Editing Needle and syringe programmes (section)

== Operation ==
Needle and syringe programs operate differently in different parts of the world; the first NSPs in Europe and Australia gave out sterile equipment to drug users, having begun in the context of the early AIDS epidemic. The United States took a far more reluctant approach, typically requiring IDUs to already have used needles to exchange for sterile ones - this "one-for-one" system is where the same number of [[syringe]]s must be returned.<ref name=":3">Public Health Impact of Needle Exchange Programs in the United States and Abroad. (1993). United States: University of California, Berkeley, School of Public Health</ref>{{Rp|192}}

According to [[Santa Cruz County, California]], exchange staff interviewed by ''Santa Cruz Local'' in 2019, it is a common practice not to count the number of exchanged needles exactly, but rather to estimate the number based on a container's volume.<ref>{{Cite web|last=Guzman|first=Kara Meyberg|date=2019-05-24|title=What we learned from looking at Santa Cruz County's needle exchange|url=https://santacruzlocal.org/2019/05/24/what-we-learned-from-looking-at-santa-cruz-countys-needle-exchange/|access-date=2020-10-10|website=Santa Cruz Local}}</ref> [[Holyoke, Massachusetts]], also uses the volume system.<ref>{{Cite web|date=2017-07-23|title=How needle exchange program needles get counted in Holyoke|url=https://www.masslive.com/news/2017/07/tapestry_healths_needle_exchan.html|access-date=2020-10-10|website=masslive.com}}</ref> United Nations Office on Drugs and Crime for South Asia suggests visual estimation or asking the client how many they brought back.<ref>{{Cite web|last=Thangsing|first=Chinkholal|year=2012|title=Needle syringe exchange program for injecting drug users|url=https://www.unodc.org/documents/southasia/publications/sops/needle-syringe-exchange-program-for-injecting-drug-users.pdf}}</ref> The volume-based method left potential for [[gaming the system]] and an exchange agency in [[Vancouver]] devoted significant effort to game the system.<ref>{{Cite book|last=Lupick|first=Travis|url=https://books.google.com/books?id=pKNoDwAAQBAJ&pg=PT140|title=Fighting for Space: How a Group of Drug Users Transformed One City's Struggle with Addiction|date=2018-06-05|publisher=arsenal pulp press|isbn=978-1-55152-713-0|quote=That left room to game the system, to which Stuerzbecher devoted significant time. "Kerstin spent hours measuring and counting needles in those disposal bins with markings on the side...}}</ref>{{Rp|140}}

Some, such as the [[Columbus Public Health]] in Ohio weigh the returned sharps rather than counting.<ref>{{Cite web|title=Discarded needles may be unintended side effect of needle access program|url=https://www.10tv.com/article/news/investigations/10-investigates/discarded-needles-may-be-unintended-side-effect-needle-access-program/530-33bdf0df-8713-4a9e-bf15-13310361571f|access-date=2020-10-10|website=10tv.com|date=20 November 2017}}</ref>

The practices and policies vary between needle and syringe program sites. In addition to exchange, there is a model called "needs-based" where the syringes are handed out without requiring any to be returned.<ref>{{Cite web|date=July 2019|title=North Dakota Department of Health Syringe Service Program Requirements & Guidance|url=https://www.ndhealth.gov/hiv/Docs/SEP/ND.SSP.FINAL.072019.pdf}}</ref>{{Rp|15–16}}

According to a report published in 1994, Montreal's CACTUS exchange which has a policy of one-for-one, plus one needle with a limit of 15 had a return rate of 75-80% between 1991 and 1993.<ref>{{Cite book|last=Programs|first=National Research Council (US) and Institute of Medicine (US) Panel on Needle Exchange and Bleach Distribution|url=https://www.ncbi.nlm.nih.gov/books/NBK236647/|title=Evaluating Montréal's Needle Exchange CACTUS-Montréal|date=1994|publisher=National Academies Press (US)}}</ref>

An exchange in [[Boulder, Colorado]], implemented a one-for-one with four starter needles and reported an exchange rate of 89.1% in 1992.<ref name=":3" />{{Rp|391}}

In the United States, where the one-for-one system still dominates, some 25% of injecting drug users are living positive with HIV; in Australia, which hands out equipment for free to anyone needing it (only charging a small fee for some more expensive equipment, like wheel filters and higher-quality tourniquets), only 1% of the IDU population is HIV-positive as of 2015, compared to over 20% in the late 1980s when NSP programs began to spread nationally and became accessible to most of the population.<ref name="ANCD"/>