Should the government fund needle exchange programs?

Yes

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by Jamie Korf

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People who inject drugs are at risk of contracting HIV, hepatitis and other blood-borne diseases if they share dirty hypodermic needles and syringes. These disease-related risks pose massive public health problems.

Nearly half of all adults living with AIDS in Philadelphia contracted HIV through injection drug use. Clean needle-exchange programs allow individuals who inject drugs to bring in their used syringes and needles and receive new, clean ones; public health researchers have proven that these programs decrease the rate of HIV transmission.

However, in 1988, the United States Congress banned federal funds from being used to support needle exchange programs.
The ban on federal funding of needle exchange programs should be lifted because needle exchange reduces the transmission of HIV and provides tools to reduce the harm of drug use while allowing drug users to retain autonomy over their lives.

Needle exchange programs effectively address the problem of the high rate of HIV infection among injection drug users, and are a crucial site for active drug users to receive other health-related materials and information. Needle exchange programs utilize principles of harm reduction to supply people who use injection drugs with increased opportunities for control over their lives and their choices, while respecting their authority over themselves and their bodies.

These programs also benefit communities by providing a safe disposal method for used needles and syringes, which may otherwise litter city streets and community space. We would all benefit from the increase in funding and visibility that needle exchange programs would receive if the federal funding ban were reversed.
Needle exchange programs were devised to reduce the spread of blood-borne diseases, and there is tremendous evidence that they work.

The first needle exchanges were developed in 1984 by the Junky Union, a group of IV drug users in the Netherlands. Their aim was to stop an outbreak of hepatitis B: the initiative was so effective that in 1985, the Amsterdam city government took it over. There is a wide consensus among public health professionals that needle exchanges are an effective tool for HIV prevention.

In 2000, then-U.S. Surgeon General, David Satcher, released a report stating that "the senior scientists of the Department [of the Health and Human Services] and I have unanimously agreed that there is conclusive scientific evidence that syringe exchange programs are an effective public health intervention that reduces the transmission of HIV and does not encourage the use of illegal drugs."

The American Academy of Pediatrics, a major association of pediatric doctors, recently revised their official policy manual to include a statement encouraging pediatricians to advocate for increased access to needle exchange programs. This public health consensus ought to be enough to convince Congress to lift the ban on federal funding of needle exchange programs.

In 1988, when they enacted the ban, Congress stated that if "the secretary of Health and Human Services (HHS) presents scientific evidence that they cut the spread of AIDS and don't increase drug use," the ban would be lifted. (Bettelheim 1056) As noted above, in 2000, the Surgeon General revealed that there was unanimous agreement between the senior members of HHS on both of those counts; yet, seven years later, the ban is still in place.

In a 2004 New York Times editorial, Brent Staples addressed the enormity of this standstill, suggesting that "narrow-mindedness at the federal level has cost lives, leaving the country 20 years behind where it could be in the battle against AIDS." If Congress fulfilled their commitment of 1988 and lifted the ban, needle exchange programs would be able to reach many more people and the number of new HIV infections would certainly decrease.

People who are actively using injection drugs are often difficult for healthcare and service providers to reach. In addition to their role in reducing disease transmission, needle exchange programs are a valuable public health initiative because they can link these individuals with information, materials and resources. Needle exchange locations can serve as a distribution site for condoms, information about safer sex, information about how to clean needles and syringes, links to drug treatment programs, and links to drug and alcohol counseling.

Some opponents to needle exchange programs contend that instead of providing clean needles, government funding should be used for drug treatment programs. However, as the editors of the New York Times point out, even if there were far more treatment programs in existence, "drug users would need to wait months or even years for help. In the meantime, they would face almost certain infection without access to clean needles." In actuality, needle exchanges and drug treatment programs mutually support each other, providing a myriad of options for active drug users who are seeking to increase their health and well-being.

Needle exchange programs are an example of harm reduction, an approach to drug use that respects the autonomy that people deserve to have over their own bodies. The traditional social services approach to drug use offers quitting drugs as the only positive option; in contrast, the harm reduction approach encourages service providers to strategize with drug users about how they can reduce the harmful effects of drugs on their lives. Needle exchange programs are an effective harm reduction intervention, as clean needles are a resource that many active drug users are interested in taking advantage of, and one that makes their lives safer. The Harm Reduction Coalition states that one principle of harm reduction is that it "affirms drugs users themselves as the primary agents of reducing the harms of their drug use."

This reflects the idea, central to harm reduction strategies, that people are experts on their own experience. The emphasis on the agency of drug users is crucial. When drug users seek out clean needles, they are taking control of their lives and taking steps toward self-care. A New Jersey health education worker said of drug users, "When they take part in needle exchange, it means they're starting to take an interest in their health. That's the first step." The presence of resources like needle exchange programs is an opportunity for drug users' to take control of their health; this process of taking control is a powerful antidote to the feelings of powerlessness endemic among people who struggle with addiction and whose very existence has been criminalized.

Needle exchange programs have a direct positive impact on the physical space of neighborhoods, because when used needles and syringes are exchanged, it reduces the number of needles and syringes littering the streets. The presence of dirty needles and syringes in communities is extremely unsafe for all community members, but especially children who may not understand the dangers of such objects. Dirty needles and syringes are dangerous not only because they can hurt people, but because they can be a source of disease transmission.

In September 2006, when needle exchange programs were still illegal in New Jersey, a resident of Camden, N.J. was quoted in support of legalizing the programs, explaining that "right now, they're disposing of these things in our back alleys, in our playground where our kids are getting pricked." (Jones 20) The presence of dirty needles and syringes in public spaces, especially spaces that children frequent, is a significant public health problem unto itself. The presence of needle exchange programs is at least a partial solution to this problem.

Needle exchange programs reduce the risk of HIV, provide a channel for other services and information to reach active injection drug users, support these individuals in acting as agents of their own self-care, and help fight the disposal of dirty syringes and needles in places where they could injure and/or infect people. Unfortunately, Congress is swayed more by political and economic power than the opportunity to prevent the infection of individuals who are seen as criminals. For the sake of injection drug users, whole communities that are affected by drug use, and indeed everyone impacted by the HIV/AIDS epidemic, Congress ought to follow through on their promise and reverse the federal funding ban on needle exchange programs.

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