Graphics appear courtesy of Safe Works AIDS Project, the Chicago Recovery Alliance, and the North American Syringe Exchange Network.
The latest chapter in the needle exchange saga unfolded in New Brunswick, NJ, when on August 11, Thomas Scozarre and Diana McCague of the Chai Project were found guilty of violating New Jersey state law for distributing a clean syringe to an undercover police officer. Their sentences, $500 fines and 6-month drivers' license suspensions were stayed pending appeal. However, Judge Brenner, of the New Brunswick Municipal Court, upon handing down the sentence called McCague a "modern day Joan of Arc" and someone whom he would be "proud to have as a daughter." The Chai Project, in operation since January 1994, currently exchanges approximately 80,000 syringes per year to IV drug users, and was recently awarded a sizable grant by the Conference of Mayors to do outreach work (other than needle exchange) with women at risk in New Jersey.
The 7th annual North American Syringe Exchange Convention met April 24-26 in San Diego, bringing together over 200 practitioners, researchers and supporters of needle exchange programs (NEPs) representing over 100 institutions. In addition to various legal and social hurdles preventing the widespread use of needle exchange programs, there were three pivotal issues: the controversial Alaska study, the possibility for lifting the federal NEP funding ban, and the so-called "safety" syringes mandated by pending New York state legislation.
The Alaska Study
The Alaska study refers to National Institutes of Health-funded research that has drawn criticism on ethical grounds. Dr. Dennis Fisher, of the University of Alaska at Anchorage, proposed to carry out research comparing syringe exchange with "enhanced pharmacy" distribution. Half of the participants would receive sterile syringes from a needle exchange program, while the other half would be given a map of the area with pharmacy locations marked. Needle exchange advocates charge that denial of sterile syringes places the latter group at increased risk of contracting HIV. Further criticisms included the condition that individuals not enrolled in the study were denied syringes.
Local activists tested the experiment's basic hypothesis, that injection drug users could obtain syringes from pharmacies, by visiting the listed pharmacies and asking for syringes. It was found that the vast majority of pharmacies were unwilling to provide syringes.
Dr. Fisher's grant to study needle exchange was approved in May. Advocates have responded to the study by starting a privately-funded needle exchange program in Anchorage, the Northern Exchange II.
Federal Needle Exchange Policies
The Clinton administration has continued to stall on the federal needle exchange issue, which centers around a legislative ban in the Ryan White AIDS Care Act. The Act prohibits states from using federal AIDS grants to fund needle exchange programs. For example, the President's AIDS Strategy, released in December, does not address questions about needle exchange. There are two conditions required for the Clinton Administration to consider lifting the current ban on federally funded needle exchange programs. Those requirements, that needle exchange programs reduce the spread of HIV and do not increase the rate of drug use, were highlighted in a report released by the Department of Health and Human Services. Curiously, however, the report did not recommend that the current ban on federally funded needle exchange programs be lifted.
During the NASEN convention and subsequent months, the federal funding ban has become a topic of increasing attention by needle exchange advocates. Under the umbrella of the National Coalition to Save Lives Now, organizations, including DRCNet have begun intensive lobbying for lifting of the ban. At the same time, some practitioners are concerned that an outpouring of government funds could bring harmful regulations while also causing private NEP funding to dry up. The Coalition is planning a major demonstration in Washington, DC on September 17th. Representatives Elijah Cummings (D-MD) and Nancy Pelosi (D-CA) have introduced legislation for allowing states to use federal AIDS funds for needle exchange, and are planning to bring needle exchange clients to Washington this fall to testify.
One of the possible regulatory requirements feared by needle exchangers is mandated use of so-called "safety syringes" - syringes that automatically retract after a single use. One of the principal problems seen by needle exchange practitioners is that in situations where a safety syringe has retracted, sharing may then be encouraged where reuse would have been possible with an ordinary syringe. Another problem is simply that most injection drug users do not like them and would be less likely to use such services. Additionally, "safety syringes" may be susceptible to losing their contents.
