HIV/AIDS: The case for needle exchange

The debate surrounding needle exchange has been highly controversial since its origin in the late 1980s. As HIV/AIDS swept through the world, it became increasingly clear that transmission through the use of shared of shared among injection drug users was a major source of new infections, particularly in North America and Europe. Activists began to establish needle exchange programs, in which used syringes are exchanged for clean ones. The programs have been hotly contested by governments and the public alike due to the fear of promoting drug use and further marginalizing the IDU community.

Needle exchange was particularly contested in New York City, the American capital of injection drug use. In 1990, it was estimated that 54 percent of the city’s injection drug users were HIV positive. The first needle exchange program was opened in 1988 as a pilot program to test the feasibility of the syringe exchange process in reducing HIV infection rates. It was closed less than a year after its inception, primarily due to the pressure of minority leaders on the city’s first African-American mayor, David Dinkins. Beginning in 1989, AIDS activists throughout the city ran underground needle exchange programs until the city eventually legalized the programs in 1992. However, a federal ban on government funding for needle exchange programs continued to prevent a widespread movement for these programs.

In New York City today, syringe exchange programs continue to attempt to protect the estimated 40,000 to 110,000 injection drug users. Injection drug users account for over 25 percent of people living with HIV/AIDS in the United States today. Largely due to harm reduction programs, the number of infections among injection drug users has fallen drastically. Between 1984 and 1986, 30,000 injection drug users were infected annually in the U.S. In 2006, less than 10,000 were infected.

During his campaign, President Obama promised to remove the ban on federal funding for needle exchange programs. While the government originally moved to repeal this ban, which had been present in every house appropriations bill in the past 20 years, a restrictive amendment was added that will prohibit the funding of needle exchange programs within 1,000 feet of any place in which children gather. This will seriously affect the implementation of funding for programs in metropolitan areas—an ironic correlation, as the highest concentrations of injection drug users and needle exchange programs are located in metropolitan areas.

The opposition against needle exchange has largely been centered around the morality of the community in question and the fear of promoting “immoral” behavior. Early opponents to needle exchange programs argued that full drug intervention programs should be the sole focus of preventing transmission of HIV through injection drug use. These opponents also worked against the large-scale problem of drug addiction.

Such people failed to recognize the unique mentality of an injection drug user suffering from addiction. Undergoing drug intervention is not a simple process, and the drug user must be ready to make the commitment. As one injection drug user described “half of the IV users aren’t ever going to stop ... those who want help, help them. But for people who don’t, help them in another way. Make sure they’re safe.” This particular injection drug user wanted to eventually stop using drugs but recognized that he was not yet ready to do so. In the meantime, he made use of syringe exchange and other safety techniques.

Harm reduction centers today offer not only needle exchange, but also a variety of other services, including medical services, testing for HIV and other infectious diseases, mental health services, drug intervention programs, transgender services, and education and outreach programs. They work to create a safe community in which drug users are given the opportunity to engage in intervention and lifestyle changes but are not made to feel obligated to do so.

Intravenous drug users become empowered through needle exchange programs. The needle exchange is the first step they take to do something for themselves, which can then lead to the eventual strength to enter a drug rehabilitation program. But until drug users reach that stage, there is no harm in ensuring their safety. Efforts must be focused on providing safe, clean needles to those who need them. In doing so, we will certainly prevent the spread of HIV/AIDS and other infectious diseases while also establishing relationships and trust with one of the most marginalized populations in our society.

The author is a Columbia College sophomore. “HIV/AIDS: The Case for Needle Exchange” is the second in a two-part series by the author on World AIDS Week.