More bad news–needle exchange

Another bad development in public health

With everything else going on, some very bad news has slipped by without a lot of public attention.

As most RBC readers know, every major public health expert body from the Institute of Medicine to the Centers for Disease Control and Prevention to UNAIDS and the World Health Organization, to the White House Office of Drug Control Policy endorses syringe exchange as an effective and cost-effective strategy to prevent HIV and other blood-borne infection among injection drug users.

Despite this evidence, Philip Smith and Maia Szalavitz report, Congress just restored the ban on federal funding for syringe exchange after the Senate took the final votes to approve the 2012 federal omnibus spending bill. 

I’ll have more to say when I get a change to learn more about the practical impact. It’s especially regrettable that the bill hinders support for evidence-based international programs that support syringe exchange. There is a fight for life against AIDS around the world. This is very detrimental.

The below press release from the AIDS Foundation of Chicago tells the basic word:

AFC Statement on Federal Funding Ban for Syringe Exchanges Monday, 19 December 2011 19:23

On Friday, December 16, Congress sent President Obama the final fiscal year 2012 appropriations bill, which reinstates a prohibition on using federal funding to support syringe exchanges. We implore President Obama to condemn the federal funding ban in the strongest language possible and begin working immediately for its repeal.“Reinstating the ban on federal syringe exchange funding is a terrible setback and a clear rejection of science and human rights,” said David Ernesto Munar, president/CEO of AIDS Foundation of Chicago. “The debate about needle exchanges was settled in 2009. Congress and the President are reversing a major public health gain at a time in the AIDS epidemic when we cannot afford to take steps backward.”

The federal ban on funding for syringe exchanges was enacted in the 1980s, and was repealed in 2009 by Congress and President Obama. Nine states and one city (Chicago) applied to the federal government to use $2.7 million federal funding for syringe exchanges, according to the National Association of State and Territorial AIDS Directors. Advocates hailed the lifting of the ban as a victory for science‐based HIV prevention services.

“We are dismayed that this year Congress threw in the towel when it comes to HIV prevention. They beat back provisions restricting abortion, workers’ rights and pollution enforcement,” Munar said. “Why aren’t people at risk of HIV just as important?”

By reinstating the federal funding ban, Congress is ignoring irrefutable scientific evidence that syringe exchanges reduce HIV and hepatitis transmission, increase participation in substance abuse treatment, and, in fact, do not encourage drug use.

Progressive sterile syringe exchange policies in Illinois have reduced by two‐thirds HIV cases among injection drug users since 2001, saving an estimated $200 million in lifetime medical costs.

In July 2010, President Obama released the National HIV/AIDS Strategy, which calls for a 25 percent reduction in new HIV cases by 2015. The strategy lists syringe exchanges as one several “scientifically proven biomedical and behavioral approaches that reduce the probability of HIV transmission.”

We are committed to working anew to repeal the federal ban on funding for syringe exchanges. We call on our state and national legislators to do the same.

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Author: Harold Pollack

Harold Pollack is Helen Ross Professor of Social Service Administration at the University of Chicago. He has served on three expert committees of the National Academies of Science. His recent research appears in such journals as Addiction, Journal of the American Medical Association, and American Journal of Public Health. He writes regularly on HIV prevention, crime and drug policy, health reform, and disability policy for American Prospect,, and other news outlets. His essay, "Lessons from an Emergency Room Nightmare" was selected for the collection The Best American Medical Writing, 2009. He recently participated, with zero critical acclaim, in the University of Chicago's annual Latke-Hamentaschen debate.

10 thoughts on “More bad news–needle exchange”

  1. Harold, what is the (approximate) lifetime cost to treat an HIV infection? And how many syringes can be purchased for that amount of cash?

  2. Heh. You mean our heroic Democratic Senators couldn’t bury this outrage? Just more fuel for the fire that they are essentially beside the point.

    1. No. If you haven’t noticed, the House has not been playing nice at all. And the Senate is in the 60 vote zone too.
      And it was allowed in 2009, and some particular body has changed since then.

      Assigning _direct_ blame is easy. Secondary blame is a different story.

  3. It’s not only federal funding. The District of Columbia is forbidden to fund needle exchange programs from its own local revenues as well.

  4. Thanks for highlighting this, Harold. It’s really tragic.

    @Herschel: DC local funds were not included in the restoration of the ban. It’s the only bright spot. Much thanks to Rep. Joanne Emerson (R-MO) – she’s chair of House Financial Services Subcommittee – who probably saved the day there. Maybe with an assist from Jose Serrano and Dick Durbin.

    @Dennis – Holtgrave estimated lifetime treatment costs at $355,000 lifetime. Does not include other care costs. A syringe costs about $0.07. estimated about $4000 – $12,000 to avert one case of HIV using syringe exchange services. No cost-effectiveness data on viral hepetitis but a liver transplant is a LOT of money.

    1. Thanks. I did a sabbatical working for our fair states medical assistance division in the Human Services Department years ago. It seemed to me (at the time) that avoiding HIV infections qualified as a Very Good Idea. Even $12K is worth it.

      Worth it to the point that private insurers ought to look at funding exchange programs.

  5. I think private insurers simply try to avoid covering people who inject drugs. This gets us back into the problems of the commons. Suppose an insurer was heavily invested in an area with a known problem among IDUs. Even if they invested in getting clean syringes to people in the area, they still might not benefit from the program if those people later shifted insurers or went on to government assistance. Of course that gets to be a problem with all prevention methods (for most diseases) and is one reason insurers are so very bad at prevention. It’s an interesting idea but you’d need to create a way for all of the insurers to share both the costs and the benefits.

    1. Of course they try to avoid covering IV drug users. Trying is manifestly not the same thing as succeeding.

      As long as we have a for-profit health finance system with multiple vendors it isn’t going to be possible to spread costs and benefits. Costs could be spread by having a foundation funded by the industry take over needle exchange programs. Perhaps, (but only perhaps!) guaranteed-issue will spread the benefit sufficiently to cause them to see it as advantageous. I won’t hold my breath waiting.

  6. The Canadian federal government tried lately to shut down a needle exchange program in Vancouver that was by all evidence working well. Actually it was not just needle exchange: it was safe injection of alternatives to heroin. The Supreme Court of Canada decided this fall that the government could not shut the program down; that would have been a denial of the rights to liberty of the people benefitting from the program.

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