The Xchange point: a drop-in center for African American active injection drug users.

A recent development in the provision of substance abuse services has been the rise of the harm-reduction model and non-abstinence-based services. Harm reduction is based on the suppositions that drug use will continue to exist for most users and that safer use is always possible (Drucker, 1995; MacMaster, in press). This public health perspective suggests that, because of the urgency of the HIV/AIDS epidemic, services for IDUs should strive to reduce risk or harm through positive changes in health behaviors; abstinence should not be the only goal (Des Jarlais, 1995). The first syringe exchange program (SEP) was established in the United States in 1988 in Tacoma, Washington (Hagan, Des Jarlais, Purchase, Reid, & Friedman, 1991). Currently there are more than 171 syringe exchange programs in this country (MacMaster & Womack, 2002). There is strong evidence supporting the effectiveness of SEPs with regard to decreased HIV-infection rates (Des Jarlais et al., 1996), decreased incidence of sharing of injection equipment (Bluthenthal, Kral, Erringer, & Edlin, 1998), and increased frequency of the disinfection of injection equipment (Hagan et al., 1993). When compared with the cost of treating an individual who has HIV/AIDS, these programs have been shown to be extremely cost-effective (Lurie, Gorsky, Jones, & Shomphe, 1998). Because of the low threshold for service use, SEPs often connect participants with abstinence-based drug treatment programs (Heimer, 1998; Heimer & Lopes, 1994; Lurie et al., 1993). Although most of the literature on SEPs has focused primarily on street-based syringe exchange activities, recent research suggests that syringe exchange alone is not enough to curtail effectively the spread of HIV/AIDS among at-risk IDUs (Strahdee et al., 1997). Ancillary services may be necessary for both meeting the needs of participants and attracting new participants to the program (Murphy & Murphy, 1998). Ancillary services also may increase involvement in educational programming and increase involvement in other community resources. A 1997 survey of SEPs (Paone, Des Jarlais, Singh, Grove, & Shi, 1998) found that more than 96 percent of the programs reported supplementing their syringe exchange services with other services. PROGRAM DESCRIPTION Located in Cleveland, Ohio, the Xchange Point is a nonprofit community-based AIDS services organization founded in 1996 as a street-based outreach and SEP. Trained community health outreach workers have conducted street-based, roving outreach in four areas of Cleveland on a weekly basis since the program's inception. The outreach workers are a heterogeneous mix of paid and volunteer staff members, many of whom are current and former IDUs, as well as concerned community members, students, and professionals. These outreach workers make initial contact with individuals and distribute information and materials related to both safer sex and drug use practices. Services provided through outreach include syringe exchange, distribution of bleach kits and other safer injection supplies and condoms and other safer sex supplies, referrals to other services, as well as distribution of literature and other educational information on a variety of health-related topics. A drop-in center was developed and implemented approxi mately one year after initiation of the outreach program. On the basis of information from syringe exchange participants contacted by street-based outreach teams, a site for the drop-in center was chosen. The program was housed in a storefront in an area reportedly known for drug trafficking and frequented by IDUs. Efforts were made to make the program as accessible as possible to potential service users by basing services on a harm-reduction model, in which reduced harm related to drug use was the goal. In keeping with this perspective, a low threshold for service entry was set. …