title: From ideology to logistics: the organizational aspects of syringe exchange in a period of institutional consolidation.
abstract: The initial period in the establishment of syringe exchange projects is often characterized by overt conflict: between community AIDS activists, on the one hand, and public officials and political leaders who remain ideologically opposed to the introduction of measures perceived as condoning illicit drug use. In this context, professionals concerned with legitimating the new institutions of syringe exchange may sometimes neglect aspects of their everyday logistics and social organization, obscuring the important choices which have to be made to carry these initiatives forward. In particular, the contrast between formally-constituted institutions-the "storefront" or "community-based" syringe exchange programs (SEPs)-and the model of low-threshold syringe availability through pharmacies, vending machines, and user networks, is here presented not as an either/or choice but rather as a pair of complementary strategies which respond to diverse needs and target different populations. The advantages and disadvantages of each particular approach make it likely that maximum effectiveness will be achieved through a combination of every possible form of needle distribution, each tailored to specific and cultural circumstances. The case is here examined in the light of the experience of the SEPs in New York City, from their clandestine origins in 1990 through their first years of official functioning in 1992-1996.
authors.affiliation: Chemical Dependency Institute, Beth Israel Medical Center, New York, New York, USA.
authors.forename: A R
authors.initials: AR
authors.lastname: Henman
authors.forename: D
authors.initials: D
authors.lastname: Paone
authors.forename: D C
authors.initials: DC
authors.lastname: Des Jarlais
authors.forename: L M
authors.initials: LM
authors.lastname: Kochems
authors.forename: S R
authors.initials: SR
authors.lastname: Friedman
mesh_terms: D001291:Attitude of Health Personnel; D003159:Community-Institutional Relations; D006801:Humans; D007373:Interinstitutional Relations; D017146:Models, Organizational; D018671:Needle-Exchange Programs / Q000458:organization & administration*; D009519:New York City; D011057:Politics; D016730:Program Development; D015397:Program Evaluation; D019037:Urban Health Services / Q000458:organization & administration*