This community study of the San Jose, Calif. syringe exchange program (SEP) compared the HIV risk behavior of exchange clients with that of nonclients. The researchers followed a prospective cohort of 259 untreated injection drug users a mean of 10.7 months after baseline. The current study corrected for respondents' baseline risk behavior in analyzing the association between the patients' follow-up use of the syringe exchange program and their follow-up risk behavior. The authors also attempted to adjust for other sources of syringes by measuring and analyzing respondents' use of sterile syringes from non-SEP sources. Analysis of potential confounders showed that the variables sex, number of injections in the previous 30 days, and number of "speedball" (heroin and cocaine) injections were significantly associated with risk behavior at follow-up.

Seventy-seven percent of the sample of predominantly male, Hispanic patients in their thirties and forties was reached for follow-up interviews. Data analysis showed a greater than twofold protective effect associated with use of syringe exchange, although the authors stress that such an association could be due in part to preexisting differences between IDUs who seek and those who do not seek to use an SEP. Analysis examining the interaction of exchange use with other sources of syringes showed the odds of HIV risk behavior were decreased more than sixfold for IDUs who obtained syringes only from the SEP.

The findings of this study support the bulk of the literature evaluating syringe exchange: the protective effect associated with such programs is considerable. Furthermore, the finding that the protective effect increases sixfold against HIV risk for IDUs without other sources of syringes emphasizes the critical nature of such programs and suggests that syringe exchange programs can gain great benefit from focusing on getting sterile syringes to these IDUs.

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