What is needle exchange?

Needle exchange is a public health intervention which is proven to reduce HIV transmission in the community. It works by providing people who cannot or will not stop injecting illegal drugs new needles, and a place to safely dispose of used needles. There are approximately 200 syringe exchange programs operating in 38 States. Needle exchange is common elsewhere in the world, with official programs being operated in at least 46 countries, including countries such as Iran, China, and Russia, where illicit drug use is often treated far more harshly than is constitutionally possible in the United States.

Why should we as taxpayers fund needle exchange?

In cities such as San Francisco, which implemented a comprehensive needle exchange program early in the HIV epidemic, about 7% of injecting drug users have HIV. By contrast, in cities such as New York, which did not allow needle exchange at all until the mid-1990s, over 40% of injectors have HIV. The lifetime cost of treating each new HIV infection is currently $119,0001. San Francisco has an estimated 15,000 injecting drug users – if 40% of them had HIV instead of 7%, it would cost an additional $589 Million to treat. By comparison, the cost of operating all of San Francisco’s needle exchanges put together is $850,000 per year2. You could run every needle exchange in San Francisco for over six hundred years on that $589 million dollars.

Why does the Haight needle exchange give needles to people who don’t bring in dirty needles?

The drug user who has no needle at all is the drug user at highest risk of using another person’s dirty needle. The Haight needle exchange, like every exchange in San Francisco, will give a limited number of clean needles to drug users who do not have any. A recent study of 26 needle exchanges in California showed that counties with a strict one-for-one policy (i.e. no needle could be given out unless a dirty one was brought in) had just as many needles found on the streets as counties such as San Francisco, which allowed exchanges to give limited numbers of needles to people who had none. However, the study found that drug users in counties with a strict one-for-one policy had higher rates of needle sharing than those without3. Additionally, in 1997, the town of Windham in Connecticut closed its only needle exchange following community concerns that the needle exchange was the primary source of street-discarded needles. A federally funded study conducted in the county during this period found that there was no change in the number of street discarded needles after the exchange closed, but that drug users were sharing and re-using those needles more often before discarding them.

More generally, studies consistently show that needle exchanges are not associated with increases in needle trash5, and that law enforcement officers report decreased rates of needle-stick injuries after the opening of exchanges, as needles are more likely to be stored in disposal containers for return to the exchange6.

How many people access the Haight needle exchange?

The Haight needle exchange is one of the smallest exchanges in the city. The exchange is open for a total of six hours each week, and serves between 40 to 90 injection drug users and their friends a week.

How do we know needle exchange reduces the number of HIV infections?

Because needle exchange has been politically contentious, it is the most thoroughly studied public health intervention of the past thirty years. These studies have repeatedly and consistently shown that needle exchange reduces new HIV infections7, increases successful uptake of drug treatment, and does not result in increased crime or violence in communities in which they are started9. Federally funded reports conducted by the National Commission on AIDS10, the General Accounting Office11, the Centers for Disease Control and Prevention (CDC)12, the National Institute of Medicine’s National Research Council13, and the Office of Technology Assessment14 have all concluded that needle exchanges reduce the transmission of HIV while not increasing drug use.


1. [PDF] Schackman, B. R.; Gebo, K. A.; Walensky, R. P.; Losina, E.; Muccio, T.; Sax, P. E.; Weinstein, M. C.; Seage, G. R.; Moore, R. D. & Freedberg, K. A. The lifetime cost of current human immunodeficiency virus care in the United States. Medical Care, 2006, 44 (11), 990-997
2. [Link] Knight, H. S.F. scrambles to fix needle-swap program after public outcry San Francisco Chronicle, 2007, A1
3. [PDF] Kral, A. H.; Anderson, R.; Flynn, N. M. & Bluthenthal, R. N. (2004), ‘Injection risk behaviors among clients of syringe exchange programs with different syringe dispensation policies’, Journal of Acquired Immune Deficiency Syndromes 37(2), 1307-1312.
4. [PDF] Broadhead, R. S.; van Hulst, Y. & Heckathorn, D. D. The impact of a needle exchange’s closure. Public Health Reports, 1999, 114 (5), 439-447
5. [PDF] Doherty, M. C.; Junge, B.; Rathouz, P.; Garfein, R. S.; Riley, E. & Vlahov, D. (2000), ‘The effect of a needle exchange program on numbers of discarded needles: a 2-year follow-up’, American Journal of Public Health 90(6), 936-939.
6. Groseclose, S. L.; Weinstein, B.; Jones, T. S.; Valleroy, L. A.; Fehrs, L. J. & Kassler, W. J. (1995), ‘Impact of increased legal access to needles and syringes on practices of injecting-drug users and police officers–Connecticut, 1992-1993’, Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 10(1), 82-89.
7. [PDF] Wodak, A. & Cooney, A. (2005), ‘Effectiveness of sterile needle and syringe programmes’, International Journal of Drug Policy 16S, S31-S44. Heimer, R.; Khoshnood, K.; Bigg, D.; Guydish, J. & Junge, B. (1998), ‘Syringe use and reuse: Effects of syringe exchange programs in four cities’, Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 18 Suppl 1(3), S37-44.
[PDF] Bluthenthal, R. N.; Kral, A. H.; Gee, L.; Erringer, E. A. & Edlin, B. R. (2000), ‘The effect of syringe exchange use on high-risk injection drug users: a cohort study’, AIDS 14(5), 605-11.
[PDF] Bluthenthal, R. N.; Kral, A. H.; Erringer, E. A. & Edlin, B. R. (1998), ‘Use of an illegal syringe exchange and injection-related risk behaviors among street-recruited injection drug users in Oakland, California, 1992 to 1995’, Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology 18(5), 505-11.
8. [PDF] Brooner, R.; Kidorf, M.; King, V.; Beilenson, P.; Svikis, D. & Vlahov, D. (1998), ‘Drug abuse treatment success among needle exchange participants’, Public Health Reports 113 Suppl 1(6), 129-39.
9. [PDF] Galea, S.; Ahern, J.; Fuller, C.; Freudenberg, N. & Vlahov, D. (2001), ‘Needle exchange programs and experience of violence in an inner city neighborhood’, Journal of Acquired Immune Deficiency Syndromes 28(3), 282-288.
10. [Link] National Commission on AIDS (1991) The Twin Epidemics of Substance Use and HIV. Washington DC.
11. [Link] General Accounting Office (1993) Needle Exchange Programs: Research Suggests Promise as an AIDS Prevention Strategy US Government Printing Office: Washington DC.
12. [PDF] Centers for Disease Control and Prevention (1993) The Public Health Impact of Needle Exchange Programs in the United States and Abroad: Summary, Conclusions and Recommendations CDC: Atlanta.
13. [Link] Institute of Medicine, National Research Council (1995): Preventing HIV Transmission: The Role of Sterile Syringes and Bleach National Academy Press: Washington DC.
14. [PDF] Office of Technology Policy Assessment of the US Congress (1995) The Effectiveness of AIDS Prevention Efforts US Government Printing Office: Washington DC.