This thesis explores the development and operation of a needle exchange service in one former health board area. It identifies the issues and barriers that are associated with these processes from the service providers perspective. This research shows why this provision is guided by the principles of the harm reduction philosophy and describes how harm reduction national policies have been translated into practice.

A single case holistic design was the methodology employed to complete the study. This design facilitated the collection of data from policy documents and service evaluation reports, qualitative interviews and observation of the service in operation.

This research found that the case exists within a social and political context. Anecdotal evidence suggested that despite having a mandate from the government, the social context hindered the first attempt to establish the service because the organization was concerned about the controversial identity of injecting drug users. However, a few years later the service was developed because there was support from senior management. A number of practical issues were involved with the service's development, including the implementation of policies and procedures that promoted service user-friendliness. The issues associated with the operation of the service included the importance of trust and confidentiality between service providers and service users; the adequacy/inadequacy of the current staffing levels and resources; facilitating the accessibility of the service in urban and rural communities. It was apparent that the service is designed to facilitate a client's engagement with the programme but responsibility for this engagement lies with the client.

This study finds that the effectiveness of the service provision can be assessed by reference to its ability to achieve its short-term objectives of changing risk taking behaviours and reducing the prevalence of blood-borne viruses and its long-term objective, of moving clients into drug treatment programmes. It is apparent that the service is effective in changing risk taking behaviours. However, at present the service cannot assess its efficacy in achieving the other two objectives. Therefore, systems should be implemented which facilitate their measurement.