Lifting the U.S. Ban on Federal Funding for Syringe
In a major change to the country's drug policy, the United States Congress has reversed a ban on federal funding of needle exchange that was first enacted 21 years ago. Within days the legislation is expected to be signed into law by President Obama and will allow funding of needle exchange programmes domestically, as well as internationally through United States Agency for International Development (USAID) and the President's Emergency Plan for AIDS Relief (PEPFAR), the world's largest single source of HIV/AIDS‐related funding. Starting in 2010, USAID and PEPFAR are expected to fund needle exchange internationally as part of programs aimed at comprehensive HIV prevention among injection drug users.
"The scientific support for syringe exchange could not be more clear. As Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases at the NIH has said, 'Clearly, needle exchange programs work. There is no doubt about that." More specifically, as Dr. Fauci confirmed during a 2008 hearing before the House Committee on Oversight and Government Reform, the science shows syringe exchanges effectively reduce new HIV infections without increasing the use of illegal drugs.
"In addition to the NIH, the Centers for Disease Control, the World Health Organization, the Institute of Medicine, the American Medical Association, the American Pediatric Association, the American Public Health Association and former Surgeon General David Satcher have all confirmed the scientific evidence in support of syringe exchange as part of a comprehensive approach to HIV prevention.
“We applaud Congress for showing leadership in the fight against HIV/AIDS and hepatitis C,” said Harm Reduction Coalition Executive Director Allan Clear. “We’ve had two decades of experience demonstrating that syringe exchange works. Communities need the flexibility to make the best use of their federal prevention dollars.”
“It’s too soon to say that America’s long national nightmare – the war on drugs – is really over,” said Ethan Nadelmann, executive director of the Drug Policy Alliance, a leading reform group.“But yesterday’s action on Capitol Hill provides unprecedented evidence that Congress is at last coming to its senses when it goes to national drug control policy.”
On the campaign trail and after the inauguration, President Barack Obama pledged to lift a ban, which is a sign of the transforming US drug policy paradigm from law enforcement to public health: “I believe in shifting the paradigm, shifting the model, so that we focus more on a public‐health approach”, said Obama, who also has called imposition of felonies on drug users as expensive and counterproductive.
A number of Members of Congress backed the initiative. Earlier in 2009, Representatives José Serrano, Henry Waxman, and Barbara Lee wrote in a letter to President Obama that “As states face budget cutbacks due to our nation’s current economic downturn, it is now more important than ever that we work together to lift the ban on the use of federal funds for syringe exchange programmes. We must provide states the resources they need to continue fighting the transmission of HIV/AIDS in ways that are proven to work. With approximately 12,000 Americans contracting HIV/AIDS directly or indirectly each year from the sharing of contaminated syringes, it becomes vital that the federal government take steps to reduce the number of contaminated syringes on our streets.”
Though the U.S. is one of the world’s largest funders of AIDS programs, Congress had prohibited the use of federal funds to carry out needle exchange programs since 1988. “For decades, the US also worked, successfully, to ensure that its particular approach was made into the global standard, which meant that the world’s largest donor to AIDS was actively working to oppose one of the most effective HIV prevention interventions. Thousands and thousands got infected with HIV as a result”, said Daniel Wolfe of the Open Society Institute.
The U.S. is a home to an estimated 1,364,000 injecting drug users, and an estimated 34% of all reported cases in the country have been among injection drug users and their sexual partners. Up to 75% of new AIDS cases among women and children are directly or indirectly a consequence of injection drug use.
Between 1984 and 1986, 30,000 injection drug users were infected annually in the U.S. In 2006, less than 10,000 were infected, with the progress attributed mainly to implementation of harm reduction programs. Currently the US has more than 200 needle exchange programs, the majority of which already receive state and local funding. However with the change in legislation, needle exchange gains full recognition from the federal government.
The American public health establishment has long been convinced of the value of needle exchange and the strategy has been endorsed by the Institute of Medicine, the Centers for Disease Control and Prevention, National Institutes of Health, and many private organizations including the American Medical Association, American Public Health Association, and the American Nursing Association. Numerous international health bodies and governments have similarly endorsed needle exchange, including the United Nations system, the European Union, and others.
This policy change is the result of years of work by government health officials, NGOs, people living with HIV/AIDS, drug users, harm reduction leaders and their allies.
This development also is a signal to number of countries, such as Russia, home to largest population of injecting drug users in the Eurasia region.