Domestic prevention advocates and members of Congress are calling on President Obama to fulfill a campaign promise by acting swiftly to lift the federal ban on funding for syringe exchange programs.
The ban, which has been in place for some 20 years, prevents federal funds from being used to support a health intervention universally recognized as being highly effective in stopping the spread of HIV and hepatitis C, and as a means for reaching drug users for other interventions. It is another in a long line
of ideologically-driven restrictions on basic prevention programs which
must be removed in US policy, both domestically and internationally.
Efforts to lift the ban on funding of syringe exchange have been underway for well over a decade. Last year, for example, the NAACP, National Urban League, and other groups called on Congress and the Bush Administration to lift it, to no avail.
But now advocacy groups are calling on the President to make good on his promise to clear the way for federal funding, highlighted as a policy position on the White House website, which states:
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“The President also supports lifting the federal ban on needle exchange, which could dramatically reduce rates of infection among drug users.”
Over 200 organizations have signed a letter urging the President to lift the ban, the text of which can be found here and below.
Meanwhile, some members of Congress also are turning up the heat. Congressman Jose Serrano recently introduced a bill that would lift the federal ban. (An action alert for the Serrano bill can be found here.) And Congressional Representatives Barbara Lee and Henry Waxman joined Serrano in sending a letter to President Obama urging him to lift the ban.
As with other similar bans, restrictions or just-plain-stupid policies that openly flout evidence and human rights (the Bush Administration HHS regulations included), the ban on syringe exchange costs lives and ultimately costs the US taxpayer more money.
The sharing of unclean needles and syringes among injecting drug users is a major factor in the spread of both HIV and hepatitis C infection in the United States. According to data compiled from various sources by the Harm Reduction Coalition (HRC):
- One quarter of people with HIV in the United States were infected through injection drug use.
- Every year, another 6,000 people are newly infected with HIV through sharing contaminated syringes.
- Every year, another 15,000 are newly infected with hepatitis C through sharing syringes and contaminated injection equipment.
- African Americans account for over 50% of all AIDS cases attributed to injection drug use, while Latinos account for nearly 25%.
- Among women, an estimated 61 percent of AIDS cases are due to injection drug use or the result of sexual contact with someone who contracted HIV through injection drug use.
- One-third of younger injection drug users generally become infected with hepatitis C within five years
Syringe access programs are the most effective, evidence-based intervention for people who use drugs, notes HRC. By intervening in the transmission of HIV and Hep C infection through outreach, groups working on syringe exchange also are better able to engage the population of drug users who need other forms of help, including programs aimed at recovery.
The efficacy of needle exchange programs has been proven in numerous rigorous studies. The Harm Reduction Coalition states that:
"Seven federally funded research studies, and [a wealth of other scientific evidence] confirm that syringe access programs are a valuable resource to prevent the spread of HIV, hepatitis C and other blood-borne diseases. Across the nation, people who inject drugs have reversed the course of the AIDS epidemic by using sterile syringes and harm reduction practices."
Both AIDS-related illnesses and hepatitis C infections result in huge social and economic costs each year. In an article published in 2000 in the American Journal of Public Health, researchers John B. Wong, Geraldine McQuillan and their colleagues write:
In the United States, chronic HCV infection accounts for 8000 to 10000 related deaths annually. It has become the leading cause of liver transplantation, accounting for 30% of all liver transplants. The Centers for Disease Control and Prevention (CDC) conservatively estimates expenditures devoted to HCV to be more than $600 million annually.
So by funding such programs, we reduce the spread of HIV and other costly infections in the first place. An ounce of prevention versus a pound of cure.
But similar to the unsupported arguments made about contraception and sexual activity (e.g. the contention that "more contraceptives cause more sex" even though the evidence says the opposite), proponents of the federal ban on syringe exchange have claimed that such programs will promote drug use. Only a little problem with this one: The evidence also says it’s just not true.
