).

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  • HIV
  • PWID
  • drugs
  • laws
  • syringe exchange
  • pharmacy sales