2010 National Survey of Syringe Exchange Programs: Summary of Results Don C. Des Jarlais, Vivian Guardino, Ann Nugent, Kamyar Arasteh, David Purchase This work was funded by amfAR, The Foundation for AIDS Research, with support from the Elton John AIDS Foundation and the Irene Diamond Foundation-Tides Foundation.

Characteristics of SEPs Participating in BIMC/NASEN Surveys United States, Numbers of SEPs known to NASEN SEPs Participating in survey (%) 60 (88%) 87 (86%) 100 (88%) 110 (84%) 127 (82%) 126 (85%) 109 (63%) 118 (71%) 150 (80%) 131 (70%) 123 (67%) 149 (74%) 147 (77%) Cities with SEPs participating States with SEPs participating * Syringes exchanged (millions) Total of SEP budgets ($, millions) Total of SEP budgets in 2010-adjusted $ (millions) (adjusted using a constant 3% annual inflation rate) Public funding as % of total SEP budgets 62% 67%69%74%67%76%74%79%73%79%80%82% * This category includes the District of Columbia and/or Puerto Rico.

Number of syringes exchanged and Total SEP budgets * adjusted using a constant 3% annual inflation rate

National Survey of Syringe Exchange Programs Methodology 2009 Survey 201 SEPs contacted in first quarter SEPs (74%) submitted completed surveys by early summer Survey 194 SEPs contacted in first quarter SEPs (77%) submitted completed surveys by early summer.

SEP Budget Dollars Total $$$$21,686,788$21,674,495 City Gov $$5,381,142$6,021,484 County Gov $$2,261,688$2,328,563 State Gov $$9,768,293$9,336,118 Foundation $$3,233,266$2,127,053 Individual Donations$536,333$833,686 Out-of-pocket $$41,959$29,830 NASEN $$45,609$67,116 CBO Donation $$2,059$27,410 Corporate Donation $$38,084$57,350 Other $$378,355$563,906

Budget Status 2009 vs. 2010

SEPs That Participated in 2009 & 2010 Surveys Total Budget $$ 2009 $20,045,912 (as reported by 115 SEPs) 2010 $18,889,998 (as reported by 115 SEPs)

Types of Areas SEPs Are Located In United States,

Gender Distribution of NSEP Participants in 2010* *Weighted by the number of syringes distributed

Ethnic Distribution of NSEP Participants in 2010* *Weighted by the number of syringes distributed

Type of Heroin Used in 2010 As Reported by SEPs

Type of Exchange Conducted by SEPs in 2010 VariationNo. (%) Allowed receipt of more syringes than brought in 123 (83%) Used Start-up Packs 90 (60 %) Used A Minimum 39 (26%) Used A Distribution Model 76 (51%) Had a Limit on Syringes Exchanged 36 (24%)

Weekly Exchange Regular, Scheduled Times & Places 2009 Total of 4,063 hours per week averaging 27.8 hours per SEP (n = 146) 2010 Total of 4,370 hours per week averaging 30.8 hours per SEP (n=142)

Number of Syringes Distributed by Syringe Exchange Programs (SEPs), by Program Size: 2009 & 2010 SEP Size (Syringes Distributed) No. of SEPs 2009 Total syringes exchanged 2009 No. of SEPs 2010 Total syringes exchanged 2010 Small (< 10,000) 25 94,611 (0.3%) 22 92,316 (0.3%) Medium (10,000-55,000) 39 1,129,493 (3.4%) ,320 (2.0%) Large (55, ,999) 70 13,011,703 (39.3%) 75 12,576,461 (35.4%) Very Large (  500,000) 14 18,879,383 (57.0%) 18 22,127,202 (62.3%) Total148*33,115, ,510,299 * In 2009, one program responding to the survey did not track the number of syringes exchanged, in 2010 nine programs did not indicate the number of syringes they distributed.

