Since Baltimore launched its needle-exchange program 11 years ago, new HIV infections among intravenous drug users (IDUs) have dropped by 20 percent, to about 40 percent of city cases. The program has registered more than 15,000 clients and has about 325 visitors a week, many whom are believed to distribute or sell their needles to other IDUs. Each week, two white vans distribute about 6,500 syringes and injection equipment in exchange for dirty syringes at a dozen sites. The vans also offer HIV tests and drug treatment information.

However, most younger IDUs are not participating, particularly white users in their teens and 20s. Only 6 percent of program clients since the exchange's inception have been younger than 25, said Monique Glover Rucker, the city's HIV/AIDS and harm reduction senior adviser.

A recent Johns Hopkins University Bloomberg School of Health study found only 10 percent of 294 IDUs who began using drugs in the last five years obtained needles mainly from an exchange. Another 18 percent -- most interviewed in Southwest Baltimore -- said they mostly obtained syringes through pharmacies, where a 10-pack costs about $2.50. The remaining majority bought their syringes on the street or shared them, both risky practices. "Habits get established very early," said Susan G. Sherman, the study's lead author, explaining the reason for reaching out to young IDUs.

In response, the city is applying for a $25,000 Tide Foundation grant to improve youth IDU services utilization. Part of the grant would pay for peer outreach and setting aside a youth-specific time for exchange services. Some IDUs suggested an exchange venue other than on the busy streets, where young IDUs may fear being recognized.

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