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House Democrats Propose Repeal of Funding Ban on Needle Exchange Programs

Democrats in the U.S. House of Representatives proposed a change to a major appropriations bill that would end the long-standing ban on federal funding to supporting needle exchange programs, which have expanded rapidly in the past decade and are a proven effective strategy for preventing transmission of HIV and hepatitis B and C.

On July 10, House Democrats removed language in an annual spending bill to fund the Departments of Labor and Health and Human Services for fiscal year 2010 that would have the effect of overturning a ban that prohibits state and local governments and organizations from spending any funds received from the federal government -- including money for HIV prevention -- to provide clean needles in an effort to prevent transmission of blood-borne diseases.

"Scientific studies have documented that needle exchange programs, when implemented as part of a comprehensive prevention strategy, are an effective public health intervention for reducing [HIV] infections and do not promote drug use," said House Appropriations Committee Chair David Obey (D-WI).

The change came on the same day a coalition of AIDS activist groups stormed the Capitol rotunda demanding more action on the domestic and global HIV/AIDS epidemics, including repeal of the needle exchange funding ban.

Advocates have long agued that the federal ban hampered a proven effective strategy for preventing transmission of blood-borne diseases. A report in the February 10, 2009 advance online edition of the journal Addiction provided a review of the current state of needle/syringe exchange programs in the U.S.

Don Des Jarlais from Beth Israel Medical Center in New York City and colleagues traced the growth of syringe exchange programs (SEPs) in the U.S. since 1994-1995, a time when these programs were being established by various AIDS service organizations and local and state public health departments. AIDS activists had run needle exchanges on an underground basis for several years before that, amid considerable controversy and legal risk. (Report co-author Dave Purchase started one of the first such exchanges in Tacoma, Wash. In 1988.)

The study authors looked at data from annual surveys of U.S. SEPs known to North American Syringe Exchange Network (NASEN), a coalition of needle exchange providers and advocates. Surveys were mailed to program executive directors and follow-up interviews were conducted by telephone or e-mail. Since the first survey was undertaken in 1996, response rates have varied between 70% and 88%.

Results

• The number of syringe exchange programs known to NASEN increased from 68 in 1994-1995 to 186 in 2007.
• The total number of syringes exchanged by programs participating in the survey increased from 8.0 million per year to 29.5 million per year over the same period.
• Total annual budgets likewise increased over the study period -- despite the federal funding ban -- from $6.3 to $19.6 million.
• Of these totals, the amount of public funding from state and local governments rose from $3.9 to $14.4 million.
• In 2007, 89% of programs permitted "secondary exchange" (allowing program participants to receive a large number of syringes distribute to their associates), while 76% encouraged it.
• Besides clean needles, the most common services offered by participating program included condoms, referrals to substance abuse treatment, HIV, HBV, and HCV counseling and testing, and naloxone for treating opiate overdose.
• Each of these services was provided by at least 40% of surveyed SEPs in 2007.

"While syringe exchange has remained controversial in the United States, there has been very substantial growth in numbers of programs, syringes exchange, and program budgets," the authors wrote in conclusion. "Utilizing secondary exchange to reach large numbers of injecting drug users and utilizing SEPs as a new platform for providing health and social services beyond basic syringe exchange have been the two major organizational strategies in the growth of SEPs in the United States."

In an editorial in the June 24, 2009 online edition of the same journal, Lisa Maher and Jenny Iversen from the University of New South Wales compared these findings about SEPs in the U.S. with those in Australia and elsewhere. Due to ongoing stigma and refusal of care, they noted, SEPs may be the only source of primary care for many injection drug users.

"Regardless of the setting, the value of SEPs as an evidence-based public health response to blood-borne viruses and injection-related injuries is overwhelming," the authors wrote. "We know what works and we have the evidence. However, if we are serious about increasing access to health care for people who inject drugs then we need to confront the stigma and discrimination that injection drug users continue to encounter in mainstream health-care settings around the world." 

7/17/09

References

DC Des Jarlais, C McKnight, C Goldblatt, and D Purchase. Doing harm reduction better: syringe exchange in the United States. Addiction. February 10, 2009 [Epub ahead of print].

L Maher and J Iversen. Syringe exchange in the United States: doing the simple things better? Addiction. June 24, 2009 [Epub ahead of print].

Other sources

Bill Would Allow Federal Funding For Needle Exchange Programs. Kaiser Daily HIV/AIDS Report. June 13, 2009.

HIV/AIDS Groups Demonstrate At Capitol Rotunda, Call For Action On Domestic, Global Epidemics. Kaiser Daily HIV/AIDS Report. June 10, 2009.