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U.S. reinstates federal funding ban for needle and syringe exchange programmes

Date: 31 December 2011

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On December 16, 2011, Congress restored the infamous ban on U.S. federal funding for needle and syringe exchange programmes. The decision comes just two years after the 21-year-old ban was repealed and signed into law by President Barack Obama in December 2009, thereby allowing states and local public health officials to utilise federal funds for sterile syringe access. The misguided move includes reinstatements of bans on both domestic and international use of US federal funds for needle and syringe exchange programmes as part of the 2012 omnibus spending bill.

In taking an action driven solely by ideology, the Republican-controlled U.S. House and the Democrat-controlled Senate ignore unanimous scientific evidence from eight federal reports showing that increasing access to sterile syringes for people who inject drugs saves lives without increasing drug use. Needle and syringe exchange programmes have been proven effective at preventing transmission of infectious diseases such as HIV and viral hepatitis, and have been shown to be cost-effective. [1] [2] Needle and syringe exchange programmes are endorsed as a core intervention as part of an evidence-based approach to HIV prevention, treatment and care for people who inject drugs by national and international agencies. These include the Centers for Disease Control and Prevention (CDC), American Medical Association, National Academy of Sciences, American Public Health Association, as well as the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA), World Health Organisation (WHO), United National Office on Drugs and Crime (UNODC) and the Joint United Nations Programme on HIV/AIDS (UNAIDS).

On World AIDS Day (1 December, 2011) President Obama delivered a bold speech, recommitting the United States to uphold U.S. funding for HIV/AIDS programmes at home and internationally during this time of economic crisis. A few weeks earlier, U.S. secretary of state Hilary Clinton promoted the prospect of an ‘AIDS-free generation’, urging renewed efforts and funds toward addressing the epidemic. Clinton urged people to grasp the “irreplaceable role the U.S. has played in the fight against HIV/AIDS”, emphasising that “the world […] will not defeat AIDS without us.”

It is difficult to understate the hypocrisy – and ominous nuance – of such statements in the face of the reinstatement of the federal funding ban. People who inject drugs make up twelve percent of all new HIV infections in the U.S., and account for 30% of HIV infections outside of sub-Saharan Africa. [3] In other parts of the world such as Eastern Europe, Central Asia and parts of South East Asia, injecting drug use is the major driver in up to 80 percent of new HIV infections. [4]

“Almost 30 years into the epidemic […] we deny people at extremely high risk of HIV the means to prevent infection,” writes Zoe Hudson, senior policy analyst with the Open Society Institute-Washington, D.C. “We could bring that number to zero -- and help people access treatment for addiction at the same time. But the Congress chooses not to."

Restoring the funding ban will result in significant human and fiscal costs as thousands of people both in America and abroad will contract HIV, hepatitis C and other infectious diseases. “Not only do opponents of needle-exchange programs misunderstand the data on their effectiveness, but they also fail to understand the invaluable message of empowerment and hope that such programs actually send," states Maia Szalavitz, a TIME health writer and former drug user.

In this precarious global economic context, the federal government’s policy change on needle and syringe exchange programmes will ensure that universal access to comprehensive HIV prevention, treatment, care and support services for people who inject drugs remains an unattainable goal. Earlier this year, The Global Fund to Fight AIDS, Tuberculosis and Malaria – the largest funder of harm reduction programming worldwide – cancelled its next funding round (Round 11) and significantly reduced the pool of eligible countries that will be able to apply for new funds in 2014, after donors failed to deliver US$2.2 billion in previously committed funding. Concerns around essential, evidence-based harm reduction programmes being scaled back or cut is growing.

At a time when global action and leadership in addressing HIV among people who inject drugs is needed most, U.S. policy-makers have chosen to regress to politics and ideology at the expense of scientific evidence, value for money and public health and safety.

References

[1] de Wit, A, & Bos, J. (2004). Cost-Effectiveness of Needle and Syringe Programmes: A Review of the Literature. In J. Jager, W. Limburg, M. Kretzschmar, M. Postma & L. Wiessing (Eds.), Hepatitis C and Injecting Drug Use: Impact, Costs and Policy Options (EMCDDA Monographs 7) (329-343). Lisbon: European Monitoring Centre for Drugs and Drug Addiction.

[2] Jones, L, Pickering, L, Sumnall, H., McVeigh, J, & Bellis, MA. (2008). A Review of the Effectiveness and Cost-Effectiveness of Needle and Syringe Programmes for Injecting Drug Users. Final Full Report - Revised Oct 2008. Liverpool: Liverpool John Moores University.

[3] UNAIDS (2010) Global Report on the AIDS Epidemic. View report Geneva: The Joint United Nations Programme on HIV/AIDS.

[4] Mathers B et al (2008). The global epidemiology of injecting drug use and HIV among people who inject drugs: A systematic review. Lancet 372 (9651): 1733-1745.