Summary

Do needle exchange programs slow the spread of the AIDS virus by reducing needle sharing among addicts? GAO identified nine needle exchange projects that had published results. Of the three studies with findings based on strong evidence, two reported a reduction in needle sharing while the third reported an increase. Seven of the nine projects looked at whether these programs increased drug use. All five projects with strong evidence found that drug use did not increase among users; four reported no rise in the frequency of injection and one found no increase in the prevalence of use. GAO also found the forecasting model developed at Yale University to be credible. This model established a 33-percent reduction in new HIV infections among New Haven, Connecticut, needle exchange program participants during one year. Although these findings suggest that needle exchange programs may hold promise as an AIDS prevention strategy, the law now blocks the Department of Health and Human Services (HHS) from using funds to directly support needle exchange programs. HHS does, however, have the authority to conduct demonstration and research projects that could provide needles to drug users.

GAO found that: (1) six of the nine needle exchange projects examined provided information on the rate of needle sharing, prevalence of injection drug use, and frequency of injection; (2) two projects indicated that needle exchange programs were associated with reduced needle sharing among intravenous drug users, while one project reported an increase in needle sharing; (3) five projects reported no evidence of increased drug use because of greater needle availability; (4) seven projects reported successes in referring intravenous drug users to drug treatment and other health services, but not all drug users were able to obtain treatment; (5) the Yale University forecasting model, which claimed that needle exchange programs could reduce HIV transmissions by about 33 percent, was credible, technically sound, and reasonable; (6) the reduction in HIV transmissions stemmed from the program's ability to lessen the opportunity for needles to become infected, shared, or infect uninfected drug users; (7) the Yale University model relied on a data collection system that monitored the amount of needles distributed and returned, identified the drug user and needle exchanges, and analyzed residual blood in returned needles for HIV infection; and (8) Congress has specifically restricted the use of appropriated funds for needle exchange programs, but GAO believes that federal funds could be used for needle exchange studies and demonstrations.