This volume addresses the interface of two major national problems: the epidemic of HIV-AIDS and the widespread use of illegal injection drugs. Should communities have the option of giving drug users sterile needles or bleach for cleaning needs in order to reduce the spread of HIV? Does needle distribution worsen the drug problem, as opponents of such programs argue? Do they reduce the spread of other serious diseases, such as hepatitis? Do they result in more used needles being carelessly discarded in the community? The panel takes a critical look at the available data on needle exchange and bleach distribution programs, reaches conclusions about their efficacy, and offers concrete recommendations for public policy to reduce the spread of HIV/AIDS. The book includes current knowledge about the epidemiologies of HIV/AIDS and injection drug use; characteristics of needle exchange and bleach distribution programs and views on those programs from diverse community groups; and a discussion of laws designed to control possession of needles, their impact on needle sharing among injection drug users, and their implications for needle exchange programs.

Contents

• PANEL ON NEEDLE EXCHANGE AND BLEACH DISTRIBUTION PROGRAMS
• [The National Academies]
• Preface
• Acknowledgments
• Executive Summary
• Introduction
• Part 1. Dimensions of the Problem
  • 1. The Epidemiology of HIV and AIDS
    • Biological Mechanisms Of Transmission
    • Epidemiologic Data
    • Hiv And Aids Among Injection Drug Users
    • Summary
    • References
  • 2. The Epidemiology of Injection Drug Use
    • Estimates Of Injection Drug Users
    • Characteristics Of Injection Drug Users
    • Summary
    • References
  • 3. Needle Exchange and Bleach Distribution Programs in the United States
    • Introduction
    • Needle Exchange Programs
    • Bleach Distribution Programs
    • Conclusions
    • References
  • 4. Community Views
    • Moral/Ethical Arguments
    • Public Opinion Polls
    • African American Views
    • Latino/Hispanic Views
    • Law Enforcement Views
    • Health Professional Views
    • Summary
    • Conclusions
    • References
  • 5. The Legal Environment
    • U.S. Drug Control Policy
    • Do Paraphernalia And Prescription Laws Contribute To Hiv Transmission
    • Should The Laws Be Changed
    • Conclusions
    • Recommendations
    • References
• Part 2. The Impact of Needle Exchange and Bleach Distribution Programs
  • 6. The Effectiveness of Bleach as a Disinfectant of Injection Drug Equipment
    • Transmission Of HIV Among Injection Drug Users
    • Bleach As A Disinfectant
    • Bleach Distribution Programs
    • Summary
    • References
  • 7. The Effects of Needle Exchange Programs
    • Potential Outcomes
    • The Panel's Approach To The Evidence
    • U.S. General Accounting Office Review
    • University Of California Report
    • Evidence From Recent Studies
    • The New Haven Studies
    • The Tacoma Studies
    • Summary
    • References
  • 8. Directions for Future Research
    • Research On Program Effectiveness
    • Research On Bleach Efficacy In Disinfection
    • Epidemiologic Research
    • Research On Community Issues
    • Other Future Research Issues
    • Broader Issues
    • Conclusion
    • References
• Appendixes
  • Appendix A Description and Review of Research Projects in Three Cities
  • Appendix B Professional Association Positions on Needle Exchange and Bleach Distribution Programs
  • Appendix C Biographical Sketches

This project was sponsored by the National Institute on Drug Abuse.

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.