Wednesday, July 14, 2010

White House Pushes Cautiously Forward on Needle Exchange

Clean syringes become part of federal AIDS strategy.

As most people know, addicts who inject drugs have played a major role in the HIV epidemic. In the U.S. alone, there are an estimated one million “injection drug users,” as the government calls them. They are linked to almost 20% of new HIV infections each year. (Roughly 56,000 new HIV infections occur in the United States annually, according to CDC estimates.)

And in black and white, on page 16 of the July 2010 position paper titled “National HIV/AIDS Strategy for the United States”, the White House made it official. In a list of “proven biomedical and behavioral approaches that reduce the probability of HIV transmission,” the report has this to say:

 “Among injection drug users, sharing needles and other drug paraphernalia increases the risk of HIV infection. Several studies have found that providing sterilized equipment to injection drug users substantially reduces risk of HIV infection, increases the probability that they will initiate drug treatment, and does not increase drug use.”

That relatively mild statement represents a bold departure from the AIDS/HIV policies of previous administrations--when such policies existed at all. The White House has bolstered its contention with citations:

Vlahov D, Junge B. The role of needle exchange programs in HIV prevention. Public Health Rep. 1998;113 (Suppl 1):75-80.

Put simply, clean needles save lives. Needle exchange programs put more addicts in contact with social services, thereby easing their entry into drug treatment programs.

“Comprehensive, evidence-based drug prevention and treatment strategies have contributed to reducing HIV infections,” the report states. “In 1993, injection drug users comprised 31 percent of AIDS cases nationally compared to 17 percent by 2007. Studies show that comprehensive prevention and drug treatment programs, including needle exchange, have dramatically cut the number of new HIV infections among people who inject drugs by 80 percent since the mid-1990s.”

By the end of this year, the report pledges, “Centers for Disease Control and Prevention (CDC)  and the  Substance Abuse and Mental Health Services Administration (SAMHSA) will complete guidance for evidence-based comprehensive prevention, including syringe exchange and drug treatment programs, for injection drug users.”

One question not answered in the White House document—how to pay for new treatment initiatives of this kind.

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