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Responding to AIDS - Home   |    About this Exhibit - Introduction   |    AIDS Emerges   |    Poised to Respond   |    New Programs: Working Together   |    Responding to Fear   |    The AIDS Prevention Project   |    A Leader in Research, Education, and Housing   |   
   |    Expanding Outreach   |   Needle Exchanges   |    The AIDS Omnibus Act: New Mandates   |    Safer Sex: The New Normal?   |    The Legacy   |    Gallery   |    Oral Histories    |    References and Resources

Needle Exchanges

Sharing Needles

By 1991, injection drug users accounted for over 25 percent of AIDS cases nationwide. The figure was far lower in King County: three percent, with another nine percent among gay or bisexual men who were also injection drug users.

But with an estimated 12,000 to 14,000 intravenous drug users in King County, over 80 percent of whom shared needles, the risk of AIDS spreading in this community was great. Sharing needles put not only users at risk, but it also risked infecting their sexual partners, as well as the fetuses of pregnant partners.

The Public Health Department’s first strategy was educating users about the risks and distributing bleach to sterilize needles.

Successful Needle Exchanges Abroad and At Home

Needle exchanges originated in Europe, Canada, and Australia around 1984 as a means to minimize the risk of HIV and Hepatitis B transmission among people unable or unwilling to cease injection drug use. New sterile syringes were exchanged for old contaminated ones. Needle sharing and reuse were more likely in states like Washington, where state law prevented the purchase of syringes without a prescription. In the United States, the first publicly funded needle exchange was established in Tacoma in 1988.

Patricia McInturff discusses how she encountered opposition from a colleague and the public, as well as support for needle exchanges from King County Executive Tim Hill and County Councilmember Greg Nickels. (Oral history interview, September 2015.)


Early efforts at fighting the spread of HIV among injection drug users discouraged needle sharing and encouraged people to use bleach to clean the syringes. From Series 1825 – History files, Seattle-King County Department of Public Health: Prevention Division / HIV-AIDS Program. [1825-5]

Harm Reduction

The idea of distributing free syringes was seen by some as encouraging drug use. But the harm reduction approach to public health argued that even when a person’s behavior (in this case, drug use) doesn’t change, the harmful impact of that behavior could, and should, be minimized. Reducing the harm of contracting HIV and spreading it to others took priority over demanding abstinence.

Gary Goldbaum on how AIDS helped the medical community begin to accept the concept of harm reduction. (Oral history interview, August 2015.)


Excerpt from the Department’s 1989 proposal “Needle Exchange: A Pilot Program to Reduce AIDS Among Intravenous Drug Users.” From Series 462 – Project files, Seattle-King County Department of Public Health: Prevention Division / HIV-AIDS Program. [462-7-3]. Click on the thumbnail to read the full proposal.

What is ACT UP?

A grassroots activist group, ACT UP formed in Manhattan in 1987 to draw attention to the AIDS epidemic and to help improve the lives of people with AIDS. From its beginnings, ACT UP used politically savvy demonstrations and civil disobedience to critique the roles of homophobia, racism, sexism, and capitalism in what they saw as an indifferent and flawed national response to the AIDS epidemic.


King County and the City of Seattle, convinced that the program was effective and had not led to an increase in drug use, continued funding the program and have done so to the present day. Seven years later, the Public Health Department could claim that its needle exchange program was “probably the largest legal program in the country” (Dr. Robert Wood, 1996), exchanging over a million needles in that year.

Robert Wood talks about the needle exchange. (Oral history interview, August 2015.)

Seattle's first needle exchange

Seattle’s own needle exchange began in March 1989, operated by the local branch of the AIDS Coalition to Unleash Power (ACT UP).
Stressing the benefits of public oversight, the Public Health Department successfully took over the program from ACT UP two months later and launched the new program with existing city and county funding. It was to be a two‐year pilot program subject to review and evaluation. The program also included referrals to drug treatment and social and health services and distribution of condoms and bleach.

Brochure for the new needle exchange. From Series 1825 – History files, Seattle-King County Department of Public Health: Prevention Division / HIV-AIDS Program. [1825-5]

459-1-9_1_--_NE_schedule_-_pocket_card--_face 1825-3-17-hot-pink-NEON-flyer_Page_1


Left: Wallet card showing needle exchange locations and schedule. From Series 459 – Legislative files, Seattle-King County Department of Public Health: Prevention Division / HIV-AIDS Program. [459-1-9]. Right/Below: The Needle Education Outreach Network (NEON) targeted a high-risk group: gay men who injected methamphetamine. A Harm Reduction Group met at the Group Health Medical Center on Seattle's Capitol Hill.


From Series 1825 – History files, Seattle-King County Department of Public Health: Prevention Division / HIV-AIDS Program. [1825-3-17]

Next: AIDS Omnibus Act

Responding to AIDS

An exhibit and oral history project from the King County Archives.

Content warning: The archival records featured in this exhibit discuss sexual behavior and illegal drug use. Please direct questions or comments to

Copyright King County Archives, Seattle Washington, June 2016.




Please note: This exhibit features historical materials relating to HIV/AIDS. For current health information, please visit Public Health, Seattle & King County - HIV/AIDS and STD Prevention and Education.



Oral histories produced with support from a 2015 4Culture Heritage Projects Grant.