From November 1987 to March 1989 total number of clients, visits made, including numbers of new clients and second visits, and referrals to other agencies were routinely monitored at The Cleveland Street Needle Exchange, the Middlesex Hospital, London. During the study period a total of 510 onward referrals were made, involving 277 clients. Of these, 305 (59.7%) were to drug agencies and 187 (36.7%) to medical services. A sample of clients were interviewed to identify demographic and behavioural characteristics. Comparisons were made between those clients receiving referrals and the general client population; no significant differences were found in terms of sex, age and current patterns of drug use. However, those who accepted and took up referrals were found to have begun opiate use, injecting drug use and daily injecting at an earlier age than the general client population. The scheme attracts and retains its clients and provides a comprehensive service to a client group not currently in contact with other services.

Despite a large number of needle-exchange schemes in the U.K., there are few accounts of how particular agencies attract injecting drug users. This paper describes a busy scheme in London, the take-up of services by clients, and the operating philosophy of the staff. From November 1987 to October 1988 The Exchange saw a mean of 257 clients per month, making an average three visits per client each month. An average of 8,950 needles and syringes were dispensed and 6,918 returned monthly, giving an average return rate of 77%. The Exchange also served as a referral agency to clients; 533 referrals were made, 63.4% of which were to drug and non-medical services, 36.6% to health services, and 9.2% to HIV services. To account for the take-up of services the paper describes The Exchange's open access policy, the staff's communication strategies and their adoption of the philosophy of harm-minimization in relation to injecting drug use. It is argued that these must be seen as integral to needle-exchange if it is to succeed as a comprehensive service.