HIV/AIDS prevention: problems and approaches to establishing needle exchange programs in rural areas.

Needle and Syringe Exchange Programs (NSEP) were established to prevent the spread of HIV/AIDS amongst intravenous drug users (IVDU). The first rural NSEP in Australia was developed in the North Coast Region of NSW. The aims and objectives of the NSW NSEP are outlined. The problems and approaches faced by health services managers in developing a needle exchange program in a conservative rural area are presented with the emphasis on 4 major groups: intravenous drug users; the media; the general community and the public health system. A brief description of the North Coast NSEP, which is a combination of fixed outlets and outreach work, is presented. During 1989, there were 4,000 direct client contacts with 65,000 needles/syringes dispensed and 45,000 collected (69% return rate) for contaminated waste disposal.