To the Editor.
—Two recent articles1,2 argue that needle-exchange programs (NEPs) are an effective human immunodeficiency virus (HIV) control strategy among injecting drug users (IDUs). Driven by the failure of current policies and European successes, NEPs have become the focus of US policy discussion, as demonstrated by the General Accounting Office report,3 the congressional allocation of $5 million to evaluate NEPs (PL 102-321, July 10,1992), and a flurry of publications and conferences. Therefore, it is critical to underline the limitations and move the policy debate beyond NEPs.Injecting drug users are forced to use dirty needles because of scarcity, higher prices, and fear of carrying needles, generated by restrictive policies and criminalization of paraphernalia possession. Thus, the most effective HIV control strategy is to increase availability through liberal policies as is done in Europe and Australia. Without it, European and American NEPs cannot be compared. Risk reductions attributed
Fernando D. Syringe and Needle Exchange to Prevent HIV Infection. JAMA. 1994;271(23):1825. doi:10.1001/jama.1994.03510470029017