There is overwhelming evidence that needle exchange programs (NEPs) work: they prevent the transmission of HIV and do not promote substance use. Since 1989, Congress has restricted the use of federal funds for needle exchange programs. Initially, Congress feared that the implementation of needle exchange programs would encourage substance abuse by sending the message that injection drug use is endorsed and promoted through the distribution of clean needles. The same thinking prevails today. While the U.S. Secretary of Health and Human Services (HHS) has the legal authority to determine whether needle exchange programs reduce the transmission of HIV and do not encourage the use of illegal drugs, competing political and philosophical interests have overruled those determinations. As recently as 1998, then Secretary of HHS Donna Shalala certified that based on extensive scientific research, needle exchange programs are an effective component of a comprehensive strategy to reduce HIV transmission and do not encourage the use of illegal drugs. Nonetheless, the ban on federal funding for needle exchange programs has not been lifted.
U.S. Surgeon General David Satcher, the American Medical Association, the American Bar Association, the American Public Health Association, and the National Conference of Mayors all support lifting the federal ban on funding needle exchange programs. Support for needle exchange programs also comes from the U.S. public. Most recently, 71 percent of Americans surveyed in a poll conducted by the Lindesmith Center-Drug Policy Foundation indicated that they support lifting the ban on the use of federal funds for NEPs. Additionally, a poll conducted by the Kaiser Family Foundation found that 66 percent of Americans support needle exchange programs. A poll by the Human Rights Campaign identified that 55 percent of Americans supported the removal of the ban on NEPs. The American public consistently supports these programs as an effective method to reduce HIV transmission.
Numerous studies in the United States and abroad have determined that needle exchange programs are effective in reducing HIV transmission among substance users. Most notably, in Southern Australia 55 NEPs serving a population of 1.2 million have resulted in no new HIV infections among injecting drug users over the past three years. Rates of HIV infection among injection drug users at a Hawaii NEP declined from five percent in 1989 to one percent in 1996. In Connecticut, there was a reported increase in re-use and sharing of contaminated injection equipment among injecting drug users after a NEP was closed down. The use of clean needles, often obtained through NEPs, reduces the risk of HIV transmission among injecting drug users.
In March of 1997, the National Institutes of Health and the Institute of Medicine demonstrated that needle exchange programs contribute to 80 percent reductions in risk behaviors in injecting drug users and a 30 percent or greater reduction of HIV transmission. NIH also concluded that there is a preponderance of evidence to show that needle exchange programs do not encourage increased substance abuse.
Noted researcher Don C. Des Jarlais has authored numerous scientific reports repeatedly demonstrating that needle exchange programs prevent the transmission of HIV. He has conducted scientific research in Glasgow, Scotland; New Haven, Connecticut; San Francisco, California; and New York City, New York. At each of these cities, Dr. Des Jarlais has repeatedly found that NEPs decrease HIV transmissions among substance abusers. Additionally, Des Jarlais has found that these programs actually encourage injecting drug users to seek treatment if the NEP is associated with a drug treatment and referral center or a methadone clinic.
Mathematical models predict that NEPs prevent HIV infections among injecting drug users, their partners, and family members at a cost of approximately $9,400 per avoided HIV infection. Considering the lifetime cost of treating a person living with HIV/AIDS is approximately $200,000, this represents a 95.3 percent savings per life. National support for needle exchange could save tens of thousands of lives and billions of dollars.