A CLOSER LOOK AT NEEDLE EXCHANGES

Allowing drug addicts to exchange old needles for new ones has been shown to
reduce needle sharing, a major source of H.I.V. infection, researchers from
the University of California at Davis reported in the current issue of the
journal AIDS.

The lead author, Dr. David R. Gibson, and his colleagues based their
findings on a review of 42 studies, published from 1989 to 1999, that looked
at needle exchange programs. Twenty-eight found a clear reduction in the
risk of H.I.V. infection, the report said, while 12 found no effect or were
equivocal and 2 found an increased risk. The Davis researchers, however,
found that flaws in the studies with neutral or unfavorable findings might
have masked the benefits of needle exchange.

All 14 studies were conducted in parts of the world where needles could be
bought legally in drugstores -- potentially diluting the effect of the
exchange programs. This was an issue in only 5 of the 28 studies that
reported favorably about the programs.

Those 28 studies found that when needle exchange programs were tried in San
Francisco, Portland, Ore., Tacoma, Wash., and Baltimore, needle sharing
decreased by a range of 16 percent to 72 percent. And in New Haven, the
study said, researchers examining needles exchanged by drug users found that
the number of needles carrying H.I.V. dropped by about a third in the first
three months of an exchange program. Still, the study acknowledged that the
programs alone might not be enough to prevent AIDS from spreading among drug
users.

And in another new study, to be published next month in The Journal of
Acquired Immune Deficiency Syndromes, researchers from Johns Hopkins report
that a majority of addicts in Baltimore still buy needles on the street,
despite available exchange programs. Only 4 percent told researchers they
used needles from exchange programs exclusively.