The AIDS epidemic changed the world.

In the late 1980s, a group of brave people in New York and San Francisco began exchanging syringes from drug users as an act of civil disobedience and called out for non-judgmental and non-coercive support services for those suffering from addiction and its attendant harms on individuals and the communities where they live.

Today, access to clean syringes and other supplies has been recognized across the globe for its success in reducing HIV and other infections as well as supporting more individuals through recovery. Contrary to claims that harm reduction methods sustain or even enable addiction, the World Health Organization, UN AIDS, and UN Office of Drugs and Crime issued a report endorsing syringe access programs and between 1991 and 1997, the US Government funded seven reports on clean needle programs for persons who inject drugs. The reports are unanimous in their conclusions that clean needle programs reduce HIV transmission, and none found that clean needle programs caused rates of drug use to increase. The federal Department of Health and Human Services currently maintains a webpage on the effectiveness of syringe exchange programs.

Needle Exchange/Syringe Access Programs can now be found all over the globe. Although still controversial and illegal in some areas, their effectiveness has been recognized. 16 states currently have laws explicitly authorizing syringe access and many others have removed syringes from drug paraphernalia laws and taken other steps to decrease the barriers preventing people from distributing or receiving clean syringes. Today there are at least 203 programs across 34 states. In addition to collecting and distributing clean syringes, these programs also:

  • Provide safer injection information to reduce damage to the veins and skin and other attendant harms of use.
  • Teach ways to avoid and manage an overdose, possibly including Narcan training. Narcan (Naloxone) is an opioid antagonist that halts an active opioid overdose by blocking receptors in the brain that respond to any opioid drug from heroin to vicodin. 
  • HIV and Hep C testing or referrals, including treatment support.
  • Encouragement for safer drug use strategies, referrals to addiction treatment and management, and support for those reducing or eliminating drug use.
  • Information about bad packages.
  • Additional health and welfare services that may include meals, basic wound care, housing/shelter linkage, condoms, hygiene, legal support, case management, and more.


“[People’s reaction to crack pipes is] similar to the reaction a lot of people had to needle exchange in the early years where as now, it’s very well accepted that syringe access is incredibly effective and cost effective at reducing new HIV transmissions. Unfortunately, the cost of that learning curve is often peoples’ lives and we don’t have time to waste on this, so we need to start implementing this now.”
— Laura Thomas, San Francisco's HIV Prevention Planning Council