December 30, 2011

Needles and the damage done

Posted: Fri, Dec. 30, 2011, 3:01 AM

By Christopher Moraff

With a single sentence buried in the 1,200-page omnibus spending package for 2012, signed into law last week by President Obama, social conservatives in the House quietly took a hatchet to one of the most effective strategies cities have for preventing the spread of HIV. The provision ended federal support for needle exchange programs that have been backed by most major health organizations, the U.S. Conference of Mayors, and Obama himself.

The subcommittee responsible for the rider is led by Rep. Denny Rehberg (R., Mont.), who once told a reporter: "The problem with AIDS is, you got it, you die. So why are we spending money on the issue?" AIDS advocates say the change will likely doom countless addicts to contracting HIV as well as hepatitis C.

Needle exchange programs have been a controversial but highly effective barrier to the spread of infectious blood-borne illnesses for nearly three decades. As the AIDS epidemic reached crisis levels in the mid-1980s, cities such as New York and Los Angeles began to copy European programs providing clean needles to addicts. Early studies showed immediate decreases in syringe sharing among drug users, one of the leading causes of AIDS.

In 1988, however, North Carolina Sen. Jesse Helms, a staunch conservative, successfully lobbied to ban all federal funding of syringe exchange programs. The prohibition lasted more than two decades, until a Democratic Congress finally voted to lift it in 2009.

According to the Kaiser Family Foundation, there are 221 needle exchange programs in 33 states and the District of Columbia, many relying on federal funding. Their impact on new HIV infections is nothing less than dramatic, research shows, reducing them by as much as a third.

Moreover, there is no attendant increase in drug use. On the contrary, the National Institutes of Health has found that drug users in areas that offer syringe exchange are more likely to get treatment due to regular contact with outreach workers.

In Philadelphia, where Prevention Point Philly's needle exchange program has been distributing clean needles since 1992, public health officials have seen a marked decrease in HIV infections. According to a study by the Center for Studies of Addiction at the University of Pennsylvania, the years following establishment of a citywide needle exchange saw the annual rate of new HIV infections among intravenous drug users drop from 6.8 percent to less than 0.05 percent.

With the fourth-largest exchange program in the country, Prevention Point Philly exchanged more than one million syringes last year, serving nearly 4,000 drug users. In 1991, a year before the program was sanctioned by then-Mayor Ed Rendell, nearly half of those people would have had HIV. Today, only one in 10 does.

And those are just the public health implications. Consider the financial ramifications: It costs just 8 cents to provide a clean needle to an addict, compared with more than $300,000 in medical costs alone to care for someone with AIDS. Even those without a care for the suffering of HIV-infected addicts can do that math.

According to executive director Jose A. Benitez, Prevention Point is unlikely to be directly affected by the reinstated federal ban, because Pennsylvania already prohibits money passing through its coffers - including federal funds - from supporting needle exchange. That's a dubious oversight in a state whose former governor helped create the program, and it has forced Prevention Point to depend exclusively on the city and a handful of foundations. Benitez expects private funding to become even tighter once federal money dries up.

By prohibiting states from using their federal HIV funding as they see fit, Congress has allowed a handful of zero-tolerance zealots to hijack a public health initiative that saves taxpayers money and prevents unnecessary pain and suffering. And these are the people we hired to look out for us?