Pursuant to a congressional request, GAO reviewed needle exchange programs’ effectiveness in reducing the spread of the human immunodeficiency virus (HIV), focusing on: (1) the success of domestic and international needle exchange programs; (2) the credibility of a Yale University forecasting model that estimates the impact of needle exchange programs on the spread of HIV; and (3) whether federal funds could be allocated for needle exchange program studies and demonstrations. GAO found that: (1) six of the nine needle exchange projects examined provided information on the rate of needle sharing, prevalence of injection drug use, and frequency of injection; (2) two projects indicated that needle exchange programs were associated with reduced needle sharing among intravenous drug users, while one project reported an increase in needle sharing; (3) five projects reported no evidence of increased drug use because of greater needle availability; (4) seven projects reported successes in referring intravenous drug users to drug treatment and other health services, but not all drug users were able to obtain treatment; (5) the Yale University forecasting model, which claimed that needle exchange programs could reduce HIV transmissions by about 33 percent, was credible, technically sound, and reasonable; (6) the reduction in HIV transmissions stemmed from the program’s ability to lessen the opportunity for needles to become infected, shared, or infect uninfected drug users; (7) the Yale University model relied on a data collection system that monitored the amount of needles distributed and returned, identified the drug user and needle exchanges, and analyzed residual blood in returned needles for HIV infection; and (8) Congress has specifically restricted the use of appropriated funds for needle exchange programs, but GAO believes that federal funds could be used for needle exchange studies and demonstrations.
