Quality & Quantity 32: 165–180, 1998.
© 1998 Kluwer Academic Publishers. Printed in the Netherlands.
The Effectiveness of Educational and Needle
Exchange Programs: A Meta-analysis of HIV
Prevention Strategies for Injecting Drug Users
JAY E. CROSS, CYNTHIA M. SAUNDERS & DEBRA BARTELLI
Abstract. A meta-analysis of 16 educational interventions and 10 needle exchange programs was
performed to estimate the effectiveness of reducing HIV risk behaviors in the injecting drug user
population. Information on intervention, outcome, design and demographics was coded and analyzed
for all educational and needle exchange program evaluation studies published between January 1984
and May 1995. The weighted mean effect size for the 6,251 study subjects of the 16 educational
interventions was 0.749 (95% CI, 0.708 to 0.790), and the weighted mean effect size for the 1,675
study subjects of the 10 needle exchange programs was 0.279 (95% CI, 0.207 to 0.352), suggesting
that both interventions had a positive impact on reducing HIV risk behaviors associated with injecting
drug use. However, these results were dependent upon research design, outcome type and follow-up
Key words: AIDS, IDU, education, needle exchange, meta-analysis.
In less than two decades, the pandemic of AIDS, generally spread through high
risk sexual and/or drug use behavior, has left a wake of more than four million
cases with an estimated 30.6 million infected with HIV, the virus that causes AIDS
(World Health Organization, 1997). Current prospects are dim for a cure or vaccine;
therefore, prevention interventions aimed at reducing high risk behaviors are the
only tools which offer hope of reversing the spread of HIV infection.
In the United States alone, approximately 32% of the AIDS cases among ado-
lescents and adults have been attributed either directly or indirectly to behaviors
associated with injecting drug use (IDU) (Centers for Disease Control and Preven-
tion, 1997). This paper aims to comprehensively examine published studies which
evaluate behavioral outcomes of two of the most frequently studied HIV prevention
approaches for injecting drug users (IDUs): needle exchange programs (NEPs) and
Authors’ note: Author order randomly determined. The authors are grateful to Cheryl Healton
and Peter Messeri for providing comments on an earlier version of this paper. Correspondence re-
garding the article should be directed to Jay Cross at the Department of Sociology, 413 Fayerweather
Hall, Columbia University, New York, NY 10027, U.S.A.