Needle exchange: the Vancouver experience

Hepatitis C is spreading rapidly in many areas despite the existence of needle exchange services. An extended case study of the hepatitis C and HIV epidemics in Vancouver, which at the time hosted the largest-volume needle exchange in North America, illustrates how adverse social, housing and economic conditions com-pounded by an upsurge in cocaine injecting can overwhelm restricted needle exchange provision. Together with other work, it suggests the need for far greater support for and investment in needle exchange, for a more interventionist but still ‘low threshold ’ working style, and, in partnership with injectors ’ for harnessing injectors ’ social networks to extend risk reduction.