How accessible are needle exchange programs in Manhattan to injecting drug user populations? A closer look at geographic access to needle exchange programs using a Geographic Information System (GIS)

Amy Welton, BA
Center for Health Education and Research (CHER)
University of Washington, 901 Boren Ave, Suite 1100
Seattle, Washington, 98104 USA
Phone: 206-685-5303 Fax: 206-221-4945
Email: mailto:wamy@u.washington.edu

Ken Patterson, BA
University of Washington, Seattle, Washington, USA

David Gilbert, BA
University of Washington, Seattle, Washington, USA


Introduction
The sparse assemblage of needle exchange locations in New York City barely serves a quarter of injecting drug users’ (IDUs) needs. Injecting drug users in New York City typically go through an average of 3-4 needles per day, at a rate of 255 million needles per year. ¹The New York City needle exchange programs serve 30,000 IDUs annually and as of 1998, distribute less than 2% of needed syringes². In a city with both the highest urban drug epidemic in the world and the largest AIDS epidemic in the United States, where injecting drug users account for nearly a quarter of persons infected with the human immunodeficiency virus (HIV), one thing is clear: there are not enough needle exchanges to sufficiently match the demand from the IDU population.

1 Background
For nearly fifteen years, the debate has continued unabated about the effectiveness of needle exchange programs in reducing HIV transmission among IDUs. Ever since injecting drug users were identified as a high risk group for the acquired immunodeficiency virus in 1982, researchers have waded against a stream of funding bans to perform research on harm reduction for IDUs³. A number of studies show that the most effective efforts in harm reduction have incorporated needle exchange programs into a broad spectrum of prevention activities, such as substance abuse referrals, education, counseling and testing. ^4,5,6,7,8 Moreover, Schechter et al found that if NEPs were designed to meet the needs of the community, they could potentially avert a larger outbreak⁹. These studies open a window onto the factors that influence the effectiveness of public health practices around harm reduction. Multiple levels of operation influence the system of harm reduction as well as the individual organizations that practice harm reduction techniques. The levels examined in this paper represent components of the policy, operations, public health, and geographic issues of needle exchange programs.

Why has the needle exchange system failed to expand to meet the IDU population’s demand? Despite a well supported effort by the first publicly supported needle exchange in Tacoma, Washington in 1988¹⁰, needle exchange programs nation-wide have struggled to develop and coordinate their services. This is due in part to the dynamics of federal policy on needle exchange programs, whereby both federal funding of needle exchange programs and research to evaluate the safety and efficacy of those programs were banned.³ For example, in the late 80s the federal government placed a ban on two types of research: research utilizing fetal tissue and research on needle exchanges¹¹. The dearth of research on the safety and efficacy of such programs contributed to political decision making that lacked an empirical basis (Ibid).¹¹ The first time this pattern was broken was when Surgeon General David Satcher who, under President Bill Clinton in the year 2000, acknowledged the scientific benefits of needle exchange programs, but continued to support the ban on federal funding for needle exchange services.3 The moral and scientific conflicts regarding research on a national level create a financially and politically unstable environment within which needle exchange programs must operate.