Obama Budget Retains Needle Exchange Ban, Leaving Drug Users and Others at Risk

In his 2010 budget, President Obama failed to deliver on his
commitment to end the ban on federal funding of needle exchange
services–an action he promised to take before and after the
election and one that would help protect the health and save the lives of tens
of thousands of injection drug users–in the U.S. and around the

Every year since 1988, Congress has tucked the ban into the Labor HHS
appropriations bill with a provision stating that "no funds appropriated
in this Act shall be used to carry out any program of distributing sterile
needles or syringes for the hypodermic injection of any illegal

These words have meant that communities across the U.S. are limited in how they can
fight HIV among some of their most vulnerable residents. Technically, they do
not apply to any funding not covered by the Labor HHS bill.  However,
bureaucrats administering U.S.
foreign assistance have felt constrained by this language and have cautiously
decided to apply it to all foreign assistance.   The harm caused by these words
goes beyond HIV as well, as needle exchange programs are also an important tool
in fighting viral hepatitis. 

Given President Obama’s strong support for needle exchange
programs and the Administration’s commitment to invigorating the federal
response to the HIV/AIDS epidemic, we hoped that the President would seize this
first opportunity for lifting federal restrictions on this lifesaving
prevention strategy by removing this provision from his FY10 budget request to
Congress.  Sadly, it remains. Denying people at risk for HIV a proven
prevention intervention is a denial of their basic human rights and it was certainly
a surprise to find it still in the budget.

The President has repeatedly expressed his support for lifting the ban,
pledging during the campaign, the transition, and after the inauguration to
take action on this issue.  Within 24 hours of his inauguration, the White
House website stated clearly: "The President also supports lifting the
federal ban on needle exchange, which could dramatically reduce rates of [HIV]
infection among drug users."   

While we are disappointed by the inaction on needle exchange funding in
the President’s budget, the prospects of lifting the federal ban have not
been defeated. We and our allies on this issue will continue working with the
Administration and Congress to remove the obstacles to the implementation of needle
exchange programs in communities devastated by HIV. 

The President must now move past simply being clear in his support for
ending the federal ban and insist that Congress not include the restriction in
the appropriations legislation they send him. The Administration must also
work with Congress to pass the Community AIDS and Hepatitis Prevention Act , and
direct HHS and State to remove all non-legislative barriers for funding of needle

While there is a lot the Obama Administration needs to do, they alone are
not responsible for paving the way for federal support of needle exchange
programs.  We know the importance of scaling up these programs in the US and
elsewhere and we must now reach out to Members of Congress to ensure that they
also allow science to guide their judgment on this issue.  They, too, have
an important role to play in lifting the ban and we must see to it that they
act with due haste.

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  • http://www.advocatesforpregnantwomen.org invalid-0

    Thank you RH Reality Check and Paola for addressing this important public health issue as a matter of reproductive health and rights. Women, of course are among those who will benefit from government funding for evidence-based, public health promoting needle exchange programs. (The benefits of this approach are so obvious that Malcolm Gladwell features needle exchange in his best selling book, The Tipping Point, as an example of a small action that can bring about almost immediate cost and life saving change). In both the drug policy and reproductive health arenas, our government not only restricts information about medically safe and useful procedures, it also restricts access to them. In the case of reproduction, access to abortion, contraception and evidence based child-birth practices are deliberately blocked, limited or discouraged. The government refuses to fund abortion services for low-income women, while ensuring that funding is available for permanent sterilization services for the same population of women. The government won’t lift the ban on needle exchange or make methadone treatment available on demand, but will spend a fortune to incarcerate hundreds of thousands of non-violent drug offender who would benefit from drug treatment. Working across issues to ensure support and funding for evidence based, public health approaches will benefit us all.

    Thank you again,

    Lynn Paltrow
    National Advocates for Pregnant Women

  • http://www.cpcwatch.org invalid-0

    Report after report shows that these programs are highly effective in reducing new cases of HIV, and also help get more users into rehabilitation programs. Obama’s refusal to lift the ban on needle exchange programs is no better than Bush’s ban on schools giving out condoms because they’ll “encourage teens to have sex.”

