Termination of an established needle-exchange: A study of claims and their impact

Despite the wealth of scientific findings showing thar needle-exchange programs reduce unsafe injection practices, and that these practices are the direct or indirect cause of one third of new HIV infections in the United States, the figure of needle-exchange in this country remains uncertain, The federal government continues to ban the use of federal funds to support needle-exchange programs. In many cities with large numbers of HIV-positive drug injectors, local and state officials continue to oppose the implementation of exchange services. Needle-exchange staff members also continue to risk arrest, prosecution and imprisonment. Whereas previous studies have focused on the effectiveness of needle-exchange programs, we offer an analysis of a unique event, the closure of a well-established needle-exchange. The study consists of two parts. The first analysis examines the claimsmaking that succeeded in defining the needle-exchange as a public health hazard and a social problem, causing it to be closed after several years of operation. In the second part, based on initial and follow-up interviews with needle-exchange clients, surveys of public drug-using sites, and ethnographic interviews, we present off impact analysis of the exchange's closure. The analysis provides a case study showing how a community's demonstrably effective HIV prevention efforts can be quickly eroded by the termination of a key harm-induction service.