Returned/Collected Syringes

Disposal Methods of Collected /Used Syringes in 2010

Syringes Exchanged By Programs That Participated in Both 2009 & 2010 Surveys 2009 (n=117 * ) 33,178,581 syringes distributed 26,953,212 syringes collected 2010 (n=117 * ) 32,650,380 syringes distributed 27,114,420 syringes collected *Only programs which reported the number of syringes distributed in both 2009 and 2010 are included in the calculations above. In 2009, five programs in this group did not report the number of syringes they collected, the number was seven in 2010.

SEP Usage of Unique Identifiers for Tracking Individuals in 2010

Secondary Exchange & Methods of Encouragement Used by SEPs in 2010 Secondary ExchangeNo. (%) SEPs allowing secondary exchange 133 ( 89%) SEPs encouraging secondary exchange 114 (77%) Methods of Encouragement Talked about it 104 (70%) Had no limit on syringes exchanged 91 (61%) Gave extra supplies 108 (72%) Provided sharps containers 100 (67%) Enrolled people receiving syringes from secondary exchange 30 (20%) Peer education 78 (52%) Gift certificates/Other incentives 13 (9%)

Weekly On-Site Medical Services 2009 Total of 1,360 hours per week, averaging 29.6 hours per SEP offering on-site medical services (n=46) 2010 Total of 1,089 hours per week, averaging 16.8 hours per SEP offering on-site medical services (n=65)

Safer Injection Supplies Provided by SEPs in 2009 & 2010

Overdose Rescue & Drug Treatment Medications Provided by SEPs in 2009 & 2010

Safer Sex Items Provided by SEPs in 2009 & 2010

Miscellaneous Supplies Provided by SEPs in 2009 & 2010

HIV and Hepatitis Related On-Site Services Provided by SEPs in 2009 & 2010

Screening Related On-Site Services Provided by SEPs in 2009 & 2010

Additional Program Characteristics in 2009 & No. (%) 2010 No. (%) Did not operate for two months or more 13 (9%)6 (4%) Any full-time (paid) staff 97 (65%)95 (64%) Operated by city, county or state health department 35 (23%) 501-C3 Status 117 (79%)116 (78%)

Additional Program Characteristics in 2009 & No. %) 2010 No. (%) Operated a Delivery Service 78 (52%)69 (46%) Was involved in formal external evaluation 28 (19%)23 (15%)

Problems SEPs Encountered in 2009 & 2010

Quality of Relationship Between SEPs and Police as Reported by SEPs in 2009 & 2010 Quality of Relationship 2009 No. (%) 2010 No. (%) Very Good 33 (22%)35 (23%) Somewhat good 45 (30%)55 (37%) Neutral 45 (30%)44 (30%) Somewhat poor 7 (5%)6 (4%) Very poor 4 (3%)1 (1%) Non-existent 12 (8%)8 (5%)

Quality of Relationship Between SEPs and Local Health Officials as Reported by SEPs in 2009 & 2010 Quality of Relationship 2009 No. (%) 2010 No. (%) Very Good 103 (69%)95 (64%) Somewhat good 28 (19%)34 (23%) Neutral 8 (5%)13 (9%) Somewhat poor 2 (1%)1 (1%) Very poor 2 (1%)0 (0%) Non-existent 4 (3%)

Strategies SEPs Used in 2010 to Gain Law Enforcement Support Strategy# of SEP’s% None 3624% Meetings 7248% Trainings 4228% Invitation to exchange 2416% Street demonstrations 64% Coalition work w/other public health activists 3926% Officer Liasons 4128% Didn’t have capacity/resources for strategy 1913% Other 139%

Any favorable or unfavorable media attention in 2010 –YES 37 programs (25%) –NO 110 programs (75%)

Federal Funding in 2010 SEPs …YesNoDon’t Know Didn’t Answer Applied for federal funding 20 (13%) 117 (79%) 8 (5%) 4 (3%) Received federal funding 20 (13%) 119 (80%) 5 (3%) 5 (3%)

Programs Used Federal Funding in 2010 to Maintain Present Services Only Expand Present Services Add New Services Maintain /Expand Present Services Didn’t Answer 9 (45%) 7 (35%) 2 (10%) 1 (5%) 1 (5%)