This report presents the findings of an evaluation of the Health Promotion Unit established in the Merchant's Quay Project in 1992. The objectives of the this evaluation study were to: examine international evaluations of syringe exchange; define the services provided by the Health Promotion Unit and identify indicators of positive effect; gather information on client behaviour; adjust the information at first contact to include baseline data on these indicators; comparatively analyse clients' behaviour according to these indicators; and, ultimately evaluate the effectiveness of the service offered by the Health Promotion Unit. The evaluation was based on information on risk behaviour collected from clients at both first intervention and a follow up visits.

The following outcome domains were examined: drug use; injecting risk behaviour; sexual risk behaviour; contact with services and health and well-being. A total of 1,337 clients attended the Unit during the 18 months under investigation and all completed the First Visit Intervention Sheet. The Unit was successful in making contacts with clients who were not attending other drug treatment services, users who had recently initiated drug use, female drug users, and those engaging in risk behaviour. Contact was maintained with a significant proportion of the 1337 first time attendees to the Unit. 28% represented at the three month follow-up, which is regarded as a reasonable figure. Patterns of drug use changed in the intervening period.

A number of attendees indicated that heroin was no longer their primary drug and there was reductions in both the numbers injecting and in frequency of injecting. There were reductions in reported lending and borrowing of injecting equipment, but no significant change in the sharing of injecting paraphernalia, nor in risky sexual behaviour. Regarding the area of general health, there was a slight increase in the numbers attending other treatment services by the end of the follow-up period, and more detailed descriptions of physical and mental condition was reported during the follow-up.

The authors argue that the study demonstrates the effectiveness of needle exchanges as a public health initiative and recommends: improved access to sterile injecting equipment; the development of more extensive harm reduction strategies; innovative HIV and Hepatitis C information campaigns; further research; and the establishment of harm reduction as a primary objective of the national drug policy.