Don C. Des Jarlais, Vivian Guardino, Ann Nugent and Alisa Solberg The Dave Purchase Memorial 2012 National Survey of Syringe Exchange Programs: Summary of Results This work was funded by amfAR, The Foundation for AIDS Research with support from the Elton John AIDS Foundation (EJAF).

Characteristics Of SEPs Participating in BIMC/NASEN Surveys United States, Year Numbers of SEPs known to NASEN ** SEPs Participating in survey (%) 100 (88%) 110 (84%) 127 (82%) 126 (85%) 109 (63%) 118 (71%) 150 (80%) 131 (70%) 123 (67%) 149 (74%) 149 (77%) 144 (73%) 142 (71%) Cities with SEPs participating States with SEPs participating * Syringes exchanged (millions) Total of SEP budgets ($, millions) Total of SEP budgets in 2012-adjusted $ (millions) (adjusted using a constant 3% annual inflation rate) Public funding as % of total SEP budgets 67%69%74%67%76%74%79%73%79%80%82%84%81% *This category includes the District of Columbia and/or Puerto Ri co. ** We attempted to contact 212 programs but 10 programs appeared to be no longer operating and 3 programs were found to have been started in 2013.

Number of Syringes Exchanged and Total SEP Budgets *adjusted using a constant 3% annual inflation rate

National Survey of Syringe Exchange Programs Methodology 2011 Survey 197 SEPs contacted in second quarter SEPs (73%) submitted completed surveys by late summer Survey 199 * SEPs contacted in second quarter SEPs (71%) submitted completed surveys by the fall of 2013 *We attempted to contact 212 programs but 10 programs appeared to be no longer operating and 3 programs were found to have been started in 2013.

SEP Budget Dollars Total $$$ $19,345,206 $19,431,912 City Gov $ $5,157,416 $5,789,118 County Gov $ $1,683,229 $1,538,358 State Gov $ $8,793,482 $8,391,180 Federal Gov $ $637,518 N/A Foundation $ $2,081,362 $1,966,688 Individual Donations $584,780 $696,947 Out-of-pocket $ $28,145 $50,525 NASEN $ $36,750 $4,150 CBO Donation $ $53,944 $28,740 Corporate Donation $ $82,464 $68,300 Other $ $202,841 $856,406

Budget Status 2011 vs. 2012

SEPs That Participated in 2011 & 2012 Surveys Total Budget $$ 2011 $15,857,761 (as reported by 104 SEPs) 2012 $17,236,124 (as reported by 104 SEPs)

Types of Areas that SEPs are Located in the United States,

Gender Distribution Of NSEP Participants in 2012* *Weighted by the number of syringes distributed

Ethnic Distribution of NSEP Participants in 2012 * *Weighted by the number of syringes distributed

Type of Exchange Conducted by SEPs in 2012 VariationNo. (%) Allowed receipt of more syringes than brought in 114 (80%) Used Start-up Packs 77 (54 %) Used A Distribution Model 73 (51%) Had a Limit on Syringes Exchanged 48 (34%) Used A Minimum 46 (32%)

Exchange Regular, Scheduled Times & Places 2011 Total of 4,144 hours per week averaging 29.4 hours per SEP 2012 Total of 3,317 hours per week Averaging 24.2 hours per SEP

Number of Syringes Distributed by Syringe Exchange Programs (SEPs), by Program Size: 2011 & 2012 SEP Size (Syringes Distributed) No. of SEPs 2011 Total syringes exchanged 2011 No. of SEPs 2012 Total syringes exchanged 2012 Small (< 10,000) 19 54,709 (<1%) 18 57,938 (<1%) Medium (10,000-55,000) ,472 (3%) ,911 (2%) Large (55, ,999) 72 13,472,727 (37%) 71 12,820,837 (33%) Very Large (  500,000) 18 22,383,837 (61%) 18 25,535,971 (65%) Total ,876, ,150,657 * In 2011, two programs did not indicate the number of syringes they distributed. In 2012, one program did not indicate the number of syringes they distributed and one program indicated that they did not distribute any syringes.

