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Public attitudes towards needle exchange programs

Quinn, Sandra Crouse

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Controversy swirls around the issue of needle exchange programs (NEP), with many state legislators reluctant to adopt legislation enabling their establishment. Although such legislation requires political support by the public, limited research exists on their knowledge of and attitudes about NEP. This study examines public attitudes on NEP as part of the Southern Focus Poll, a random digit dial telephone survey conducted at the University of North Carolina-Chapel Hill in 1997. The sample included 1250 respondents (808 Southerners and 442 non-Southerners) with 77% (959) white, 13% (158) African American, and 10% (122) other. A total of 46% (569) were men and 54% (681) were women. The response rate was 57%. This report includes only statistically significant differences of P≤0.05 on chi-squared tests and t-tests.

A total of 40% (495) of respondents reported knowing someone with HIV/AIDS, whereas 60% (747) did not. Fifty-five per cent of African Americans reported that they knew someone compared with only 37% of whites. Those who attended church less (two to three times a month or less), those with incomes of US$30000 and above, and those with a high school education or greater were more likely to report that they knew someone with HIV/AIDS.

A total of 61% (767) agreed with, “Some people say that making clean needles available to drug users who inject drugs will reduce the spread of HIV“. Almost 30% (376) disagreed and 8.5% (106) were unsure. On the item, “Some people say that making clean needles available to drug users would increase drug use“, 40% (497) agreed, whereas 49% (632) disagreed and 9.6% (120) were unsure. Those who attended church once a week or more, identified themselves as conservative, identified themselves as Republican, and were Southerners were significantly more likely to believe that providing clean needles increases drug use. As income increased, respondents were more likely to disagree with the item. Those with educational level as some college and above and respondents from a metropolitan area were also more likely to disagree with the item.

When asked, “Currently, pharmacies are not allowed to sell clean needles to drug users. Do you think this should be changed or not?“, 44% (548) supported legislative change, whereas 45% (559) opposed and 11.4% (142) were uncertain. A total of 48% (603) answered affirmatively to this item: “Would you favor or oppose the creation of needle exchange programs like this in your state?“. Forty per cent (505) opposed NEP and 11.3% (141) did not know. One item explored the use of state tax revenues to fund NEP, with 39% (449) favoring the use of state tax revenues, whereas 55% (690) opposed and 9% (110) did not know.

The support for NEP scale (Cronbach‚s alpha: 0.76) consisted of four items with a range for the scale from 3.5 to 8; the higher mean score indicated as greater support for NEP. Non-Southerners, African Americans, those who reported knowing someone with HIV/AIDS, those who attended church two to three times a month or less, those who described themselves as politically liberal or moderate and those who identified themselves as Democrats had significantly higher mean scores (see Table 1).

Table 1
Table 1:
Mean scores on support for needle exchange programs scale by multiple variables

A linear regression model was employed to examine the effects of the independent demographic variables on the support for NEP scale. Being African American, self-identified as liberal, female, higher education and knowing someone with HIV/AIDS were positively associated with support for NEP. Twenty-two per cent of the variance in the dependent variable was accounted for in the model.

The National Research Council has affirmed the scientific evidence on NEP, which finds that they reduce HIV transmission without increasing drug use [1]. In this study, the majority of respondents believed that the availability of clean needles would reduce the transmission of HIV. However, a substantial percentage of respondents were still concerned that NEP could increase drug use. Support for the use of state revenues to fund NEP was somewhat low, which may reflect the prevailing sentiment of the 1990s on less government expenditure. On several items, significant percentages of respondents reported that they did not know or had no answer. This may suggest a comprehensive educational campaign on NEP as a strategy to increase support from this uncertain group, and to decrease opposition from those who are not strongly opposed to NEP. Education about the scientific evidence may help shape public opinion more consistently with that evidence. Further research that examines public attitudes is critical to enhance the efforts of public health professionals to address this urgent problem.


1. Normand J, Vlahov D, Lincoln M. Preventing HIV transmission: the role of sterile needles and bleach. Washington, DC: National Academy Press; 1995.
Copyright © 1999 Wolters Kluwer Health, Inc.