Multnomah County, Oregon, has a long history of providing needle exchange programs aimed at preventing the spread of HIV. Beginning in 1989, Outside In, a community-based organization located in Multnomah County, received county funds for a needle exchange program, making it one of the first needle exchange programs in the United States. In the spring of 1996 Multnomah County Health Department (MCHD) began needle exchange services, also funded through county general funds. This effort has been extremely successful in reaching injection drug users (IDUs) by working collaboratively with members of the community. The following information highlights key elements of the MCHD exchange program which contributed to this success.

Description of the Target Population: Multnomah County is the largest metropolitan area in the state of Oregon. The total population of Multnomah County is estimated at 639,000. It is located on what is known as the "I-5 corridor," the main system of freeways connecting San Diego, California, with Vancouver, British Columbia. The I-5 corridor is a major route for drug trafficking and use on the West Coast. Primary drugs of choice for injectors are heroin, amphetamines, and cocaine. In the county, IDUs are the second largest group of people with AIDS (20 percent of all cases). Thirty-six percent of the children with AIDS in Oregon are the children of IDUs. However, the overall incidence of HIV infection in IDUs in Multnomah County, as measured by public HIV counseling and testing services, has remained at less than 2 percent. Unlike other areas of the U.S., Multnomah County has not seen a dramatic increase in the number of new HIV infections among IDUs. We believe this is primarily due to early, innovative prevention efforts specifically targeted to the community of IDUs residing in the county. In addition, several characteristics exist in Multnomah County and in Oregon which support effective prevention services. These include:

The Legal Climate: In 1989, drug paraphernalia law was passed in Oregon which exempted syringes. It is legal to buy syringes over the counter in Oregon and to possess syringes. (Pharmacists, however, are often unwilling to sell to people who cannot verify that they have a medical condition.) Minors are prohibited from being sold a syringe unless authorized by a physician's prescription. We do not distribute syringes to anyone under 18 years of age.

Support from Key County/City Officials: MCHD, and needle exchange programming in general, have had strong support from the County and City Commissioners, the Health Department administration, and local law enforcement agencies. There has been a mutual understanding of the need for public health measures such as needle exchange and a willingness to provide funding and resources to see that these measures are available in our community.

Collaboration among programs providing needle exchange and other harm reduction services: The Harm Reduction Coalition, a group of organizations and individuals providing needle exchange services throughout the county has been instrumental in seeing that services are provided as effectively as possible. Group members meet on a regular basis and share information on programming, volunteers, site choices, scheduling, and training opportunities.

Description of the MCHD Needle Exchange Program: MCHD provides needle exchange services in a variety of ways:

• Street outreach workers carry clean syringes with them to exchange with regular clients along their route. Street outreach targets homeless individuals, those working in the sex industry, minority IDUs and men who have sex with men.
• A county van parks in an area frequented by IDUs and provides exchange services 5 days each week.
• An exchange site located in the part of town frequented by African American IDUs is staffed 2 days each week. Outside In provides exchange services at this site an additional 3 days per week.
• Outreach workers drive to areas known to be frequented by IDUs and provide exchange services directly from our van.
• MCHD provides clean syringes and pick up and disposal of used syringes to a number of other organizations in the county who provide exchange services.

Coordination of Services: MCHD provides a wide range of services through the exchange. These include on-site HIV counseling and testing, and referral to social services, detox, and substance abuse treatment services. Through counseling and testing services provided at corrections institutions in the county, MCHD is able to follow many clients as they enter and leave the corrections system.

Incentives: Coffee.

Use of Volunteers: MCHD has been very successful in recruiting volunteers directly from the client base. These volunteers have been extremely effective in getting the word of the exchange out to IDUs and providing knowledgeable, respectful services at the exchange sites. An added benefit has been that volunteers use this opportunity as motivation to get clean and stay in recovery. It has become an effective way for many of these individuals to begin to prepare for work in more traditional settings.

Development of local materials: MCHD has developed a number of materials which are specific to IDUs within the county. These materials have been very effective prevention/harm reduction tools.

In 2002, MCHD exchanged close to a quarter of a million syringes. That translates to about 20,000 syringes exchanged per month.

For more information on the Multnomah County Health Department needle exchange program, contact Loreen Nichols. You can call her at 503-988-3030, e-mail her at loreen.nichols@co.multnomah.or.us, or write to her at Multnomah County Health Department HIV Prevention Program, 3653 SE 34th Ave Portland, Oregon 97202.

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