Sterile Needles and the Epidemic of Acquired Immunodeficiency Syndrome: Issues for Drug Abuse Treatment and Public Health

The debate over the provision of sterile injection equipment to intravenous drug users, as a means of preventing the spread of the AIDS epidemic, has a number of political, ethical, and clinical implications. The issue has in some respects been inappropriately dichotomized as a conflict between public health agendas and the traditional priorities of drug treatment. The relevant issues include: (1) the existence of evidence for needle-sharing as a route of transmission of human immunodeficiency virus among intravenous drug users; (2) the role of needle scarcity as a factor promoting needle-sharing behavior, and evidence for the ability of drug users to change such behavior; (3) the possibility of increased needle availability leading to increased prevalence of intravenous drug abuse; (4) the possibility that the provision of sterile needles would compromise treatment efforts among drug abusers currently or potentially engaged in the treatment system. These issues are discussed in light of relevant existing data; a multilevel strategy for AIDS prevention among drug users is suggested, addressing both the availability of sterile injection equipment and the promotion of drug treatment goals.