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Barbara Tempalski, PhD, MPH, Peter L. Flom, PhD, Samuel R. Friedman, PhD, Don C. Des Jarlais, PhD, Judith J. Friedman, PhD, Courtney McKnight, MPH and Risa Friedman, MPH

Barbara Tempalski, Peter L. Flom, Samuel R. Friedman, and Don C. Des Jarlais are with the Center for Drug Use and HIV Research, National Development and Research Institutes, Inc, New York, NY. Samuel R. Friedman is also with the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md. Don C. Des Jarlais is also with the Baron de Rothschild Chemical Dependency Institute, Beth Israel Medical Center, New York. Judith J. Friedman is with the Department of Sociology, Rutgers University, Piscataway, NJ. Courtney McKnight is with the Baron de Rothschild Chemical Dependency Institute, Beth Israel Medical Center, NY. Risa Friedman is with the Department of Public Health, Universidad San Francisco de Quito, Quito, Ecuador.

Correspondence: Requests for reprints should be sent to Barbara Tempalski, PhD, MPH, National Development and Research Institutes, 71 W 23rd St, 8th Floor, New York, NY 10010 (e-mail: tempalski{at}ndri.org).

Community activism can be important in shaping public health policies. For example, political pressure and direct action from grassroots activists have been central to the formation of syringe exchange programs (SEPs) in the United States.

We explored why SEPs are present in some localities but not others, hypothesizing that programs are unevenly distributed across geographic areas as a result of political, socioeconomic, and organizational characteristics of localities, including needs, resources, and local opposition. We examined the effects of these factors on whether SEPs were present in different US metropolitan statistical areas in 2000.

Predictors of the presence of an SEP included percentage of the population with a college education, the existence of local AIDS Coalition to Unleash Power (ACT UP) chapters, and the percentage of men who have sex with men in the population. Need was not a predictor.

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