Removing Obstacles to Prevention One Ban at A Time: New Bill Would Allow Federal Funds for Syringe Exchange

Representative Jose Serrano (D-NY) yesterday re-introduced HR 179, the Community AIDS and Hepatitis Prevention (CAHP) Act of 2009.  The bill, which has 28 original co-sponsors, would eliminate all laws preventing federal funding from being used by state and local jurisdictions for syringe exchange.  The New York-based Harm Reduction Coalition is spearheading an advocacy effort through Democracy In Action to get more cosponsors and to pass the bill.

Lifting the ban on federal funding would be one of several wins needed in the struggle to restore evidence-driven approaches to prevention across a wide-spectrum of public health programs.  Bans on syringe exchange have been in place for years, even through the Clinton Administration.  Under the Bush Administration, domestic bans on federal funding were used to create de facto bans on U.S. international funding of syringe exchange: USAID and the State Department "voluntarily" applied the domestic ban on federal funding of needle and syringe exchange to foreign assistance programs under pressure from the White House.

These bans have been maintained despite mounting evidence of the efficacy of exchange programs.  According to a study by the University of California-Davis, for example:

Drug users with access to controversial syringe-exchange programs are up to six times less likely to put themselves at risk of HIV infection.

Among injecting drug users who already have some access to clean syringes, a syringe-exchange program results in a two-fold reduction in HIV risk behavior, according to the study.   For drug users with no other easy access to clean syringes, the benefits are even more significant — a six-fold reduction in risk behaviors. 

Syringe exchange and other tales of corrupted policy are the neglected underbelly of the global AIDS success story of the Bush Administration.  Along with restrictions on funding for prevention of sexual transmission, the ban on needle/syringe exchange greatly undermined U.S. efforts to prevent new HIV infections under the President’s Emergency Plan for AIDS Relief (PEPFAR).  For example, in Vietnam, a country funded by PEPFAR, the U.N. estimated that there were 260,000 people living with HIV in 2005 with 57% of HIV cases among injecting drug users. 

Likewise, in sub-Saharan Africa, where 80 percent of new infections result from unprotected sex, the U.S. has funded and continues to fund organizations that refuse to provide comprehensive information on safer sex practices….indeed which deny that safer sex is even possible.  And the links are clear:  People who are addicted to injection drug use also have sex, acting as a pathway to HIV and Hepatitis infection among others.

Last year, Serrano was widely lauded by prevention advocates for his efforts to lift the needle exchange ban in the District of Columbia.  The ban on the use of local and federal funds for this purpose had been written into DC’s federal appropriations since 1998, during which time countless new HIV infections took place through use of dirty needles.   Serrano oversees the budget for D.C. in his role as Chair of the House Appropriations Subcommittee on Financial Services and General Government.

With the introduction of HR 179, we may finally get rid of one more piece of a legacy of ideology and political expediency over evidence that has cost lives and money in the United States and abroad.  The Obama Administration can hasten this process by showing unflinching support for evidence-based programs such as syringe exchange.  The good news is that the most immediate problem is not so much a lack of resources as a complete waste of the resources being deployed.

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  • invalid-0

    finally we can look at installing science-based prevention strategies above morality. I fully support Serrano’s move, it needs to be early on during the administration so we can see the progress (drop in HIV infection rates) and the cost-effectiveness of these programs.

  • jodi-jacobson

    Hi Anon,


    I share your strong sense of relief at the prospect of a shift from the dark ages toward an evidence- and human-rights based approach to public health.  However, I believe we are *not* shifting away from or above morality but rather taking a moral and ethical stand of another kind….one that recognizes that narrow religious and political ideologies do not trump the universal values of human rights, evidence and public health and that there is no monopoly here on morality and ethics.  Frankly, I find nothing moral in denying people access to methods, information or services that can save their lives, denial that is based on and perpetuates stigma and discrimination.

    Let’s reclaim this issue of morality in a different light.


    bset wishes, Jodi