Giving clean needles to drug users: Helps or hurts?
Over the last decade, AIDS in the United States has become increasingly concentrated in the South, which accounts for nearly half of all new AIDS cases.
Yet, despite the emergence of AIDS as one of the region’s most serious health problems, Southern states too often fail to use the weapons that are available to prevent new HIV infections. This is especially true when it comes to support for harm reduction programs that prevent new cases of drug-related HIV transmission.
In my own state of Florida, one of the worst hit by AIDS, not a single publicly funded syringe exchange program – one that exchanges used needles for new ones to injection drug users — currently operates.
As a minister, I am acutely aware of the painful toll that drug abuse takes on our families and communities. But in addressing the harms of drug abuse, we need to adopt approaches that are sound, effective and compassionate. Too often, our approaches in the South don’t meet this test.
The numbers say it works
Dozens of studies have confirmed that syringe exchange programs represent the most effective tool available to prevent drug-related HIV transmission. In countries that have aggressively supported syringe exchange, HIV transmission through drug use has been virtually eliminated. They also serve as a vital bridge to services such as drug treatment, housing, employment and overdose prevention.
However, in a misguided effort to display toughness on drugs, Congress voted in 2011 to prohibit federal funding from being used to support this highly effective approach. With the federal government representing the lion’s share of funding for HIV prevention services, the termination of its support for syringe exchange has caused many local programs to cut staff, reduce services and consider going out of business.
It is important to understand during these times of fiscal restraint that lifting the ban on federal funding for syringe services programs will not cost any additional money. It simply allows localities to spend their federal dollars on syringe exchange services if they choose to do so. We know that every dollar spent on syringe exchange saves $3 to $7 in HIV treatment costs alone. In other words, lifting the ban would save lives and dollars without costing a dime.
In response to the loss of federal funding, many states and localities have stepped into the breach, providing essential funding to keep these life-saving programs from going under. That hasn’t been the case throughout the South, a region with the largest percentage of injection drug users diagnosed with AIDS in the country in 2011.
We have seen the result of this inaction by the presence of gross health disparities – and the statistics are heartbreaking. Nationwide, African-Americans are eleven times and Latinos are five times more likely to become infected with HIV from injection drug use than Caucasians. At the end of 2010, more than half of adult and teenage injection drug users living in the United States with HIV were African-American. As the Chairman of the National Black Leadership Commission on AIDS Inc., and the resident of a state with a sizeable Latino community, I have personally witnessed these disproportionate and devastating results.
Safer for everyone
By exchanging contaminated needles for sterile ones, syringe exchange also keeps used injecting equipment from being discarded in our communities. This diminishes the likelihood that children or others will encounter contaminated needles in a park or other public space. And keeping used needles off the streets is especially important for police officers and medical first responders, who run the risk of needlestick injuries while doing their jobs.
For example, in 2008 and 2009, Miami – a city without syringe exchange programs – saw eight times as many improperly discarded needles compared with San Francisco – a city with syringe exchange programs and twice as many injection drug users. In North Carolina, 9.5 percent of police officers have experienced a needle-stick or cut on a crack pipe. This is twice the rate of South Carolina, where syringes are decriminalized.
In short, the case for syringe exchange is overwhelming. Efforts by Congress and state legislatures in the South to burden or end syringe exchange are undoubtedly well-intentioned. But what these measures have actually done is make our communities less safe, undermining a vital bridge to drug treatment, and hinder national efforts to prevent the spread of HIV, hepatitis and other blood-borne diseases. As it begins to consider the budget for 2014, Congress urgently needs to reverse this counterproductive restriction and allow localities to respond to their epidemic, as they know it best.
President Obama gets it. When the White House released two months ago the budget proposal for 2014, it included language that would allow local and state policy makers to determine for themselves whether to use federal funds for evidence-based syringe services programs.
Regardless of what Congress decides to do with respect to federal funding, state leaders in the South need to display wisdom, courage and compassion. I personally have seen the faith communities lead these efforts in several southern states, and will continue to support their efforts. We must use every tool available to us to bring about change.
The Reverend Dr. W. James Favorite serves as Chairman of the Board of the National Black Leadership Commission on AIDS Inc. Rev. Favorite is also a senior pastor and Shepherd of the historical Beulah Baptist Institutional Church in Tampa Bay, Florida, where he currently resides.