title: Impact: a case study examining the closure of a large urban fixed site needle exchange in Canada.
abstract: BACKGROUND
  In 2008, one of the oldest fixed site needle exchanges in a large urban city in Canada was closed due to community pressure. This service had been in existence for over 20 years.
  
  
  METHODS
  This case study focuses on the consequences of the switch to mobile needle exchange services immediately after the closure and examines the impact of the closure on changes in risk behavior related to drug use, needle distribution and access to services The context surrounding the closure was also examined.
  
  
  RESULTS
  After the closure of the fixed site exchange, access to needle exchange services decreased as evidenced by the sharp decline in numbers of clients reached, and the numbers of needles distributed and collected monthly. Reports related to needle reuse and selling of syringes suggest changes in risk behaviors. Thousands of needles remain unaccounted for in the community. To date, a new fixed site has not been found.
  
  
  CONCLUSIONS
  Closing the fixed site needle exchange had an adverse effect on already vulnerable clients and reduced access to comprehensive harm reduction services. While official public policy supports a fixed site, politicization of the issue has meant a significant setback for harm reduction with reduced potential to meet public health targets related to reducing the spread of blood borne diseases. This situation is unacceptable from a public health perspective.
authors.affiliation: School of Nursing, University of Victoria, P,O, Box 1700, Victoria, BC, V8W 2Y2, Canada. joanm@uvic.ca.
authors.forename: Joan
authors.initials: J
authors.lastname: Macneil
authors.forename: Bernadette
authors.initials: B
authors.lastname: Pauly