Needle Exchange Program FAQ

Of all the prevention strategies, past, present and future, needle exchange will remain the most controversial. Just mention those words and the battle lines are drawn. Reduction of risk versus enabling drug use — its a controversy that will never be resolved one way or the other. In April of 1998, HHS Secretary Donna E. Shalala announced that based on the findings of extensive scientific research, she has determined that needle exchange programs can be an effective part of a comprehensive strategy to reduce the incidence of HIV transmission and do not encourage the use of illegal drugs.

The structure of a needle exchange program is much the same in every instance: the program does not distribute hypodermic needles, but provides an opportunity for individuals to exchange dirty needles they have been using in a one-to-one ratio for an equal number of sterile ones. The site for the exchange may differ from program to program... some on-the-street sites, some sites run by private agencies, some sites provided by public health departments.

Advocates cite scientific studies that show needle exchange does not lead to increased drug use and that needle exchange is estimated to reduce new HIV infection by a striking 30%. Opponents of the programs are just as adamant that needle exchange promotes, encourages and enables drug use. It is a head-to-head battle that may never be resolved.

At a needle exchange program, injection drug users bring their used equipment to a known exchange site and trade their dirty syringes for clean equipment. Syringes are dispensed on a one-for-one basis only, thus encouraging participants to return all equipment and not increasing the number of needles discarded and available on the streets. Used syringes are disposed of in accordance with established biohazardous waste standards. Needle exchange programs are intended to prevent the spread of the HIV virus and other blood-borne diseases, such as hepatitis B and C among injection drug users and therefore, their sexual partners and children. Equally important as the actual exchange of syringes is the opportunity for outreach workers to provide participants with updated information and referrals regarding medical and social services in the community related to both drug treatment and HIV medical care and support services.

Does needle exchange reduce the number of HIV infections? Yes. Scientific study after scientific study has shown that needle exchange reduces the number of new HIV infections. Six federally funded reports conducted independently by: the National Commission on AIDS in 1991, the General Accounting Office in 1993, the University of California in 1993, the Centers for Disease Control and Prevention (CDC) in 1993, the National Academy of Sciences it 1995, and the Office of Technology Assessment in 1995 are among those scientific studies. Studies show that needle exchange programs can reduce HIV infections by at least one-third and reduce risk behavior by as much as 80%.

Does needle exchange increase drug use? No. Scientific study after scientific study has shown that needle exchange does not increase drug use when conducted with referrals to both drug treatment and HIV medical care and support services. The same six federally funded reports (listed above) found that needle exchange programs do not increase drug use and that needle exchange programs do reduce new HIV infections.

Does needle exchange increase Crime? No. In fact, needle exchange may ultimately result in diminishing drug-related crime. If needle exchange programs are able to link drug users with drug treatment, the number of individuals using drugs may decrease, thereby reducing demand for drugs. Decreased demand for drugs can contribute to decreased drug-related crime, and therefore, increased public safety.

Does needle exchange increase the number of contaminated syringes on the streets? No. Needle exchange programs actually encourage individuals to retrieve dirty needles from the streets to trade them in at the needle exchange site. In fact, the discarding of used, infectious needles on the streets was virtually eliminated due to needle exchange in New Haven, according to a US Conference of Mayors report. Eliminating needles on the streets can reduce the risk of accidental needle sticks to children and others. Law enforcement officials report that "pat downs" of those individuals participating in a needle exchange program are less likely to result in needle sticks because syringes are more likely to be capped.

How Can needle exchange help a community? The CDC reports that more than 33% of all AIDS cases are among injection drug users, their partners and children, and the numbers continue to climb. Over 63% of AIDS cases among women are related to injection drug use and over 50% of AIDS cases among children are attributable to injection drug use by their parents, according to the CDC. Because AIDS cases are growing fastest among these vulnerable populations, needle exchange should be an option for local communities to utilize as part of a comprehensive HIV prevention plan. In San Francisco, needle exchange, coupled with effective prenatal HIV intervention, has been credited with eliminating pediatric AIDS for the past two years. Results like this show that needle exchange can directly reduce HIV infection among drug users, their partners and children.

Do Americans support needle exchange? Yes. Two recent national surveys indicate that a majority of voters support needle exchange, and a Kaiser Family Foundation survey in March 1996 found that 66% of Americans support such programs. At least 100 needle exchange programs, in both fixed and mobile sites, currently operate in the United States. Local communities have developed and implemented needle exchange programs, which operate in a manner appropriate to the community standards and norms of the locale.

What Is our current federal policy on needle exchange? At this time, there are three separate and distinct prohibitions on needle exchange programs at the federal level — in the Ryan White CARE Act authorization, in the Substance Abuse and Mental Health Services Administration (SAMHSA) authorization, and in the BY 1997 Labor-Health and Human Services (HHS)Education appropriations legislation. The prohibition in the Labor - HUS appropriations legislation not only applies to the Ryan White and SAMHSA authorizations, but also to HIV prevention funding at the CDC. The Labor-HHS appropriations legislation prohibits needle exchange "unless the Secretary of Health and Human Services determines that such programs are effective in preventing the spread of HIV and do not encourage the use of illegal drugs."

What should federal government do regarding needle exchange? The Secretary of Health and Human Services, in recognition of the overwhelming scientific evidence that needle exchange is effective in preventing the spread of HIV and does not increase the use of illegal drugs, should exercise the waiver authority provided under the FY 1997 Labor - HHS appropriations legislation. Once the federal prohibition is removed, resources should be made available, if desired, so that state and local public health officials may utilize appropriate federal resources for needle exchange as part of a community's comprehensive HIV prevention plan.