The Fight Against HIV: Will Congress End the Syringe Exchange Funding Ban?

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Despite overwhelming evidence that giving drug users access to clean syringes prevents HIV and hepatitis C transmission, saving lives and public health costs, Republicans in Congress have worked to keep federal funds from supporting syringe exchange programs since the late 1980s, when panic and homophobia clouded public policy surrounding the effort to fight HIV. Now lawmakers have a chance to change that.

On Tuesday, the Senate is expected to vote on the budget deal approved by the House last week. Appropriations staffers already are working on the omnibus package to fund the government in 2014, giving lawmakers a chance to replace a ban on funding syringe exchange programs with language allowing health agencies to allocate federal money to the programs.

Public health proponents say Democrats need to make lifting the ban a political priority and stand up to House Republicans, who once again may attempt to place the ban in their funding proposal.

Syringe exchange programs allow injection drug users to exchange their used needles for a limited number of new ones. This prevents users from resorting to sharing and reusing needles. An overwhelming body of scientific evidence, including eight federal studies, has shown that syringe exchanges save lives by preventing the spread of blood-borne illnesses without increasing drug use. Many syringe exchanges also offer STD screening, medical care, health information, free condoms and referrals to substance-abuse programs.

With support from the Obama administration, Congress in 2009 removed a 21-year prohibition on spending federal money on syringe exchange programs. But in 2011, House Republicans inserted language into the 2012 federal spending bill that reinstated the ban, throwing federal policy on HIV prevention back into the dark ages. The mainstream media ignored the ban at the time. And weary of political deadlock, Democrats made little effort to remove the ban before the bill landed on Obama’s desk. (Read Truthout’s analysis here and here).

Will Senator Mikulski Stand Up for Public Health?

Exchange advocates are hoping the 2014 budget negotiations will not be a tragic repeat of the past, and they have their eyes on Sen. Barbara Mikulski, a Democrat from Maryland and the Senate’s appropriations chairwoman.

In a letter to the senator, 70 Maryland-based scientists and doctors wrote that Mikulski’s home state already had seen the benefits of exchange in Baltimore, where syringe programs have helped reduce the state’s rate of HIV transmission from injection drug use from an all-time high of 53 percent in 1992 to 15.9 percent in 2010.

Speaking on background, a spokesman for Mikulski’s office told Truthout last week that the senator supports lifting the funding ban and language to do so already has been approved by her committee. Her staffers are waiting to see if the House version of the omnibus spending bill once again will contain language to continue the ban.

Michael Collins, policy manager at the Drug Policy Alliance, called Mikulski a “champion of positive public health policies” but warned that it will take more than simply supporting a change in federal policy to lift the ban. Ending the ban is a priority for HIV prevention and Mikulski’s constituents, Collins said, and as appropriations staffers hammer out a government funding compromise behind closed doors, Mikulski needs to make lifting the ban a political priority.

“We believe this is what it’s going to take: someone to stand up and say this ban has got to go,” Collins said. “… Someone like Mikulski needs to be in the room. It’s great to have her in our corner.”

In Congress’ bitter budget battles, where lawmakers haggle over items from defense spending to Planned Parenthood, the funding ban simply may be an outdated bargaining chip for the GOP. But convincing budget slashing, Obamacare-hating Republicans of the benefits of syringe exchange does not seem like a difficult task when you look at the numbers.

Syringes cost less than 50 cents, but the lifetime cost of treating an HIV-positive person is estimated to be between $385,200 and $618,900. And many injection drug users rely on government programs such as Medicaid and Medicare for health services, according to the American Foundation for AIDS Research (AMFAR). Every dollar spent on expanding exchange services can save about $3 in treatment costs, potentially saving taxpayers hundreds of millions of dollars.

Mary Beth Levin, an associate professor of medicine at Georgetown University and a public health consultant for AMFAR, told Truthout that inserting language to end the ban would not divert any additional federal funds to syringe exchanges but simply would allow grant providers and health agencies to allocate money to the more than 200 exchange programs operating in 34 states. New programs and clinics could be opened as well.

“It’s a way to save lives without spending a dime,” Levin said.

A Seal of Approval for Harm Reduction

Levin said that lifting the ban would put a seal of political approval on syringe exchange and help motivate policy makers. Exchange programs in New Jersey, she said, benefited from federal funds while the ban was lifted. And after it was reinstated, the state assembly voted to replace the federal funds because the programs had such good results.

Levin spoke to Truthout last week at the Southern Harm Reduction and Drug Policy Conference in New Orleans, a city that provides alarming evidence in support of offering clean needles to injection drug users. Archaic state drug laws and harsh policing tactics targeting sex workers and transgender women have helped make the HIV infection rate in New Orleans that second-highest in the nation, according to a recent report by Human Rights Watch.

Possession of a syringe without a prescription can be a felony offense in Louisiana, but state law allows syringes to be distributed for medical reasons, including disease prevention, according to the report. This loophole protects workers and volunteers at the single legitimate exchange clinic operating in New Orleans, but the threat of arrest can be a deterrent for potential clients.

The clinic is open for only two hours a week and operates on a limited budget with little help from state agencies. The lack of services has inspired activists to organize small underground exchange programs in the city. Volunteers, risking arrest, ride bikes and carpool to meet with drug users in public parks and under bridges, exchanging syringes and handing out condoms and health information.

Perhaps, with the help of a little leadership in Washington, HIV prevention and harm reduction activists would have the resources they need to save lives – and public health costs – without needing to turn sick people away or hide in the shadows.

Correction: Mary Beth Levin is a public health consultant for AMFAR, not a lobbyist, as an original version of this article had stated.