A Publication from The Kaiser Forums; Sponsored by The Henry J. Kaiser Family Foundation
Edited by: Jeff Stryker, Center for AIDS Prevention Studies University of California-San Francisco; Mark Smith, M.D., M.B.A. -

Public health officials have understood the tragic link between injection drug use and the human immunodeficiency virus (HIV) since the early 1980s. By now, a third of all cases of acquired immune deficiency syndrome (AIDS) result from shared needles and syringes. But drafting sound public policy and changing behavior to sever that link has proved far more difficult than understanding HIV's deadly routes. Indeed, no issue in HIV prevention is more controversial or emotional than the issue of needle exchange. Should doctors and health officials promote the availability of free, sterile needles to illegal drug users to slow the spread of HIV? Is it possible that needle exchange programs designed to fight HIV might encourage the use of drugs? Will health officials and law enforcement officials undercut each other's efforts? To explore these issues objectively and encourage all sides to air their views together, in December 1992 the Kaiser Family Foundation convened a two-day Kaiser Forum on needle exchange. Papers summarizing the key presentations at that forum are compiled in this book. The papers examine existing needle exchange programs--how they were implemented, funded, and evaluated. They discuss legal issues that must be addressed before such a program can begin. And they frankly discuss the concern in ethnic minority neighborhoods that health officials and society are more concerned about AIDS than about violence and drugs that destroy the lives of so many poor Americans. Allowing free access to sterile needles and syringes is not an easy thing for our society to accept. Nor are its ramifications well understood. Still, we must grapple with this topic; the HIV epidemic demands that we consider many policies regarded as unthinkable two decades ago. By convening the Kaiser Forum and publishing this book, the Kaiser Family Foundation does not endorse or oppose needle exchange. But we do encourage open debate based on solid information. Only then can society make a rational decision.

Drew E. Altman President Kaiser Family Foundation
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