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Obama's Policy on Needle Exchange Programs

A needle exchange program is a social policy based on the concept of harm reduction, where IV drug users can obtain intravenous needles and related injection equipment at little or no cost. Many programs are called “exchanges” because they require exchanging used needles for an equal number of fresh new needles. The aim of these services is to reduce the damage associated with sharing used needles.

A comprehensive study by the World Health Organization (WHO) in 2004 stated that there is a “compelling case that needle exchange programs substantially and cost effectively reduce the spread of HIV and AIDS among intravenous drug users and do so without evidence of exacerbating IV drug use at either the individual or societal level.” The WHO’s findings have also been supported by the American Medical Association (AMA), which in 2000 adopted a position strongly supporting needle exchange programs, when combined with drug addiction counseling.

With her gray hair and pink sweater, retired teacher Joanne Iannotti looks like a typical grandmother as she slowly walks out of her home with a little bag of dirty hypodermic needles. She walks up to a van and exchanges her bag for clean needles for her adult sons, who shoot heroin with their friends. “They tend to want to share,” Iannotti says. “But I tell them, ‘No wait. I have clean needles for all of you.”

Iannotti participates in one of nearly 200 needle exchange programs in the United States. Research has found that needle exchange programs reduce the spread of AIDS without increasing drug use. But local budget cuts and a federal ban on funding such programs in the United States and abroad are hurting the programs at a time when injection drug use is fueling a global AIDS epidemic, advocates say.

“Funding for needle exchange programs in the United States has always been difficult because the government never wanted to support what they see as a morally slippery intervention,” said Dr. Peter Havens of the Medical College of Wisconsin. Physicians for Human Rights held congressional briefings last week to build support for needle exchange and other programs to prevent the spread of HIV and AIDS among drug users. The group also wants the U.S. to lift constraints on programs that receive U.S. funding so they can collaborate with needle exchange programs funded by other donors.

About one-fourth of the nearly 950,000 AIDS cases in the United States through 2005 involved injection drug use, according to the Centers for Disease Control and Prevention. The rate is even higher in many other countries, experts say. Critics say needle exchange programs encourage risky behavior and work against efforts to fight drug abuse. But many European and Asian countries have increasingly recognized the benefits of needle exchange programs. After several studies, then-Health and Human Services Secretary Donna Shalala determined in 1998 that such programs reduce the transmission of HIV and do not encourage the use of illegal drugs.

“They work,” said Ricky Bluthenthal, senior social scientist at Rand Corp. who has studied the programs in Connecticut and other states. “The evidence in support of them is quite strong.” The New Haven program was touted as a national model after a Yale University professor in the early 1990s was among the first to document the effectiveness of providing clean needles to slow the spread of the HIV virus that causes AIDS.

Iannotti says one of her sons was getting violent, had wrecked cars and even stole her funeral money. But Ducheli arranged for him to get into treatment last week. “His mood is completely different,” Iannotti says. “He wants to stay longer.”

A proposed state budget would cut about $100,000 from the $500,000 spent on needle exchange programs in New Haven, Hartford, Danbury, Stamford and Bridgeport. That cut would make it difficult to operate the New Haven program and could lead to some of the other programs being eliminated, officials said. “You’re talking about trading lives for $100,000,” said David Purchase, chairman of the North American Syringe Exchange Network.

New Jersey, the only state without either a needle exchange program or one that allows syringes to be sold without a prescription, recently legalized needle exchange programs after a long struggle.

In Chicago, a cut in funding this year will mean 800,000 fewer dirty needles will be taken off the streets, according to Dan Bigg, program director. Funding was cut from about $1.1 million to $870,000 because of a decrease of HIV cases involving injection drugs, said Christopher Brown, a Chicago health official. He credited the needle exchange program with causing the decline, but said officials try to match limited funds with the type of transmission that accounts for the most new cases.

Iannotti says the program kept her sons from getting infected with the AIDS virus. “I think it’s fabulous,” Iannotti says. “I think it saves a lot of lives.”

But buried on page 795 of President Obama’s annual budget was a paragraph banning the federal funding of needle-exchange programs for drug addicts. A 180 degree turn on his campaign promise to overturn that longstanding ban. To further enrage AIDS and addiction activists, a statement of support for needle exchange programs was removed from the White House website. It appears Obama is reversing course on his campaign promises.

The Administration says that is not the case. Jeff Crowley, director of the White House Office of National AIDS Policy said that President Obama has no plans to abandon needle exchange, but is simply not moving forward on the issue. “The President is looking forward to working with Congress and the American people to build support for this change,” says Crowley, “and his Administration is committed to moving forward to address the federal ban on syringe exchange programs as a part of a national HIV/AIDS strategy.”

Although conservative critics have long opposed giving clean needles to drug addicts on moral grounds, the consensus among public health experts — including the World Health Organization and the American Medical Association — is that the strategy works to reduce the spread of HIV and AIDS. “I think the evidence for needle exchange is stronger,” says Don Des Jarlais, director of research for the Baron Edmond de Rothschild Chemical Dependency Institute at Beth Israel Hospital in New York, comparing the scientific support for needle exchange to the overwhelming evidence of human impact on the climate.

Des Jarlais’s studies of HIV infection among drug addicts in New York City have found that new infection rates dropped more than 75% after city and community activists expanded clean-needle programs, beginning in the early 1990s, and later legalized possession of needles. Likewise, needle-exchange programs in other cities, including Montreal and Vancouver, had similarly positive result. So, why has the federal funding ban on these programs remained intact for two decades?

It’s politics as usual. The funding ban was introduced by conservative Senator Jesse Helms, and Democrats afraid of being labeled as soft on drugs have been reluctant to reverse it ever since. In 1998, President Clinton said he intended to lift the ban, under a provision in place at the time that allowed the President to do so if the science proved convincing. Although the Clinton Administration admitted the evidence was there, at the last minute, drug czar Barry McCaffrey managed to convince the President that “sending the right message” on drugs was more important.

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