"Clean needles and syringes and other drug use paraphernalia are provided through a network of low-threshold services, outpatient counselling facilities and vending machines. Data on the number of syringes distributed are not available for the country as a whole, but data from local syringe monitoring are available in the Land North Rhine-Westphalia and some larger cities, including Frankfurt and Berlin.

"In the Netherlands, harm reduction activities are implemented through outreach work, low-threshold facilities and centres for ‘social addiction care’, the main goal of which is to establish and maintain contact with difficult-to-reach drug users.

"The National Board of Health and Welfare and the Public Health Agency of Sweden defines the procedures that county councils should follow when setting up NSPs [Needle and Syringe Exchange Programs], which include a justification of need (e.g. an estimate of the number of potential service users), an assessment of available resources, a provision plan for complementary and additional care services (e.g. detoxification, drug treatment and aftercare), and service quality requirements.

"Eighteen states had laws that were categorized as least comprehensive related to the prevention of HCV transmission among persons who inject drugs. In particular, these 18 states had no laws authorizing a syringe exchange program, decriminalizing possession and distribution of syringes and needles, or allowing the retail sale of syringes without a prescription.

"The basic service offered by SSPs [Syringe Services Programs] allows PWID [People Who Inject Drugs] to exchange used needles and syringes for new, sterile needles and syringes. Providing sterile needles and syringes and establishing appropriate disposal procedures substantially reduces the chances that PWID will share injection equipment and removes potentially HIV- and HCV-contaminated syringes from the community. Many SSPs have become multiservice organizations, providing various health and social services to their participants (8).

Click here for the complete datatable of Characteristics of SEPs Participating in Beth Israel Medical Center/North American Syringe Exchange Network (NASEN) Surveys, 2004-2011

"We found that in cities with NEPs HIV seroprevalence among injecting drug users decreased on average, whereas in cities without NEPs HIV seroprevalence increased. A plausible explanation for this difference is that the NEPs led to a reduction in HIV incidence among injecting drug users.

"As of March 2014, 204 SSPs were known to be operating in the United States in 2013."