Alex Blaze

Needle exchange isn't a priority and probably won't happen

Filed By Alex Blaze | May 20, 2009 12:30 PM | comments

Filed in: Living, Politics
Tags: Barack Obama, DOMA, drug abuse, HIV infection, HIV/AIDS, Kerry Eleveld, needle exchange, time magazine

A needles.jpgfew weeks ago I posted about how the White House website was de-gayed. The site offered a lot of policy proposals right when Obama was sworn in, but many were removed several months later as, I suppose, the Obama administration realized that a lot of them would require some real political capital and the LGBT items lost out.

Sure, the White House was eventually persuaded to change "change" back to "repeal" when it came to DADT, but I think we saw the administration position revealed there. And most of the other changes are still in effect.

Like needle exchange. It's proven to be one of the more effective means of fighting STD's, especially HIV, but it's also been one of the most controversial. No politician wants to be seen as giving needles to drug users, but it reduces HIV infection rates and might even reduce drug use rates as people who come in can be connected with social services to help them cope with their addiction.

As always, it's a style versus substance conflict, and, in Washington, style wins out.

Now Time is reporting that, buried in Obama's budget, is a proposal to maintain the federal ban on needle exchange. Which means that the changes to the website were probably a real indicator of the administration's legislative intentions.

From Time:

Buried on page 795 of President Obama's budget, released last Thursday, is a paragraph banning the federal funding of needle-exchange programs for drug addicts -- an apparent about-face on his campaign promise to overturn that longstanding ban. To the further consternation of AIDS and addiction activists, a statement of support for needle exchange was recently removed from the White House website. Is Obama reversing course?

Of course, Time eats this up because it reinforces the "Democrats are weak" meme (which would be harder for them to push if Democratic politicians would, you know, stand up for what they believe in every now and then).

The administration is saying that they'll wait on needle-exchange for a later date, but I'm not hopeful. Now would be the easiest time for them to get it through.

And it spells bad news for America, since these programs reduce HIV infection rates (same link as above):

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 -- after a rocky start -- Montreal and Vancouver, had similarly significant impact. So, why has the federal funding ban on these programs, enacted by Congress in 1988, remained intact for two decades?

And could reduce drug use rates:

Recent research studies document the role that effective syringe exchange programs serve as mechanisms to engage very high risk and hard to reach individuals in substance abuse treatment services. Brooner et al (1998) found that half of syringe exchange program clients referred for substance abuse treatment actually entered treatment, with 76% completing the first 13 weeks of treatment. These results were achieved despite the fact that these clients had more severe drug use, more HIV risk behaviors, less employment and greater engagement in illegal activities than, clients referred to substance abuse treatment from traditional sources. Hagan et al (In Press) reported reduced frequency of injection drug use among current and former users of a needle exchange program, and entry into methadone treatment programs among former, current and new users of a syringe exchange program. Strathdee et al showed that attendance at a syringe exchange program was positively associated with individuals entering detoxification services independent of other variables, again representing an important bridge that facilitates entry into substance abuse treatment.

These were the other programs removed from the section about HIV/AIDS:

  • Comprehensive sex education: Not even on the "Education" page, this is gone. The REAL Act, which would shift funding from abstinence-only over to comprehensive sex ed, isn't on his agenda.
  • Sex education and condoms in prison: Gone, not even in "Criminal Justice Reform."
  • Condom distribution: Gone.
  • Funding to search for microbicides for women: Gone, not in the "Women" section.

Also, DOMA repeal was one of the casualties, and, as Kerry Eleveld found out, it's not even on the agenda.

So, there we go. It's gonna be a little harder than just electing someone who personally agrees with us (and I think still he does) to get these items through.

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I didn't even know there were still people who opposed needle exchange programs--they seem like such a non-controversial harm reduction strategy.

On the wider issue, it's movements and organized campaigns that moves the conversation and therefore gets policies changed. It won't happen just because we elect different people--they need the push _and_ the political cover that movements provide.

christophe | May 20, 2009 2:22 PM

what impact has needle exchange had on other countries so as to give it credibility?

I don't know, why don't you start here:

It is getting harder and harder for me to be a Democrat. It is such a shame that the body politic has moved so far to the right that I have to pretend to be a leftist.

You don't need to look outside the U.S. for examples of the effects of needle exchange programs--a number of U.S. cities have been running their own programs since the early 1990s. Studies have shown dramatic decreases in the HIV infection rate among injection drug users and higher-than-typical enrollment in and completion of drug treatment programs. For a summary of Baltimore's program effects and links to studies on it, see .

I'm from Baltimore. Needle exchange has made a huge difference and it has widespread political support, including in the neighborhoods that the vans visit.

The problem is that some jurisdictions don't have the money, political will, and/or local school of public health to fund and run a needle exchange program without the "blessing" of it being part of the federal HIV prevention strategy and funding.

christophe | May 21, 2009 1:17 AM

I just felt it would have been important in order to gain support for the program if we also had data on other NE programs from other Countries. By having such data it could greatly influence the Governments position on NE........Maybe