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Operational issues in syringe exchanges: The New York City tagging alternative study

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Abstract

It is estimated that 50% of the approximate 200,000 intravenous drug users (IDUs) in New York City (NYC) are infected with HIV. Syringe exchange, a common method of HIV prevention in many countries was legalized in NYC in 1992. As syringe exchange has gained public support and the number of functioning exchanges has grown in the country, more attention has been given to the study of operational characteristics of syringe exchanges.

Syringe exchanges may be considered health service delivery organizations, and the specific methods of service delivery may greatly influence their effectiveness in reducing HIV risk behavior among injecting drug users. Improving operational characteristics of syringe exchanges requires both careful data collection, in order to reduce ambiguity in interpretation, and methods for cumulating knowledge, so that previous learning experiences need not be repeated with each new exchange. We report here on the practice of marking (“tagging”) syringes distributed by exchanges in NYC during the period from 1990 through 1994. During this period the NYC exchanges operated illegally as underground exchanges, and then received legal status and expanded greatly.

Developing regulations that reflect the reality of the program operations while allowing for monitoring and oversight is a complicated process, especially when implemented in states that maintain paraphernalia and prescription laws and where “unauthorized” possession of injection equipment remains a criminal activity under existing legal statutes. The particular situation in NYC which required the revision of existing regulations during a period of rapid program expansion and implementation of a large system of syringe exchange further illustrates the multiple pressures which accompany such a process. In order to implement meaningful regulations which maximize the public health benefits of syringe exchange programs on an individual and community level, recommendations are made.

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Authors and Affiliations

  1. Chemical Dependency Institute, Beth Israel Medical Center, 16 St. at First Avenue, 10003, N.Y., NY

    Denise Paone EdD

Authors
  1. Denise Paone EdD
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  2. Don C. Des Jarlais PhD
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  3. Stephanie Caloir MPH
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  4. Jessica Clark BA
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  5. Benny Jose MS, CPA
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Additional information

Presented as part of a symposium, “Turning Points: Key Policy Debates on HIV in the Inner City,” held on April 8, 1994 at the State University of New York, Health Science Center at Brooklyn.

The authors gratefully thank Elvin Gonzalez, a student intern, and the syringe exchange staff—Allan Clear, Hector Garduno, Alfredo Mirando, Pablo Pabellon, and Joyce Rivera-Beckman—for their time and cooperation. The authors also thank Nina Peyser, Maggie Reinfeld, Lee Kochems and the New York State Department of Health/AIDS Institute, particularly Alma Candelas and Michael Cowing, for their review of the manuscript. The New York AIDS Institute provided funding for this study. Views expressed in this paper do not necessarily reflect the position of the granting agency.

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Paone, D., Des Jarlais, D.C., Caloir, S. et al. Operational issues in syringe exchanges: The New York City tagging alternative study. J Community Health 20, 111–123 (1995). https://doi.org/10.1007/BF02260333

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