Current State of Syringe Exchange Programs in the US: Crisis and Opportunity

Background: Syringe exchange programs began in the US in the late 1980s and there are presently approximately 180 active syringe exchange programs (SEPs). During this time period, HIV incidence among IDUs declined by 80%. The ban on federal funding for syringe exchange was recently removed, but programs may be facing severe budget cuts due to fiscal problems among state and local governments.

Methods: A survey of executive directors of US syringe exchange programs participating in the North American Syringe Exchange Network (NASEN) was conducted in Spring, 2009. The questionnaire asked about program operations in 2008 and was emailed with follow-up telephone interviews. Similar surveys have been conducted since 1994, and a survey is currently being conducted for 2009 program operations. Data from the current survey will be included.

Results: 123 of 180 programs provided data for 2008. SEPs were active in 98 cities in 30 states. 29.1 million syringes were exchanged, and total SEP budgets totaled $21.2 millon, of which $16.8 (79%) was from local and state governments. SEPs provided many services in addition to basic syringe exchange: 98% provided male condoms, 87% HIV testing, 65% HCV testing, 55% STI screening, 49% HBV vaccination, and 89% referrals to substance abuse treatment.

Conclusions: US SEPs have become multi-service organizations heavily dependent upon state/local government funding. The 2008 data provides a baseline and the 2009 data will provide a first assessment of state/local budget reductions and how SEPs expect to use any federal funds that become available.