Posted by: Randy Allgaier | April 19, 2009

Priority 1 for Obama’s HIV policy agenda must be Needle Exchange

President Obama has vowed a renewed focus on the domestic HIV epidemic. The only thing that I can give President Bush is establishing the President’s Emergency Plan for AIDS Relief (PEPFAR) to address HIV/AIDS globally but he failed miserably at addressing the epidemic in this country. President Obama’s pledge is critical to the 1.1 million people living with HIV in the country.

President Obama has already made some progress towards that pledge. He signed a budget for FY 2009 that had some much needed funding increases for key federal programs – the first increases seen by some programs in many years. On April 7th the CDC launched a new $45 million media campaign is set to target African-American groups, including teens, gay and bisexual men, and heterosexual women, about the risk of HIV infection and the value of testing for the virus. About one-fifth of the estimated 1.1 million Americans infected with HIV don’t know they have the virus, putting them at high risk for spreading the infection or progressing to AIDS themselves, according to the CDC.

He also appointed Jeffrey S. Crowley, MPH as the Director of National AIDS Policy in the White House. Crowley has deep roots in the HIV/AIDS advocacy community and was a choice roundly applauded.

The White House is expected to develop a national HIV/AIDS strategy that will include input from government, medical researchers, medical providers, social scientists, experts in HIV care and prevention and representatives of the community including consumers.

Crowley has said the strategy will back up President Obama’s pledge to base national science policy on “sound science.” That is likely to include controversial efforts promoting needle exchange programs, he says. Such programs have been shown to cut HIV infections rates among injection drug users, but they’re also politically charged because some believe they tacitly promote illegal drug use.

“The president believes that syringe exchange programs should play a role,” Crowley told Web MD “Certainly those types of issues will be considered.”

I personally would reword Jeff’s remarks. I would say,”syringe exchange programs MUST play a role.”

At an event I attended this week, Speaker Pelosi, who has long supported lifting the ban on federal funds for syringe exchange re-committed herself to this effort.

There is overwhelming evidence that syringe exchange programs (SEPs) work: they prevent the transmission of HIV and do not promote substance use. Since 1989, Congress has banned the use of federal funds for Syringe Exchange Programs. In 1998, Secretary of Health and Human Services (HHS) Donna Shalala certified that based on extensive scientific research, syringe exchange programs are an effective component of a comprehensive strategy to reduce HIV transmission and do not encourage the use of illegal drugs, but the Clinton administration did not remove the ban.

Shalala reaffirmed this position in 2000. In June 2007, the House voted to lift a ban on local funding for SEPs in Washington, DC. The Senate has also voted to lift the local ban in past years.

Former U.S. Surgeon General David Satcher, the American Medical Association, the American Bar Association, the American Public Health Association and the National Conference of Mayors all support lifting the federal ban on funding syringe exchange programs. Support for SEPs also comes from the U.S. public. In 2001, the Kaiser Family Foundation reported that 58% of Americans favor syringe exchange. In 2003 the International Journal of Drug Policy reported that as many as 66% of Americans favor syringe exchange programs.

Numerous studies in the United States and abroad have determined that SEPs are effective in reducing HIV transmission among substance users.

A 2005 study published in The Lancet found that in cities with syringe exchange programs HIV infection rates decreased by 5.8%per year, as compared to a national increase of 5.9%per year. In New Haven Connecticut, the SEP not only cut down on syringe sharing and HIV infections, but also led to fewer syringes being discarded, decreasing the public health hazard of accidental infection from needle sticks with contaminated syringes.

A December 2005 CDC Fact Sheet reports that the National Institutes of Health (NIH)and the Institute of Medicine(IOM) concluded that syringe exchange programs contribute to 80% reductions in risk behaviors in injecting drug users and a 30% or greater reduction of HIV transmission.11 NIH also concluded that there is a preponderance of evidence to show that syringe exchange programs do not encourage increased substance abuse.

Syringe exchange programs save lives and are an integral part of combating the spread of HIV/AIDS.  SEPs do not increase drug use, but instead encourage education, teach safer injection practices,
and refer IDUs to treatment programs. Addiction should not be a death sentence, and SEPs provide the best way to reach an ostracized at risk population. It is undeniable that we can lower HIV rates through SEPs without increasing substance abuse.

We cannot wait- the ban must be lifted NOW!


  1. Hi Randy… I know its been awhile.. sorry.
    I have but one question for you and keep in mind, I’m very liberal when it comes to drug laws. Question is, why should tax money pay for any of this?

  2. Wow- I haven’t heard from you in ages! Hope you are well. If I had my druthers- syringes could easily be sold in drug stores without a prescription. But the conservatives would never allow that to happen – so the next best is needle exchange. Needle Exchange is a clear way of preventing the spread of HIV, Hepatitis C and a score of other illnesses. Now here is where I know you and I will differ. I think providing clean needles ensures that the public health system isn’t burdened with the cost of caring for people with HIV/AIDS, Hep C, etc. 2 cents for a syringe could save tens of thousands of dollars in health care costs… But I know you probably don’t think there should be any public health system.
    Oh yeah- you might want to take a look at my “About” page. There are a couple of recently uploaded pictures that I am sure you will love—- to use as dart boards!

  3. Yeah, this macabe circus they call life keeps us busy huh?

    Well, selling needles in stores isn’t going to make a junkie waste drug money on a clean syringe or stop sharing them and regardless of the cost differences… I still fail to see how paying for any of it is MY responsibility.. I say let people do what they want, kill themselves via bad choices all they want, but the minute they get near me or my loved ones, its time for me to aim, squeeze, repeat… its all about freedom right?

    And yes, Pelosi and Boxer are worthy of grenade range practice…

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