The U.S. Congress passed a sprawling spending bill over the weekend — a massive piece of legislation that will fund the federal government for the next nine months — that contained a number of social riders that have gone largely unnoticed in this holiday season of tax standoffs and shutdown threats. One in particular should trouble advocates of evidence-based policy: Congress has once again banned federal funding for sterile syringe exchange programs.
Public health advocates consider such harm-reduction programs a crucial tactic in halting the spread of HIV/AIDS. Research suggests injection drug use has accounted directly or indirectly for a third of AIDS cases in the United States. Programs that give sterile syringes to the users of these drugs repeatedly have been found to stem new infections from sharing used needles — while at the same time linking those users to treatment and public health networks they might not otherwise encounter.
Meanwhile, government reports and other research over the years concluded that syringe exchange programs don’t increase drug use. And the Centers for Disease Control and Prevention, the American Medical Association, and the National Academy of Sciences have all found the policy effective.
The idea, though, has long been controversial among social conservatives, who see government-backed syringe exchange programs as a kind of taxpayer assist for illegal drug use. This week — and for the second time in the last two decades — that concern has trumped the science in setting federal AIDS prevention policy.
“The evidence is overwhelming that places that adopt syringe exchange have lower HIV/AIDS transmission rates — and for that matter hepatitis C rates – than places that don’t,” said Bill Piper, director of national affairs for the Drug Policy Alliance Network.
The federal government banned funding for syringe exchange programs in 1988. Proponents of the policy didn’t finally overturn the ban until 2009, following an election-season pledge from the Obama campaign. The new policy, though, has turned out to be short-lived. And the story of the government’s shifting position over the last two decades has more to do with political winds in Washington than any new research revelations.
“The science was pretty much already there in the ’80s,” Piper said. “Congress ignored the science in the ’80s, whereas Canada and Europe and elsewhere followed the science. And the result was that hundreds of thousands of Americans got HIV/AIDS either directly or indirectly from injection drug use.”
Public health advocates talk about “direct” and “indirect” infection because the drug users themselves aren’t the only ones who benefit from sterile syringes. People who have sex with infected injection drug users — and the people who have sex with them — also spread infection. And children born to any of these people are at risk as well.
The ban passed this week won’t save taxpayers any money. Federal AIDS prevention money is given to states to spend as they see fit, whether the need is for condom distribution, public education campaigns, or other programs. The federal government will dole out funding the same, but states will now be forbidden from using any of it on needle exchanges. This means the ban won’t save taxpayers anything in the short term, and will likely cost them down the road.
“Syringes are really, really cheap,” Piper said, “whereas treating someone with HIV/AIDS is really expensive.”
A 2002 report from the Institute of Medicine estimated the cost effectiveness of needle exchange at $3,000 to $50,000 for each HIV infection prevented. More recently, the District of Columbia Department of Health studied the impact of syringe exchange programs in a city with one of the worst AIDS epidemics in the United States. It found that between 2008 and 2010, four programs in the city exchanged nearly 800,000 needles, while providing more than 5,000 HIV tests and linking more than 900 people to drug treatment. During this period, the city experienced a 60 percent decrease in the number of new HIV/AIDS cases, a drop the health department attributes directly to the syringe exchange.
Washington, D.C., in particular has been at the whims of Congress on this issue. For a decade, the city was barred from spending not only federal money, but its own funds on syringe exchange programs. And the results have illustrated the folly of resting public health policy not on the recommendation of researchers, but the distaste of politicians.
“It’s very disappointing,” Piper said of the latest decision. “But we’re hopeful that if we repealed it once, we can repeal it again.”