1. 2011 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 (EJAF) and the Irene Diamond Foundation.

2. Characteristics of SEPs Participating in BIMC/NASEN Surveys United States, 1996-2011 Numbers of1996199719982000200220042005200620072008200920102011 SEPs known to NASEN101113131154148174166188186184201194197 SEPs Participating in survey (%) 87 (86%) 100 (88%) 110 (84%) 127 (82%) 126 (85%) 109 (63%) 118 (71%) 150 (80%) 131 (70%) 123 (67%) 149 (74%) 149 (77%) 144 (73%) Cities with SEPs participating 6978779897889011310098115119117 States with SEPs participating * 2933 3632 2932313033 32 Syringes exchanged (millions) 13.917.519.422.624.924.022.527.629.529.133.135.536.9 Total of SEP budgets ($, millions) 7.38.48.612.013.011.614.517.419.621.321.621.719.3 Total of SEP budgets in 2011-adjusted $ (millions) (adjusted using a constant 3% annual inflation rate) 10.611.912.016.016.514.017.120.022.023.222.922.419.3 Public funding as % of total SEP budgets 62%67%69%74%67%76%74%79%73%79%80%82%84% * This category includes the District of Columbia and/or Puerto Ri co.

3. Number of syringes exchanged and Total SEP budgets 1996-2011 *adjusted using a constant 3% annual inflation rate

5. National Survey of Syringe Exchange Programs Methodology 2010 Survey 194 SEPs contacted in first quarter 2010 149 SEPs (77%) submitted completed surveys by early summer. 2011 Survey 197 SEPs contacted in second quarter 2011 144 SEPs (73%) submitted completed surveys by late summer.

6. SEP Budget Dollars 20102011 Total $$$$21,674,495 $19,345,206 City Gov $ $6,021,484 $5,157,416 County Gov $ $2,328,563 $1,683,229 State Gov $ $9,336,118 $8,793,482 Federal Gov $ ------------ $637,518 Foundation $ $2,127,053 $2,081,362 Individual Donations $833,686 $584,780 Out-of-pocket $ $29,830 $28,145 NASEN $ $67,116 $36,750 CBO Donation $ $27,410 $53,944 Corporate Donation $ $57,350 $82,464 Other $ $563,906 $202,841

7. Budget Status 2010 vs. 2011

8. SEPs That Participated in 2010 & 2011 Surveys Total Budget $$ 2010 $17,451,562 (as reported by 110 SEPs) 2011 $17,866,457 (as reported by 110 SEPs)

10. Type of Exchange Conducted by SEPs in 2011 VariationNo. (%) Allowed receipt of more syringes than brought in 123 (85%) Used A Distribution Model 84 (58%) Used Start-up Packs 81 (56 %) Used A Minimum 48 (33%) Had a Limit on Syringes Exchanged 44 (31%)

11. Number of Syringes Distributed by Syringe Exchange Programs (SEPs), by Program Size: 2010 & 2011 SEP Size (Syringes Distributed) No. of SEPs 2010 Total syringes exchanged 2010 No. of SEPs 2011 Total syringes exchanged 2011 Small (< 10,000) 22 92,316 (0.3%) 19 54,709 (0.1%) Medium (10,000-55,000) 25 714,320 (2.0%) 33 965,472 (2.6%) Large (55,001-499,999) 75 12,576,461 (35.4%) 72 13,472,727 (36.5%) Very Large (  500,000) 18 22,127,202 (62.3%) 18 22,383,837 (60.7%) Total 140 35,510,299 142 36,876,745 * In 2010, nine programs responding to the survey did not track the number of syringes exchanged, in 2011 two programs did not indicate the number of syringes they distributed.

12. Returned/Collected Syringes in 2010 and 2011

13. Syringes Exchanged By Programs That Participated in Both 2010 & 2011 Surveys 2010 (n=110 * ) 32,947,282 syringes distributed 27,204,851 syringes collected 2011 (n=110 * ) 34,447,074 syringes distributed 28,983,403 syringes collected *Only programs which reported the number of syringes distributed in both 2010 and 2011 are included in the calculations above. In 2010, seven programs in this group did not report the number of syringes they collected, the number was eight in 2011.

14. Secondary Exchange & Methods of Encouragement Used by SEPs in 2011 Secondary ExchangeNo. (%) SEPs allowing secondary exchange 130 ( 90%) SEPs encouraging secondary exchange 116 (81%) Methods of Encouragement Talked about it 109 (76%) Gave extra supplies 103 (72%) Provided sharps containers 96 (67%) Had no limit on syringes exchanged 83 (58%) Peer education 61 (42%) Enrolled people receiving syringes from secondary exchange 23 (16%) Gift certificates/Other incentives 14 ( 10%)

15. SEPs Providing On-Site Medical Services 2010 Number of SEPs=65 2011 Number of SEPs=75

16. Overdose Rescue & Drug Treatment Medications Provided by SEPs in 2010 & 2011

17. Additional Program Characteristics in 2010 & 2011 2010 No. (%) 2011 No. (%) Did not operate for two months or more 6 (4%)8 (6%) Any full-time (paid) staff 95 (64%)83 (58%) Operated by city, county or state health department 35 (23%)34 (24%) 501-C3 Status 116 (78%)100 (69%)

18. Additional Program Characteristics in 2010 & 2011 2010 No. %) 2011 No. (%) Operated a Delivery Service 69 (46%)77 (53%) Was involved in formal external evaluation 23 (15%)20 (14%)

19. Problems SEPs Encountered in 2010 & 2011

20. Quality of Relationship Between SEPs and Police as Reported by SEPs in 2010 & 2011 Quality of Relationship 2010 No. (%) 2011 No. (%) Very Good 35 (23%)29 (20%) Somewhat good 55 (37%)42 (29%) Neutral 44 (30%) 50 (35%) Somewhat poor 6 (4%) 5 (3%) Very poor 1 (1%) Non-existent 8 (5%) 17 (12%)

21. Strategies SEPs Used in 2011 to Gain Law Enforcement Support Strategy# of SEP’s% Meetings6948% Trainings3826% Officer Liaisons3826% Coalition work w/other public health activists 3524% None3222% Invitation to exchange2618% Didn’t have capacity/resources for strategy2014% Other1611% Street demonstrations43%

22. Federal Funding in 2010 and 2011 SEPs …20102011 Applied for federal funding 20 (13%) 19 (13%) Received federal funding 20 (13%) 14 (10%)

23. Programs Used Federal Funding in 2010 and 2011 to 20102011 Maintain Present Services Only9 (45%)7 (50%) Expand Present Services7 (35%)1 (7%) Add New Services2 (10%)2 (14%) Maintain/Expand Present Services 1 (5%)2 (14%) Didn’t Answer1 (5%)2 (14%)

24. Naloxone Services and Funding at SEPs in 2011 # of SEP’s % Program distributes Naloxone 6847% Funding source for programs providing Naloxone Regular budget item 3551% Special funding 3349%

25. Type of Naloxone Provided by SEPs in 2011

26. Very Special Thanks to: Alisa Solberg Jill Westermark Kay Borba for their generous help contacting SEPs and encouraging survey submissions.