Short report
Misdirected opposition: Evidence opposing “not in my back yard” arguments against syringe exchange programmes

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Abstract

Background

Despite overwhelming evidence of their effectiveness, the establishment and maintenance of syringe exchange programmes (SEPs) in the US continue to draw opposition from community members, religious and political leaders, and law enforcement officials. One argument against SEPs is that they draw drug activity into the communities where they operate.

Methods

We use 8 years of survey data from participants attending an SEP in Chicago to explore this argument by reviewing responses (N = 4827) to a question asking participants the main reason they spend time in the area.

Results

Findings show far more participants come to the area to buy drugs (60%) than to exchange needles (3.8%), and differences exist by ethnicity. More whites than blacks or Latinos reported being in the area primarily to buy drugs and use the SEP.

Conclusion

Re-directing opposition from SEPs to constructive ways of addressing fundamental causes of drug markets is recommended.

Introduction

The first organised syringe exchange programmes (SEPs) in the US were established in the late 1980s as a harm reduction policy to stem the tide of HIV and other blood-borne infections resulting from injecting drugs (CDC, 2005). After 20 years, their operation continues to draw varying degrees of opposition from community members, religious and political leaders, and law enforcement officials in cities across the United States (Cooper et al., 2009, Downing et al., 2005, Shaw, 2006, Tempalski et al., 2007a, Tempalski et al., 2007b). While there is much evidence to show that SEPs are an effective HIV prevention strategy (Bluthenthal et al., 2007, Fisher et al., 2003, Huo et al., 2006, Huo and Ouellet, 2007, NAS, 2006, Vlahov et al., 2001, Wodak and Cooney, 2005, Wodak and Cooney, 2006), negative perceptions persist because of ideological differences and erroneous beliefs about SEPs (Des Jarlais et al., 2010, Tempalski et al., 2007a, Tempalski et al., 2007b, Shaw, 2006). One concern remains largely ignored in the research literature: the belief that SEPs draw drug users and drug activity to the neighbourhoods where they operate. As a result, some opposers adopt a “not in my back yard” stance, complicating efforts to establish and maintain SEPs. This belief likely stems, in part, from the co-location of SEPs in areas with high drug activity. This is a spatio-temporal misconception given SEPs were established in response to drugs and their adverse consequences (CDC, 2005, Johnson et al., 2000, Vlahov et al., 2001). In this brief report, we address this misperception as an empirical question and examine data from those attending a SEP in Chicago to assess the reasons why SEP participants spend time in the area where the SEP is based. Additionally, in light of persistent ethnic disparities in illicit drug availability and drug-related consequences, the report assesses the reasons provided by ethnicity to offer some insight into ethnic differences underlying this geopolitical phenomenon.

Section snippets

Methods

Data were collected at a SEP in Chicago, operating from four storefront offices and two motor home sites located on the city's north, near northwest, west, south, and lower west sides. The sites also offer HIV counselling, testing, case management, HIV medical clinics, and other services. After providing informed consent, participants enroll in the SEP anonymously and complete a staff administered HIV risk assessment. One of the questions on the brief questionnaire is “What is the main reason

Results

Table 1 shows the characteristics of SEP participants who enrolled between 2001 and 2008. The mean age was 34 years and 70% of participants were male. Over half (54%) were white, 21% were black, and 21% were Latino. In the past 30 days, 61% injected daily and approximately 18% had used a needle that someone else had used before them.

Table 2 presents the frequencies for each response to the question, “What is the primary reason you spend time in the area?” Frequency totals are shown (column 2)

Discussion

Results contradict notions that SEPs attract substantial numbers of problem drug users and other drug activity to the areas where they operate. Our results show that one-quarter of participants lived in the area, and that opportunity to purchase drugs was the main attraction for SEP participants to visit the area. Given that SEPs were purposely located in areas with major illicit drug markets or large numbers of IDUs, this relationship is not surprising. Thus, it appears the more important

References (20)

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