Community in a Time of Crisis: Yale, New Haven, and HIV/AIDS, 1981-1996

Needle Exchange

New Haven's needle exchange program was featured on the front cover of The New Journal. A man stands with a bag, collecting needles. An AIDS Brigade volunteer remembered being told that "everybody out there who's been shooting drugs for the last five years has the virus... every one. Some of them just don't know it yet."

The New Journal, December 6, 1991.

In the early years of the AIDS crisis, it was illegal to buy or possess syringes without a prescription. Without a source of clean needles, people who used IV drugs often shared their syringes. Over the course of the 1980s, New Haven became home to a bold and innovative program that cut HIV transmission rates within the city by tracking the circulation of used syringes and providing clean ones. Initially an informal and illegal initiative that faced tremendous backlash, the program gained legitimacy—and eventually the support of the city itself—as Yale researchers proved its efficacy through a combination of laboratory testing, epidemiological surveys, and mathematical modeling. New Haven’s needle exchange program served as a blueprint for similar programs around the United States. 

Parker reflects upon his experience with AIDS activism at Yale.

Cover of Jon Stuen-Parker’s autobiography, Letter to Norman Mailer: From Jail to Yale (National AIDS Brigade, 1998).

In 1986, YSPH student Jon Parker launched an underground outreach program: The AIDS Brigade. It provided needle exchange services out of a storefront on York Street and by van around New Haven. Other Yale-affiliated students, researchers, and physicians soon joined in, risking legal and professional consequences to ensure access to clean needles. 

In 1990, a coalition of physicians, public health experts, policy makers, and other advocates convinced the Connecticut legislature to conduct a trial run of a formal needle exchange program. The research team had one year and $25,000 to prove that the program reduced HIV transmission in New Haven. This was the first government money allocated for a needle exchange program in the United States. 

Because the diagnosis of AIDS could lead people to be harassed, outed, or fired from their jobs (and because there was no treatment), researchers found it unethical to test vulnerable individuals to see if the needle exchange was working. To solve that problem, YSOM professor Edward H. Kaplan, PhD, developed the idea of testing the needles themselves for the presence of HIV, and Yale School of Medicine (YSM) pharmacologist and epidemiologist Robert Heimer, PhD, developed a way to use polymerase chain reaction technology to do so. This method both preserved the anonymity of those who participated in the exchange and allowed researchers to track the number of HIV-containing needles circulating throughout the city—a number that decreased the longer the program was in place. 

The needle exchange program benefited from an unlikely collaboration across disciplines. Kaplan used his expertise in mathematical modeling for operations management to demonstrate that the needle exchange program cut the HIV infection rate among its clients by one-third. 

Ed Kaplan's mathematical modelling proved that clean needles become infected when used by an infected person, while infected needles become uninfectious if they are cleaned.
This equation models the cumulative incidence of HIV infection per drug injector over time.
This equation models the reduction in HIV incidence following needle exchange.
Series of equations used by Edward H. Kaplan to demonstrate efficacy of needle exchange program in the 1993 article "Let the Needles Do the Talking! Evaluating the New Haven Needle Exchange."

The success of New Haven’s program paved the way for exchanges in cities around the country. In late 1991, New York Mayor David Dinkins, for example, reversed his stance on needle exchanges as a result of the Yale study. Connecticut launched several more programs around the state and legalized the possession and over-the-counter sale of syringes. 

Many of the participants in Needle Exchange used pseudonyms like "Bootsie," "Serious," "Bubble," and "Orange Cap." The Needle Exchange workers recorded the site of exchange and the number of needles exchanged. They also marked which needles contained visible blood. The final needle on this log sheet was number 5245.

Needle exchange program log sheet, showing user pseudonyms, exchange location in New Haven, and syringe tracking numbers.

This page from Dr. Kaplan's personal scrapbook celebrates the extensive media coverage the 1.5 year-old Needle Exchange had received. A newspaper photograph shows Needle Exchange workers standing defiantly in front of their van.

Needle exchange program director Elaine O’Keefe, foreground, with outreach workers (left to right) Michael White, Chris Brewer, Dominick Maldonado, George Edwards, and Sonia Lugo. 

Two young people work at a lab bench. They are analyzing samples.

Photograph of Kaveh Khoshnood, PhD., MPH., and Bini Jariwala that appeared in Bridgeport Post, May 7, 1992.

Dr. Kaplan appeared on the Tonight Show alongside celebrity guests.

Materials related to Edward Kaplan’s appearance on Today on NBC on August 6, 1991 to discuss New Haven's needle exchange program. 

In his scrapbook, Ed Kaplan collected ephemera related to Needle Exchange. Here, documents emphasize that the Needle Exchange program was Free, Legal, and Anonymous. The Needle Exchange van was decorated with an artistic mural. Needle Exchange participants used pseudonyms such as "Street cat," "Jazz," "Attica," "Blue Thunder," "downtown," and "tired."

Materials related to the needle exchange program, including image of van and tracking log with participants’ pseudonyms, early 1990s

We invite you to watch a 10-minute documentary film about needle exchange in New Haven:

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