“They do not encourage drug use,” Congresswoman Barbara Lee told the Associated Press last year. One
of the leading congressional opponents of the ban, Lee said, “These programs are
the way you really reach these drug users and help them end their
To make matters worse, the domestic ban was used an excuse by the Office of the Global AIDS Coordinator and the Bush White House to put in place a de facto ban on funding syringe exchange within US global AIDS policy, and to lobby other countries to reduce support for evidence-based programs. Another small problem here: Infections among injecting drug users are leading contributors to HIV infection in places like Russia and Vietnam. Left unchecked, infections among drug using populations fuel the spread of the epidemic to the general population. So by throwing out effective strategies based on ideological constraints, we actually fan the flames of HIV infection and of an epidemic we claim to want to end.
Another drive is under way to ensure that the Obama Administration takes concrete action to revise US international policy on this issue at an upcoming meeting March 12th – 13th in Vienna, Austria. (See Allan Clear’s excellent piece on AlterNet).
The legislative vehicles through which lifting the federal ban could most easily be accomplished are coming up soon. As a result, advocates are urging our new President to act swiftly to lift the ban and support sound public health policies.
"While Congress debates the stimulus package," states the cover note to the sign-on letter, "House and Senate Appropriations Committees are finalizing the spending bills for FY 2009, and the White House is putting together its budget for FY 2010. Congressional leadership is telling advocates that they are reluctant to lift the federal ban on syringe exchange funding without a clear signal from Obama.
"We’re asking President Obama to call on Congress to remove the federal
ban language from the FY 2009 Appropriations Omnibus bill and to call
for an end to the federal ban in the FY 2010 budget that he will submit
to Congress this spring."
Below is the text of the organizational sign-on letter. If your organization would like to sign the letter, please write Daniel Raymond, firstname.lastname@example.org or email@example.com. The deadline for sign-ons is Tuesday, February 10th. Solidarity is needed from across the community of organizations working on prevention efforts.
Dear President Obama,
We salute your commitment to federal funding of syringe exchange, which you recently reaffirmed in the debut of the revamped White House website.
We now ask you to call on Congress to strike the language banning federal funding for syringe exchange from the FY 2009 Appropriations Omnibus bill. We also ask that your budget specifically call on Congress to allow funding in the Labor, Health and Human Services, and Education Appropriations bill to be used for syringe exchange when you submit the FY 2010 budget to Congress. Taking action now to remove the ban in the FY ’09 Omnibus is the most expeditious route to allow cities and states the needed flexibility to tailor existing federal funding streams to fight deadly infectious diseases based on the needs and conditions of local communities.
In recent years, the Labor, Health and Human Services, and Education Appropriations bill includes a provision stating that "no funds appropriated in this Act shall be used to carry out any program of distributing sterile needles or syringes for the hypodermic injection of any illegal drug" (Title V, Sec. 505). Congress needs a clear directive from the White House to strike this language and allow local flexibility in the design and implementation of programs to prevent HIV and other infectious diseases.
Injection drug use remains a major driver of the HIV/AIDS epidemic in the United States, and the leading cause of new hepatitis C infections. Abundant research, endorsed by the findings of eight federally commissioned reviews, has conclusively demonstrated that syringe exchange is effective in reducing the transmission of HIV without increasing drug use. Syringe exchange programs currently operate in 36 states, the District of Columbia and Puerto Rico, but can only meet a fraction of the need due to the federal funding ban. Existing syringe exchange programs provide a growing range of critical health services, education, and support to vulnerable groups otherwise denied access to timely health care. Moreover, such programs serve as a crucial link for countless substance users to addiction treatment and recovery programs through counseling and case management. The ban on federal funds has had international repercussions as well, unnecessarily hampering our ability to assist countries experiencing explosive HIV/AIDS epidemics driven by injection drug use.
In 2007, Congress took an initial step by striking the Appropriations provision that had restricted the District of Columbia from using its own funds for syringe exchange. This action has resulted in new and expanded programs better poised to halt the devastating HIV/AIDS epidemic in the nation’s capital. Strong leadership now can extend this promising sign of progress to the rest of the country.
We’ve learned a lot about syringe exchange since the federal funding ban was originally enacted. It’s time for the federal government to use every tool at its disposal to arrest the further spread of HIV/AIDS and hepatitis C.
For background information and advocacy materials on syringe exchange and the federal funding ban, visit here.
Advocacy groups also continue to pursue passage of Rep. Serrano’s Community AIDS and Hepatitis Prevention (CAHP) Act. Individuals can take action on the CAHP Act here.