Needle Exchange Programs and Experience of Violence in an Inner City Neighborhood *†Sandro Galea, *Jennifer Ahern, *†Crystal Fuller, ‡Nicholas Freudenberg, and *†David Vlahov *Center for Urban Epidemiologic Studies, New York Academy of Medicine, New York; †Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, New York; and ‡Program in Urban Public Health, Hunter College, City University of New York, New York, U.S.A. Objective: To assess the association between proximity to a needle exchange pro- gram (NEP) and experience of violence in an inner city neighborhood. Methods: A cross-sectional survey of residents of Harlem, New York City provided data for this study. We used geocoding to obtain the distance between respondents and the nearest NEP. Respondents reported violence they were aware of or had personally experienced in their neighborhood. Multiple logistic regression analyses assessed the relation between violence and distance from the nearest NEP. Results: Among 220 respondents, 50.1% were African American, 39.0% were Latino, 44.7% were male, and the mean age was 44.5 years. In separate age-, race-, sex-, and income-adjusted logistic regression models, there was no significant asso- ciation between (1) reporting a fight and distance from the nearest NEP (odds ratio [OR]  1.05, p  .89); (2) robbery in the neighborhood in the previous 6 months and distance from the nearest NEP (OR  1.13, p  .71); (3) ever having experienced violence and distance from the nearest NEP (OR  0.72, p  .52); or (4) ever having been robbed by drug users and distance from the nearest NEP (OR  1.05, p  .91). Conclusions: There was no consistent association between living close to NEPs and violence reported by residents of Harlem in this study. This study suggests that NEPs do not adversely affect rates of violence in their vicinity. Key Words: Needle exchange programs—Violence—Inner city neighborhood. Injection drug use is one of the leading causes of HIV transmission in the United States (1). In New York City, approximately half (47%) of total reported AIDS cases are a result of injection drug use (2). Needle exchange programs (NEPs) have been implemented in many U.S. cities as a public health measure to reduce transmission of HIV and other infectious disease (e.g., hepatitis B and C) (3–6). NEPs have been shown to reduce risk-taking behavior among injection drug users (IDUs) (7,8), to reduce discarded syringes in neighborhoods (9), and to increase referrals to drug abuse treatment among sub- stance users (10–12). In spite of these benefits, there remains a Congressio- nal ban on federal funding for NEPs in the United States (13,14). Although a number of expert panels have rec- ommended lifting the Congressional ban (15), legislators continue to express concern that NEPs can result in in- creased drug use, crime, and violence in their vicinity (16). These concerns have not been borne out by recent studies demonstrating that NEPs are cost-effective (17,18) and that the introduction of NEPs does not in- crease drug use (19–22) or crime rates in the surrounding neighborhoods (23). Although research has failed to identify an association between official crime records and NEPs, it is possible that persons who live close to NEPs (and who might thus Address correspondence and reprint requests to Sandro Galea, Cen- ter for Urban Epidemiologic Studies, New York Academy of Medicine, 1216 Fifth Avenue, Room 556, New York, NY 10029–5293, U.S.A.; e-mail: sgalea@nyam.org Manuscript received March 6, 2001; accepted July 23, 2001. JAIDS Journal of Acquired Immune Deficiency Syndromes 28:282–288 © 2001 Lippincott Williams & Wilkins, Inc., Philadelphia 282