STERN: Needle exchanges work

A Stern Perspective

For six and a half years, Margaret Lippitt, a student in the Yale Graduate School of Public Health, worked for an organization with a slightly jarring name: Helping Individual Prostitutes Survive. HIPS provides services including disease testing and support groups to prostitutes, intravenous drug users and other at-risk individuals.

One of HIPS’s many services is to drive a van around many of D.C.’s most dangerous neighborhoods late at night. Workers in this van distribute condoms, lubricant, dental dams and other supplies. They also pass out sterilized syringes and other paraphernalia needed to inject intravenous drugs. This is part of HIPS’s syringe exchange program.

In syringe exchange programs, drug users receive hypodermic needles and other injecting equipment, usually for free. These programs are often known as exchange programs because users exchange their old, dirty needles for new, sterilized ones.

When people initially hear what syringe exchange is, many seem a little unsettled. It does, after all, enable drug use. Many see it as helping addicts continue to behave in a harmful, not to mention illegal, manner. Wouldn’t it be better, critics ask, to not give them new needles? Without the instrument to inject their drugs, wouldn’t they be forced to quit?

Sadly, it’s not that simple. Drug users don’t stop injecting drugs when they run out of needles; they just use dirty needles and share needles with other users. The consequences of this behavior are dire. Sharing needles contributes to a considerable number of new HIV infections, sexually transmitted infections and the spread of hepatitis C.

Syringe exchange programs drastically reduce this risk. A study performed by Baron Edmond de Rothschild Chemical Dependency Institute found that new infection rates plummeted by more than 75 percent when cities instituted syringe exchange programs. In 2002, 45.4 percent of all new HIV infections were caused by injection drug use; in 2009, after the federal government started funding syringe exchange programs across the country, that percentage fell to 12.5. The evidence is incontrovertible. Syringe exchange is an exceptionally cost-effective way to prevent the spread of disease. Syringe exchange also helps people who don’t do intravenous drugs but instead need needles to inject medication or hormones.

Yet syringe exchange programs have been stripped of all of their federal funding. Despite having reinstated federal spending on the programs in 2009, a single line in the 2012 budget banned funding for the programs.

Let’s disregard for a moment that the federal government gave hardly any money at all to syringe exchange, and that lifting the previous ban (and presumably keeping it lifted) was among Obama’s campaign promises. Let’s even disregard how effective the program is. The simple truth is that to lift the ban — and to start funding syringe exchange programs again — would cost nothing at all. Not a penny.

The federal government is already giving money to fight the spread of HIV/AIDS. Eliminating the ban on syringe exchange would just be diverting a small fraction of the money already meant for public health purposes into syringe exchange programs — one of the most cost-effective ways to fight the spread of disease. It would not allocate any new money.

There is little cogent criticism of syringe exchange. Its opponents simply hate it because it seems so unsavory. Sort of like putting condoms in schools, syringe exchange may sound off-putting when one first hears about it. But — like putting condoms in schools — it is very effective at reducing the transmission of diseases.

We now have a few months to get the ban lifted in the new federal budget. This is such a minor part of the budget, an inexpensive, effective little program that is happening anyway but would be so much better and broader with federal support. No one can argue with the effectiveness of syringe exchange; its opponents can only obfuscate with misplaced moralizing.

Scott Stern is a freshman in Branford College. Contact him at scott.stern@yale.edu.

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