The impact of the needle and syringe-exchange programme in Amsterdam on injecting risk behaviour.

We interviewed a group of 145 injecting drug users (IDUs) in Amsterdam about their drug use, participation in a needle-exchange programme and needle sharing. Approximately 1 year later 60 IDUs were followed up. IDUs who exchange regularly ('exchangers') are older, inject longer and are more often in contact with methadone programmes. Exchanging is associated neither with an increase in injecting nor with lending needles to other IDUs. The risk level of injecting of the exchangers is much lower than that of the non-exchangers. From this it can be concluded that a needle exchange is an effective prevention programme against the spread of HIV infection. However, efforts have to be made to reach the group of younger short-term injectors and those IDUs who are not in contact with methadone-maintenance programmes. Since there are indications that regular injectors in particular exchange, and since young male injectors are more at risk of borrowing independent of exchanging, it is argued that an exchange programme should be complemented with other prevention approaches, i.e. intensive counselling and the spread of leaflets with information on cleaning used needles with bleach.