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August 10, 1994

Regulating Syringe Exchange Programs: A Cautionary Note

Author Affiliations

Beth Israel Medical Center New York, NY
National Development and Research Institutes Inc New York, NY
Beth Israel Medical Center New York, NY

JAMA. 1994;272(6):431-432. doi:10.1001/jama.1994.03520060029016

To the Editor.  —Recent estimates of new human immunodeficiency virus (HIV) seroconversions in the United States suggest that the plurality of new infections are associated with illicit drug injection.1 Syringe-exchange programs (SEPs) are a common method for reducing HIV risk behavior among injecting drug users (IDUs) in other countries, but have remained quite controversial in the United States. There are many methodological difficulties in conducting and interpreting syringe-exchange evaluations. Nevertheless, reviews of evaluation studies,2,3 as well as more recently published data,4,5 suggest that SEPs may be able to substantially reduce HIV risk behavior in the United States.For SEPs to have a large impact on risk behavior, however, the scale of service would have to be greatly expanded. (By our most recent estimates, there are 41 SEPs in the United States, providing services to less than 5% of IDUs.) Large-scale expansion would almost certainly require additional public

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