Stakeholders Criticize Ban on Federal Funding for Syringe Exchange Programs

Most programs won't see a significant financial impact, but see the move as a step backward for public health

January 24, 2012 -- Syringe exchange programs are unlikely to suffer major financial impact as a result of a Congressional vote in December that halted federal funding.  

“It's actually going to have minimal impact,” said Kathy Oliver, executive director of Outside In, which has been operating a needle exchange since 1989. “It's a giant step backward in terms of public policy.”

Many exchange sites already relied on other sources of revenue because the ban on federal funding had only been lifted in 2009 after being in effect for 21 years.  

Outside In will lose about $6,000 in federal funding – a tiny fraction of its $190,000 budget for the exchange. Its support comes from the state, county and the city.

“In Portland, we're fortunate that Multnomah County and government providers have supported needle exchanges for years,” said Michael Kaplan, executive director of the Cascade AIDS Project. “Of course, those resources are getting tighter and tighter.”

He called the decision to re-enact the ban “ideologically stupidity” that flies in the face of decades of research about the effect of syringe exchanges on public health. “It's an opportunity lost.”

According to the North American Syringe Exchange Network, Oregon has seven needle exchange programs. NASEN, which is based in Tacoma, has been running an exchange program since 1988 – making it the oldest in the country.

Outside In might have been the first; Oliver tried to open its exchange around the same time – but the organization's insurer balked and it took her a year to find another insurer willing to cover the program.

“It was definitely in response to HIV, which at that time was a death sentence,” said Oliver who’d met two young women both of whom were pregnant and seeking prenatal care at Outside In's clinic. Both women had HIV, possibly acquired through intravenous drug use – a habit they were both trying to kick.

After learning about syringe exchanges in The Netherlands, Oliver decided to try the idea to help addicts and keep the public safe.  

Supporters see syringe exchanges both as a bridge to drug treatment and medical care. Since starting the program, Outside In has referred 457 clients to treatment programs and 229 to medical care.  

HIV infection rates increased by 5.9 percent per year in cities without needle exchange programs and decreased by 5.8 percent per year in cities with such programs, according to a study published in The Lancet.

Data released jointly by the Center for Disease Control and the Oregon Department of Human Services said 21.4 percent of people infected with HIV in Oregon occurred among those who had either used or had a sexual partner who used intravenous drugs.

Needle exchanges are also an ounce of prevention. The advent of anti-retroviral drugs has dramatically increased the life expectancy of people diagnosed with HIV – but increased the cost of treatment for HIV patients.

If the syringe exchange can prevent two HIV infections a year, it more than pays for itself, according to Kelly Anderson, development and communications director at Outside In.

Some researchers estimate the lifetime cost of care for HIV patients at more than $600,000.

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