Legitimate and underground needle exchange programs, specifically targeted for intravenous drug users (IVDUs) (i.e., currently the second largest risk group in the AIDS epidemic), have emerged in various locales in a desperate attempt to change their drug use practices and behaviors associated with the transmission of HIV-1/AIDS. This study focuses on one such program, the Tacoma-Pierce County Needle Exchange Program, in which the pioneering efforts of a private individual are provided, the manifestations of public entrepreneurism are examined, and in which various attributes of program acceptance are identified and explored. An introductory and exploratory case study approach is the research strategy used in this dissertation, since it is adaptive and flexible to accommodate the use of multiple data sources. Data have been collected through semi-structured interviews involving four law enforcement personnel and 21 program clients (i.e., IVDUs), which consisted of open-and close-ended questions regarding program acceptance. Existing data sources, such as court documents, published interviews with key officials, journals, and various news articles provide an assessment of the events and activities that relate to the evolution and success of the Tacoma-Pierce County Needle Exchange Program. The attributes identified and explored in this study include: settings, type of staff, method of service delivery (including spillover effects), nature of the geographic area, concern over the effects of AIDS, external environmental conduits (the informal communication network and the media), and characteristics of program clients. These attributes were found to be important to program acceptance of the Tacoma-Pierce County Needle Exchange Program; however, they should be further examined in other communities to see if they remain important. To this extent, the findings indicated that needle exchange programs have complex characteristics attached to them, and that they deserve to be further studied to understand those complexities. Other benefits of the Tacoma-Pierce County Needle Exchange Program found to be important include: (1) fewer citizen complaints about the carelessly discarded, used syringes often found in gutters, parks, greenbelts, alleys, and streets; and (2) fewer reports of infections caused by accidental needle stick injuries among law enforcement personnel (which can occur when a law enforcement officer frisks a suspect), maintenance employees, and grounds-keepers. Overall, phenomenal savings can accrue from such unintentional and additional benefits of needle exchange programs. In light of this debilitating disease, and of the high cost associated with medical care, such innovative interventions are perceived worthy in the course of this deadly epidemic.

Bakgrund: Långvarigt drogbruk leder till negativa fysiologiska och psykologiska konsekvenser. Samsjuklighet, stigmatisering och abstinens är några anledningar till att patientgruppen fortsätter sitt drogbruk. Droginjicering är en av orsakerna till att blodsmittor sprids i samhället. Sprututbytesprogrammet är riktat till personer med intravenöst drogberoende och erbjuder remittering, sprututbyte, samtalskontakt och antidotpreparat. Syfte: Syftet var att beskriva patienters upplevelse av skadereduktion och påverkan påriskbeteende genom deltagande på sprututbytesprogrammet. Metod: En allmän litteraturstudie utgjordes av tio kvalitativa originalartiklar som analyserades tematiskt. Resultat: Tre huvudteman och sex subteman identifierades. Minskat riskbeteende med subtema egenvårdsförmåga och hjälp från flera håll. Ökad relationsbyggnad med subtema hälsofrämjande verksamhet och vårdmötet. Begränsade resurser med subtema fortsatt stigmatisering och när drogberoendet tar överhand. Slutsats: Sprututbytesprogrammet ökarkunskapen om riskbeteende, egenvårdsförmågan och hälsofrämjande livsstilsförändringar. Behandling, utbildning och en känsla av trygghet är viktiga komponenter för konsekvent deltagande på Sprututbytesprogrammet. Verksamheten ökar självkänslan hos patientgruppen till skillnad från annan hälso- och sjukvård och bidrar till att minska sociala klyftor mellan patientgruppen och övriga samhället. Fortsatt stigmatisering och strukturella hinder gör patientgruppen skör vilket belyser behovet av vidare forskning och utbildning för att kunna möta deras vårdbehov. / Background: Addictive disorders lead to negative physiological and psychological consequences. Comorbidity, stigmatization and abstinence are reasons for continued drug use. Intravenous drug use contributes to the spread of blood-borne diseases. The needle-exchange program targets intravenous drug users and offers referrals, needle-exchange, counselling and naloxone. Aim: The purpose was to describe patients' experience of harm reduction and the impact on risk behavior through participation in the syringe exchange program. Method: A literature study based on ten original qualitative articles that were thematically analysed. Result: Three main themes and six sub-themes were identified. Positive life-style change with sub-themes self-care ability and help from different directions. Relationship building with sub-themes health-promotion operations and care meeting. Limited resources with sub-themes continued stigmatization and when drug addiction takes over. Conclusion: Needle-exchange increase patients’ knowledge of risk behaviour, self-care, and positive life-style changes. Treatment, education, and safety are components for continued participation. The program increases self-esteem, and helps reduce the social divide between people with drug addiction and the rest of society. Our research revealed that there are obstacles to consider. Continued stigma and structural barriers make the patients fragile, which highlights the need for continued research and education to be able to meet their care needs.

