Faculty Bibliography

The most common method of syringe exchange program (SEP) development in the United States has been for SEPs to be started by activists without funding and then to become a government-funded community-based organization. This developmental process, which has not been studied to date, involves major organizational change. We report our findings on three New York City syringe exchanges experiencing this type of transition. Our data illustrate that following legalization, increased legitimacy and funding allowed all three SEPs to expand the size and scope of their programs (e.g., adding hours, sites, referral services, and the ability to support user groups), resulting in a rapid growth in participation (over 15,000 in 18 months). Regulation accompanying legalization posed significant challenges to SEPs, including added record-keeping and reporting tasks, increased demand for referrals, and accommodating evaluation, which affected already overburdened staffs. The transition process poses significant challenges to these developing organizations as well as opportunities for improved services.

Review of Kevin Anderson's Lenin, Hegel, and Western Marxism

In a cross-sectional study of 174 new injecting drug users (IDUs) in New York City who had injected for < or = 6 years, we examined whether those who both share syringes and have personal risk networks that include high-risk injectors are particularly likely to be infected with HIV. Subjects were street recruited between July 1991 and January 1993, were interviewed about their risk behaviors in the prior 2 years and their personal risk networks with other IDUs in the prior 30 days, and were tested for HIV; 20% were HIV seropositive. Among those who both shared syringes and had a personal risk network member who injected more than once a day, 40% were HIV seropositive (versus 14% for others, p < 0.001). In simultaneous multiple logistic regression, the interaction of both sharing syringes and having a personal risk network member who injected more than once a day remained independently and significantly associated with being HIV seropositive (OR, 3.57; 95% CI, 1.22, 10.43; p < 0.020), along with Latino race/ethnicity and exchanging sex for money or drugs. These findings suggest that the combination of sharing syringes with having a high-risk personal network is a risk factor for HIV infection among new IDUs. Studies of risk factors for HIV infection among new IDUs and interventions to reduce the spread of HIV among them should focus on their risk networks as well as their risk behaviors.