received 2,394,460, a shortage of 83,902 needles. In 2016, it was reported that Cleveland Needle exchange program sees "mostly white suburban kids ages 18 to 25". San Francisco Since the full sanction of syringe exchange programs (SEP) by then-Mayor Frank Jordan in 1993, the San Francisco Department of Public Health has been responsible for the management of syringe access and the proposed disposal of these devices in the city. This sanction, which was originally executed as a state of emergency to address the HIV epidemic, allowed SEPs to provide sterile syringes, take back used devices, and operate as a service for health education to support individuals struggling with substance use disorders. Since then, it was approximated that from July 1, 2017, to December 31, 2017, only 1,672,000 out of the 3,030,000 distributed needles (60%) were returned to the designated sites. In April 2018, acting Mayor Mark Farrell allocated $750,000 towards the removal of abandoned needles littering the streets of San Francisco. General characteristics As of 2011, at least 221 programmes operated in the US. Most (91%) were legally authorized to operate; 38.2% were managed by their local health authorities. The CDC reported in 1993 that the most significant expenses for the NSPs is personnel cost, which reports it represents 66% of the budget. More than 36 million syringes were distributed annually, mostly through large urban programmes operating a stationary site. Syringes are supplied nationwide by mail in the US by Next Distro. More generally, US NEPs distribute syringes through a variety of methods including mobile vans, delivery services and backpack/pedestrian routes that include secondary (peer-to-peer) exchange. Funding In the United States, a ban on federal funding for needle exchange programs began in 1988, when republican North Carolina Senator Jesse Helms led Congress to enact a prohibition on the use of federal funds to encourage drug abuse. The ban was briefly lifted in 2009, reinstated in 2010, and partially lifted again in 2015. Currently, federal funds can still not be used for the purchase of needles and syringes or other injecting paraphernalia by needle exchange programs, though can be used for training and other program support in the case of a declared public health emergency. In the time between 2010 and 2011 when no ban was in place, at least three programmes were able to obtain federal funds and two thirds reported planning to pursue such funding. A 1997 study estimated