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Don C. Des Jarlais, PhD; Denise Paone, EdD
Beth Israel Medical Center New York, NY

Samuel R. Friedman, PhD
National Development and Research Institutes Inc New York, NY

Nina Peyser, MBA; Robert G. Newman, MD
Beth Israel Medical Center New York, NY

JAMA. 1994;272(6):431-432.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

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 . . . [Full Text PDF of this Article]

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