Returned/Collected Syringes in 2011 and 2012

Disposal Methods of Collected/Used Syringes in 2012

2011 (n=108 * ) 31,662,789 syringes distributed 27,078,225 syringes collected 2012 (n=108 * ) 36,919,542 syringes distributed 31,987,385 syringes collected Syringes Exchanged by Programs That Participated in Both 2011 & 2012 Surveys * Only programs that reported the number of syringes distributed in both 2011 and 2012 are included in the calculations above. In 2011, eight programs in this group did not report the number of syringes they collected, the number was also eight in 2012.

SEP Usage of Unique Identifiers for Tracking Individuals in 2012

Secondary Exchange & Methods of Encouragement Used by SEPs In 2012 Secondary ExchangeNo. (%) SEPs allowing secondary exchange 119 ( 84%) SEPs encouraging secondary exchange 92 (65%) Methods of Encouragement Talked about it 83 (58%) Gave extra supplies 71 (50%) Provided sharps containers 71 (50%) Had no limit on syringes exchanged 59 (42%) Peer education 44 (31%) Enrolled people receiving syringes from secondary exchange 18 (13%) Gift certificates/Other incentives 12 ( 8%)

SEPs Providing On-site Medical Services 2011 Number of SEPs= Number of SEPs=71

Safer Injection Supplies Provided by SEPs in 2011 & 2012

Overdose Rescue & Drug Treatment Medications Provided by SEPs in 2011 & 2012

Naloxone Services and Funding at SEPs in 2012 # of SEP’s % Program distributes Naloxone 7150% Funding source for programs providing Naloxone Regular budget item 3144% Special funding 4158%

Type of Naloxone Provided by SEPs in 2012

Safer Sex Items Provided by SEPs in 2011 & 2012

Miscellaneous Supplies Provided by SEPs in 2011 & 2012

HIV and Hepatitis C Related On-site Services Provided by SEPs

Screening Related On-site Services Provided by SEPs in 2011 & 2012

Additional Program Characteristics in 2011 & No. (%) 2012 No. (%) Did not operate for two months or more 8 (6%)15 (11%) Any full-time (paid) staff 83 (58%)78 (55%) Operated by city, county or state health department 34 (24%) 501-C3 Status 100 (69%)100 (70%)

Additional Program Characteristics in 2011 & No. (%) 2012 No. (%) Operated a Delivery Service 77 (53%)63 (44%) Was involved in a formal external evaluation 20 (14%)18 (13%)

Problems SEPs Encountered in 2011 & 2012

Quality of Relationship2011 No. (%) 2012 No. (%) Very Good 29 (20%)36 (25%) Somewhat good 42 (29%)43 (30%) Neutral 50 (35%) 37 (26%) Somewhat poor 5 (3%) 7 (5%) Very poor 1 (1%) 2 (1%) Non-existent 17 (12%) 13 (9%) Quality Of Relationship Between SEPs and Police as Reported by SEPs in 2011 & 2012

Quality Of Relationship Between SEPs and Local Health Officials as Reported by SEPs in 2011 & 2012 Quality of Relationship 2011 No. (%) 2012 No. (%) Very Good 87(60%)77(54%) Somewhat good 29(20%)33(23%) Neutral 16(11%)13(9%) Somewhat poor 3(2%)1(1%) Very poor 0(0%)2(1%) Non-existent 9(6%)10(7%) Did not answer 0 (--)6 (4%)

Strategies SEPs Used in 2012 to Gain Law Enforcement Support Strategy # of SEP’s% Meetings6646% Trainings3726% Officer Liaisons3021% Coalition work w/other public health activists 3625% None3122% Invitation to exchange2920% Didn’t have capacity/resources for strategy1913% Other1611% Street demonstrations 1 1%

Does the Affordable Care Act Present Your Program with Any New Opportunities for Revenue?

Any Favorable or Unfavorable Media Attention in 2012 YES 29 programs (20%) NO 105 programs (74%) Did not answer 8 programs (6%)

Very Special Thanks to: Jill Westermark Shantel Davis for their generous help contacting SEPs and encouraging survey submissions.