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The <jats:styled-content style=\"fixed-case\">B<\/jats:styled-content>altimore <jats:styled-content style=\"fixed-case\">N<\/jats:styled-content>eedle and <jats:styled-content style=\"fixed-case\">S<\/jats:styled-content>yringe <jats:styled-content style=\"fixed-case\">E<\/jats:styled-content>xchange <jats:styled-content style=\"fixed-case\">P<\/jats:styled-content>rogram (<jats:styled-content style=\"fixed-case\">NSP<\/jats:styled-content>) operated under a 1\u2010for\u20101 syringe exchange policy from its inception in 1994 through 1999, when it implemented a restrictive policy (2000\u20132004) that dictated less than 1\u2010for\u20101 exchange for non\u2010program syringes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design and Methods<\/jats:title><jats:p>Data were derived from the <jats:styled-content style=\"fixed-case\">B<\/jats:styled-content>altimore <jats:styled-content style=\"fixed-case\">NSP<\/jats:styled-content>, which prospectively collected data on all client visits. We examined the impact of this restrictive policy on program\u2010level output measures (i.e. distributed\u2009:\u2009returned syringe ratio, client volume) before, during and after the restrictive exchange policy. Through multiple logistic regression, we examined correlates of less than 1\u2010for\u20101 exchange ratios at the client level before and during the restrictive exchange policy periods.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>During the restrictive policy period, the average annual program\u2010level ratio of total syringes distributed\u2009:\u2009returned dropped from 0.99 to 0.88, with a low point of 0.85 in 2000. There were substantial decreases in the average number of syringes distributed, syringes returned, the total number of clients and new clients enrolling during the restrictive compared to the preceding period. During the restrictive period, 33\u2009508 more syringes were returned to the needle exchange than were distributed. In the presence of other variables, correlates of less than 1\u2010for\u20101 exchange ratio were being white, female and less than 30 years old.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion and Conclusions<\/jats:title><jats:p>With fewer clean syringes in circulation, restrictive policies could increase the risk of exposure to <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content> among Injection Drug Users (<jats:styled-content style=\"fixed-case\">IDUs<\/jats:styled-content>) and the broader community. The study provides evidence to the potentially harmful effects of such policies. <jats:italic>[Sherman SG, Patel SA, Ramachandran DV, Galai N, Chaulk P, Serio\u2010Chapman C, Gindi RM. Consequences of a restrictive syringe exchange policy on utilisation patterns of a syringe exchange program in Baltimore, Maryland: Implications for HIV risk.<\/jats:italic> Drug Alcohol Rev<jats:italic> 2015;34:637\u2013644]<\/jats:italic><\/jats:p><\/jats:sec>","DOI":"10.1111\/dar.12276","type":"journal-article","created":{"date-parts":[[2015,4,28]],"date-time":"2015-04-28T12:27:21Z","timestamp":1430224041000},"page":"637-644","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Consequences of a restrictive syringe exchange policy on utilisation patterns of a syringe exchange program in <scp>B<\/scp>altimore, <scp>M<\/scp>aryland: Implications for <scp>HIV<\/scp> risk"],"prefix":"10.1111","volume":"34","author":[{"given":"Susan G.","family":"Sherman","sequence":"first","affiliation":[{"name":"Department of Epidemiology Johns Hopkins Bloomberg School of Public Health  Baltimore 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