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To assess the association between proximity to a needle exchange program (NEP) and experience of violence in an inner city neighborhood.Methods: A cross-sectional survey of residents of Harlem, New York City provided data for this study. We used geocoding to obtain the distance between respondents and the nearest NEP. Respondents reported violence they were aware of or had personally experienced in their neighborhood. Multiple logistic regression analyses assessed the relation between violence and distance from the nearest NEP.Among 220 respondents, 50.1% were African American, 39.0% were Latino, 44.7% were male, and the mean age was 44.5 years. In separate age-, race-, sex-, and income-adjusted logistic regression models, there was no significant association between (1) reporting a fight and distance from the nearest NEP (odds ratio [OR] = 1.05, p = .89); (2) robbery in the neighborhood in the previous 6 months and distance from the nearest NEP (OR = 1.13, p = .71); (3) ever having experienced violence and distance from the nearest NEP (OR = 0.72, p = .52); or (4) ever having been robbed by drug users and distance from the nearest NEP (OR = 1.05, p = .91).There was no consistent association between living close to NEPs and violence reported by residents of Harlem in this study. This study suggests that NEPs do not adversely affect rates of violence in their vicinity.