  • emily-douglas

    Thanks for the comment, Lynn. Needle exchange really clarifies the entire harm reduction paradigm for me. It really doesn’t matter what we think morally or ethically about intravenous drug use, or what distributing clean needles suggests about that — the public health evidence is just so clearly in favor of that approach. I think this is a helpful thought experiment to apply to abortion, sex work, and other reproductive justice issues too. Amanda Allen of Law Students for Reproductive Justice has written about harm reduction applications for addressing sex work here on RH Reality Check.  Anyway, I agree that the links are strong and it’s important as reproductive justice advocates to include this issue in our activism.

  • http://www.smallworldview.blogspot.com invalid-0

    Thank you for the highlighting this critical health issue that affects millions of people around the world and hasn’t received any 1% of the media coverage according to H1N1… I say millions of people because one of the consequences of the Obama administration’s failure to lift the federal ban on funding needle exchange is that it has left in place the Bush administration’s limitation on PEPFAR funding for needle exchange and other harm reduction programs. Funding could be provided to international programs absent Congressional action, but without clear instructions, agency officials are reluctant to act.

    In the meantime, the problem of drug-related HIV in Eastern Europe, Central and Southeast Asia continues unabated. Many fear the combination of increased cultivation in Afghanistan and development of new trafficking routes thru countries in North and West Africa, could lead see IDU playing a growing part in the AIDS epidemic in the regions.

    Additionally, not only has the new administration not fulfilled on its promise to lift the ban on NEP funding, it had done little to address the Bush administration suppression of information about the efficacy of needle exchange. Thankfully, Obama administration withdrew statements submitted before the inauguration by US officials challenging the science supporting needle exchange but information available to the public on websites like those maintained by SAMSHA and the CDC are woefully lacking in useful information. I just happened to be surfing the CDC website today looking for updated data on HIV in the African-American community. I was surprised to see that although the CDC charts clearly show that IDU accounts for 24% of HIV cases among Black men and 23% of HIV cases among Black women, this is all that appears on the issue of substance abuse:

    “Injection drug use is the second leading cause of HIV infection both for black men and women. In addition to being at risk from sharing needles, casual and chronic substance users are more likely to engage in high-risk behaviors, such as unprotected sex, when they are under the influence of drugs or alcohol. Drug use can also affect treatment success. A recent study of HIV-infected women found that women who used drugs, compared with women who did not, were less likely to take their antiretroviral medicines exactly as prescribed.”

    CDC Fact Sheet: HIV/AIDS Among African-Americans

    Under prevention there is nothing written about preventing HIV transmission among injection drug users – there is a brief reference to helping people reduce high risk behaviors – that’s it. In fairness, the page has not been updated since September 2008. However, it appears there is no immediate intention to update the information. On the CDC page dealing with HIV and Injection Drug Use the following notice appears at the bottom of the webpage:

    This CDC Web site is no longer being reviewed or updated and thus is no longer kept current. This site remains to assist researchers or others needing historical content.
    Last modified: 05/08/2009
    Last reviewed: 12/31/2005 Historical Document

    Content Source: National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention

    The cost of this inaction will surely be more people needlessly infected and in parts of the world where HIV treatment for drug users is almost nonexistent – it will mean more needless deaths. Given the nature and scope of the problem, one would think addressing the HIV/AIDS epidemic would merit at least as much attention as ‘swine flu’. Let’s hope someone in the White House is listening and more important, let’s hope they really care…….

  • http://www.thelastresortpa.com invalid-0

    While I don’t agree with the pratice of shooting up obviously. I do believe that this program of needle exchange is well worth it…Sweden does something like this and their STD rates are super low.

  • http://club-cult.blogspot.com/ invalid-0

    Perhaps therefore struggle against a narcotism is conducted so senselessly, worthlessly and absurdly. On my memory twice, at the present president, started to make active struggle against a narcotism.