Research questions were: 1: Will Drug Injectors Use An Exchange In A StateWhere Syringes Are Legal? 2: Will Drug Injectors Using An Exchange Decrease Risky Behavior? 3: Will Frequent Clients Change Risk Behaviors More Than Infrequent Clients? 4: Will Drug Injectors Using An Exchange Change Risk Behaviors More Than A Comparison Group Not Using An Exchange? 5: Does An Exchange Have An Impact On The Number Of Discarded Syringes On The Streets? 6: Is There A Difference In The Rate Of Spread Of HIV Infection Among Users And Non-Users Of The Exchange. Drug injectors will use needle exchange programs, even in a state where syringes are legal. During the first four years, nearly 2,000 drug injectors made approximately 16,000 visits to the Exchange. Clients of the Exchange reduced risky behavior from intake to six months. Change lasted over time: at twelve months, change in behaviors continued to be significant. Frequent users of the Exchange were better on two variables than infrequent users: they borrowed syringes less, and were less likely to use a syringe and throw it away. Drug injectors using the Exchange were compared to those not using the Exchange, but using a bleach/outreach project. Clients of both projects reduced risky behaviors, with Exchange clients better on two variables: re-using syringes without cleaning, and throwing away used syringes. The two projects attracted different drug injectors, and should be viewed as complementary rather than competing AIDS prevention strategies. The impact of the Exchange on the community was evaluated by the change in the number of discarded syringes found on the streets. The number of syringes found per month decreased from 5.14 before the Exchange opened to 1.9 after it began -- a significant side benefit. The data presented here support the growing evidence that needle exchange programs produce behavioral risk reductions, and that the number of potentially infected syringes in public places can be reduced.

Earlier research shows that persons who inject drugs are in heightened need of healthcare and medical assistance. But research has also shown that it can be difficult for them to receive care and assistance due to their circumstances. Sweden has a long history of restrictive drug policy and practice. This has affected how care for drug users has been managed and formed. In recent years, due to a change in the Swedish legislation, it has become easier to establish needle exchange programs. As a result, there has been an increase in the number of needle exchange programs during the last five years. The aim of this study was to examine the harm reducing work that is done within the swedish needle exchange program. For this, the study primarily focused on how the staff perceived harm reduction work, its possibilities and difficulties. The data was collected through four semistructured interviews with staff at needle exchanges in Sweden. The participants were either nurses or counselors, working at either newer or more established needle exchanges. The data was coded into the following themes; Reduction of harm- and transmission of infectious diseases, The outlook on drug abuse and The importance of treatment and relations. The results show that harm reduction is perceived to be a pragmatic alternative to the traditional care of drug users by the staff. The participants do stress that needle exchange programs by themselves aren't enough to reduce the harms of addiction. The results also highlight the importance of the relational- and emotional work, which is a real factor for effective harm reduction work. By developing trust and relations, the target groups' needs are both easier expressed and met at needle exchanges.