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Syringe Exchange Program in D.C. March 4, 2010

Posted by Anita Balan in Prevention, Wellness.
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Washington D.C. has 3% of its residents living with HIV/AIDS. This rate is highest in the nation. According to December 2005 fact sheet CDC estimates that almost one fifth of all HIV infections are transmitted by Intravenous Drug Use (IDU). As an emerging public health professional who believes in prevention, and harm reduction, I think it is, once again, time to look at the benefits of needle exchange or Syringe Exchange Programs  (SEP) and the ways in which it is beneficial to prevent the spread of HIV, Hepatitis C.

SEP has been implemented in this country for more than twenty years and has helped in reducing the transmission of HIV and Hepatitis C. The way it works is very simple: Those who share needles, either to inject drugs or hormones can exchange their used needles for sterile ones.  This prevents users from sharing contaminated needles with one another thereby preventing the spread of HIV, Hepatitis C and other blood borne diseases . SEP is administered throughout the country including D.C. by hundreds of not-for-profit and community- based organizations. SEP has been proven to  cost-effective, effective in reducing transmission and overall rates of HIV and Hepatitis C and do not promote substance use/abuse. SEP also reduce the sharing of needles among users and encourage users to use sterile needles until they are ready to quit using.

more after the jump…

According to October 2007, AIDS Action policy Brief, syringe sharing was reduced by two thirds in Washington D.C in a study conducted among 2000 users in 1992. Additionally, according to a study conducted in 2005 by American Foundation for AIDS Research, the rate of new AIDS cases by Intravenous Drug Use dropped by 73% when compared to 52% drop in overall AIDS cases in D.C. Furthermore, CDC calculated that each syringe costs only $0.97 and successful implementation of SEP to prevent HIV infection in a person/family costs $4,000 – 12, 000. But lifetime medical costs of someone who is HIV positive is $619,000. According to Dec 2005 CDC fact sheet, many research studies and positive results led the National Institutes of Health Consensus Panel on HIV Prevention, to conclude that:

“An impressive body of evidence suggests powerful effects from needle exchange programs….Studies show reduction in risk behavior as high as 80%, with estimates of a 30% or greater reduction of HIV in IDUs.”

Syringe Exchange Programs not only include exchanging needles, but most organizations provide a comprehensive harm reduction program that includes syringe exchange, counseling, HIV/STD testing, and information about sexual health and risky sexual behavior. While many organizations have one-for-one policy, where users can exchange only one sterile needle for one used needle, few other organizations do not have such a restriction thereby allowing users to take as many needles as they need in exchange for used needles.

In spite of overwhelming evidence in favor of SEP, and the support of such programs from government agencies such as  CDC, NIH etc…, many community-based organizations face problems locally from residents that have moral objections or restrictive policies put in place by governments.  In D.C. currently there are at least four organizations, which administer SEP: Prevention Works, Bread for the City, Family Medical Counseling Services and HIPS. Until recently these organizations were struggling to render their services which were restricted by 1000 feet ban. This ban which was in place for over 2 years prevented the SEPs from being implemented within a 1000 feet of any place where children gathered in the district. But the ban was lifted through the FY 2010 appropriations bill in Congress. Additionally President Obama also lifted a ban of federal dollars from being used for SEP. While these policies are a step in the right direction to address the HIV/AIDS epidemic in the district, President Obama’s recent announcement of spending freeze for three years on non-defense discretionary spending might jeopardize community-based organizations that receive any federal funding for SEP. Thus it is not only important to have good science and evidence for successful implementation of a harm-reduction program, but it is also essential that such evidence is supported with smart policies in local, state and federal level.

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