Progress and Setbacks in New England
According to the 11/21 edition of USA Today, the Board of Selectmen in Willimantic, CT requested that the state end a six-year-old needle-exchange program on the grounds that discarded needles are littering the streets and parks. Advocates of needle exchange plans contend that local police collected empty syringes and claimed that syringes were littering the town's parks.
Our sources claim that none of the needles were from the exchange. They also note that one of the primary benefits of a needle exchange is the exchange. This means that users must bring back, rather than discard, their used syringes, which are then safely discarded, rather than throw them away.Another setback in New England is New Bedford, MA, where opponents of a needle exchange program that had been approved by the city council got it defeated in a ballot measure.
According to Dan Sundquist of the New Hampshire Harm Reduction Alliance, the state has asked cities to submit proposals to the Commission of Health for needle exchange programs. Only one will be sanctioned; it is scheduled to begin in January 1998 for a two year pilot. No state money will be used for the program, with the proposing city left to choose between city funding and joint city/private funding. Cities will not be required to participate. Sundquist has noted that none of members of the Advisory Board formed to draw up guidelines for the state program have experience in needle exchange, and doesn't believe they have an understanding of the issues involved. Sundquist's fear is that the program may be set up to fail.
The pilot has faced local resistance in the city with the highest AIDS rate in the state. Manchester's Board of Mayor and Aldermen overwhelmingly supported Police Chief Mark Driscoll in his opposition to community participation in the program, with only one Alderman, Donna Soucy, dissenting, according to the Manchester Union Leader, August 7th. Another New Hampshire bill that would have decriminalized and deregulated possession of syringes was passed by the House but killed by the Senate Committee on Health and Human Services.
On April 23, the State Senate of Rhode Island voted to make a pilot needle exchange permanent. The bill has to pass the House of Representatives to become law. The program is funded by a federal grant and private donations, and is staffed mostly by volunteers. A week later the House passed a law decriminalizing the possession of hypodermic needles, following an emotional debate.
Cleveland NEP Wins Fight
The Xchange Point needle exchange program in Cleveland was threatened with legal sanctions after the city government contradicted its own emergency order authorizing needle exchanges and later revised the order to make it impossible for The Xchange Point to comply with it. Director Ken Vail, a graduate of the Case Western Reserve University School of Public Health, commenced program operations on October 2, when it became clear that the city had no intention of acting in good faith and recognizing that the exchange fulfilled all the requirements of the emergency order passed in January 1995. Following very positive coverage in the Plain Dealer newspaper, the city threatened the needle exchange volunteers and board of members with criminal prosecution if they continued operating, and the exchange shut down. In March, however, the Mayor's Office indicated an intention to revoke the revised emergency order and work things out with the exchange. The offer came the day before a press conference had been planned by The Xchange Point with prominent NEP researcher Dr. Peter Lurie. Program operations commenced at the end of April.
Illinois Legislation Fails; Chicago Exchange Struggling Financially
This Spring, the Illinois legislature considered a bill which would allow the purchase of up to 10 syringes from a pharmacist without a prescription. House Bill 686/Senate Bill 148 was sponsored by Rep. Feigenholtz and Sen. Trotter. HB 686 passed out of the Illinois House Human Services Committee on February 27, 1997 but died on the floor of the House on April 25th, having never been called for a vote. A major proponent of the bill was the Chicago Recovery Alliance (CRA), one of the largest needle exchange programs in the country. CRA, which expects to exchange nearly 2 million syringes this year, has recently faced a major funding cut from the city and is $133,228 short of its needed budget for this year. 1998's HIV prevention funding request for proposals from the City of Chicago offers less than 23% of the $1.6 million to reach injection drug users when it is expected that 60% of new HIV infections will occur among people injecting drugs. Even if all money targeted to injection drug users goes for syringe exchange the Chicago Health Department's 1998 HIV prevention money for syringe exchange will drop over $35,000 for 1998. For further information, or to make a donation, contact Dan Bigg at (773) 471-0999.
