One step forward, half a step back. That’s where advocates of evidence-based treatment of HIV/AIDS seem to have landed Friday in their efforts to overturn the two-decades-old ban on federal funding for needle exchange programs.
Last week, Rep. David Obey, D-Wis., chairman of the House Appropriations Committee, successfully moved to nix the needle-exchange ban when a subcommittee took up the FY2010 spending bill for health and labor programs. But when the full committee took up the bill late Friday, Obey offered an amended version that would bar needle exchange programs from operating within 1,000 feet of certain organizations, such as schools and arcades. His move seriously watered down the provision, potentially make it difficult to find a legal location for a syringe exchange program. But Obey reportedly acknowledged that this would be unworkable and said he would try to find an alternative approach as this bill moves forward.
Obey’s move was likley an attempt to pre-empt Republican efforts to fully reinstate the ban; an amendmend to do just that was voted down after Obey’s substitute provision was accepted.
Physicians and scientists who specialize in treating HIV/AIDS have long argued that needle exchange programs are a proven, cost-effective way to prevent new HIV infections and do no promote drug use. In addition to preventing new infections from dirty needles, syringe exchange programs also connect vulnerable hard-to-reach populations to primary health care and to addiction treatment. Intravenous drug users account for up to 16 percent of new HIV infections in the United States each year. They represent 20 percent of the more than 1 million people in this country living with HIV/AIDS.
“An estimated 55,000 people are infected with HIV every year in this country—one new infection every 9.5 minutes,” said Daniel Kuritzkes, MD, a member of the Center’s Scientific Advisory Committee. “It’s crucial that we have a full arsenal of evidence-based measures to prevent new HIV infections, including needle exchange programs.”
If it becomes law, the House measure would give states and local jurisdictions the ability to use federal funds for needle exchange programs, but it would not require them to do so.
The measure, even in its watered-down state, could also have positive implications for US global AIDS programs. Although the provision doesn’t apply to international funding, in the previous administration PEPFAR refused to fund any needle exchange programs overseas. President Obama has said he favors lifting the ban, so if Congress sends it to his desk, that should be a green light for PEPFAR to reverse course.