Denver Mayor Backing Needle Exchange
In early February the Judiciary Committee of the Colorado House of Representatives chose to back HB 1289, a bill allowing communities to permit needle exchange programs. Health professionals testified on behalf of the measure, according to the Rocky Mountain News on Feb. 7, but the most startling testimony was provided by Megan Ross of Denver, a foster mother who works with AIDS babies. She brought three HIV-infected toddlers, her foster children, to the hearing, and held up a string of 18 empty syringes, representing the daily medication of one of the children, a 2-year-old girl born with full-blown AIDS. "Help prevent this," Ross said. But even this tragic sight failed to move the bill's chief opponents, the Colorado Association of Chiefs of Police, and the bill was defeated in the House less than two weeks later. Paul Simons of PEERS (People Engaged in Education and Reduction Programs), stated "The war on drugs got the front seat. The fight against AIDS got the back seat." In July, Denver Mayor Wellington Webb pledged that within the next year he would propose an ordinance allowing a needle exchange in Denver. He has asked the city attorney's office to explore legal issues connected to such a move.
Philadelphia NEP Weathers Threat
The Philadelphia Inquirer reported that Philadelphia's needle exchange program, Prevention Point, survived a proposal by City Council member Frank Rizzo to suspend Prevention Point's operations pending an investigation of whether needles distributed by Prevention Point might be sold on the market. On March 11, the Inquirer reported that while AIDS-related deaths among whites in Philadelphia fell 41 percent during 1996, they only declined 13 percent among African Americans.
Maryland and Washington, DC
On March 4, the Maryland General Assembly enacted legislation allowing Baltimore's needle exchange program, authorized for three years, to continue operating. Advocates of the program say it has prevented 84 people from contracting HIV over the past three years, and State Senator Paula Hollinger, a Democrat representing Baltimore, noted that the state saved $120,000 a year in AIDS care costs for each person.
Washington DC's fledgling needle exchange program faced political resistance. A November 29 article in USA Today reported that the District's new human services procurement director, Wanda Mormon, did not approve of the needle exchange program, and that Wayne Casey, interim director of the department, claimed the program faced too many "technical problems". As of this printing, however, the DC needle exchange is up and running. As of July 3rd, the exchange had enrolled 1,683 clients (96% of whom have returned to the exchange), distributed 53,478 sterile needles in the course of 5,575 transactions, collected 10,243 non-program needles (which otherwise might have been reused or discarded unsafely), and referred 640 persons to drug treatment, according to Whitney Taylor of the Drug Policy Foundation.
A bill in the state legislature to decriminalize syringe possession failed to pass, as did an attempt to include funding of syringe exchange as a line item in the New York State budget. Money for needle exchange in New York State currently comes out of reappropriated unspent AIDS dollars, which is always very precarious.
While the debate over federal needle exchange funding heats up, private sector philanthropy has provided the field with a boost. The August 17th New York Times reported that financier George Soros is donating $1,000,000 to needle exchange through the San Francisco-based Tides Foundation. "Probably of all the money we spend on various projects," said Soros, this is the one that is actually going to save the most lives."
The National Coalition to Save Lives Now! is organizing a demonstration at the Dept. of Health and Human Services at 12:30pm on Wednesday, Sept. 17th, to call for lifting of the ban on use of federal AIDS funds for needle exchange. Initial sponsors include ACT UP Philadelphia, the Atlanta Harm Reduction Coalition, Exponents, Inc./ARRIVE, Harm Reduction Care Network of New York, Housing Works, Mobilization Against AIDS, New Orleans Syringe Exchange Network, The Harm Reduction Coalition, The National Coalition to Save Lives Now!, The Latino Commission on AIDS and The North American Syringe Exchange Network. For further information, contact NCSLN at (212) 213-6376, ext. 17, e-mail [email protected], or visit http://www.safeworks.org/savelivesnowon the web.