Syringe Exchange Programs Expanding, Receiving More Funding
By Sharon Egiebor
Syringe Exchange Programs across the country are receiving more funds and expanding the number of services offered to intravenous drug users, according to a summary released by the CDC. The report, which summarizes SEP activities during 2005 and compares the findings with previous surveys, also indicated that the process of exchanging dirty needles for clean ones should continue as a prevention tool to reduce the spread of blood-borne pathogens, such as HIV, hepatitis B and hepatitis C. Syringe exchange programs are fraught with disention. Although numerous scientific surveys and studies support the practice, others question the wisdom of providing clean needles to drug addicts as an HIV prevention tool. “Syringe Exchange is the one prevention technique that has realistic, concrete data to prove that it works,” said Joy Rucker, executive director of Casa Segura, the HIV Education Prevention Project of Alameda County, Calif. “If this country could just get pass the moral issues, it would save a lot more people. It would be like Europe where they have the lowest rate of infection of HIV because they provide syringe exchange.” As of November 2007, a total of 185 SEPs were operating in 36 states, the District of Columbia (DC), and Puerto Rico, according to unpublished data from the North American Syringe Exchange Network, a report contributor. Most are in the Mid-Atlantic-north region up to Massachusetts, on the West Coast in California, Oregon and Washington, and in the Midwest. Experts put the number of programs at 218, saying many fail to report their activities because they are working underground. Federal funding for syringe exchange (also called needle exchange) has been prohibited since 1998 and the practice is illegal in many states. Syringe Exchange came on the scene in the early 1990s when evidence was beginning to show the link between rising HIV rates and intravenous drug users and their sexual partners. Allan Clear, executive director of Harm Reduction Coalition, a national advocacy and capacity building organization that promotes the health and dignity of those impacted by drug use, said most agencies say New York has 200,000 injection drug users with a need for 1 million clean needles daily. For the United States the number of injection drug users could be anywhere from 364,000 to a high of 1.3 million. "No one really knows because it comes out of different surveys." Since the HIV epidemic began, injection drug use has directly and indirectly accounted for more than one-third (36 percent) of AIDS cases in the United States. The trend appears to be continuing. Of the 42,156 new cases of AIDS reported in 2000, 11,635 (28 percent) were IDU-associated. Racial and ethnic minority populations in the United States are most heavily affected by IDU-associated AIDS. In 2000, IDU-associated AIDS accounted for 26 percent of all AIDS cases among African American and 31 percent among Hispanic adults and adolescents, compared with 19 percent of all cases among white adults/adolescents, according to the CDC. The report shows local, state and private funding increasing over the past few years. The mean SEP budget increased from $131,301 in 2004 to $133,450 in 2005. In 2005, a total of 30 (31 percent) SEPs operated with a budget of <$25,000, 29 (30 percent) with $25,000--$100,000, and 38 (39 percent) with >$100,000, according to the report. SEPs reported multiple sources of financial support in 2005, including individuals, foundations, and state and local governments. In 2005, a total of 72 (61 percent) of the 118 SEPs that responded to the survey received public funding totaling nearly $11.3 million from city, county, and state governments, accounting for approximately 74 percent of total funding. Public Welfare Foundation, a Washington-D.C. private funding organization, has provided grants to 14 organizations totaling nearly $3 million since 1996 to support the work of syringe exchange programs, said Adisa Douglas, who as senior program officer in charge of the Reproductive and Sexual Health Program superv “They take the person where they are that day and do the best they can. They never become preachy or judgmental,” said Douglas, who road vans with workers to drug-ridden neighborhoods. “It is a very soft way of interacting with people.” Douglas said her agency’s distributed its last cycle of funding on sexual reproduction issues this summer. The board changed policies this year and is no longer funding syringe exchange programs that fall outside of the law. The SEPs that received that grants in the last cycle but were not within those guidelines could use the funds for other services, including advocacy for more drug treatment programs, she said. The foundation also is phasing out the Reproductive and Sexual Health Program, saying in a release on its website that funding priorities would shift to other areas of need where fewer philanthropies and governmental agencies are engaged. In California, where the state just passed two bills relating to needle exchange, state and local funding is now available for several organizations. Syringe exchange is now supported by the tobacco tax settlement funds and Measure A, a half-cent tax on cigarettes, which is divided between the county hospital (75 percent) and community-based organizations (25 percent). Tucker said the change in law was the impetus for the HIV Education Prevention Project to go from an underground organization in 1996 to a nonprofit in 2001, with access to state funding. “We are one of the better-funded syringe exchanges in the Bay Area. In California, where a lot of syringe exchanges have popped out of other agencies, we started as a syringe exchange and have added ancillary services as needed,” Rucker said. Her program provides HIV and hepatitis C testing, vaccines for hepatitis A and B, abscess wound care, acupuncture, drug referrals to detox programs, showers, laundry and food for everybody that comes to a syringe exchange. Syringe exchanges are conducted in three predominantly drug neighborhoods in Oakland. A recent increase in funding will allow the agency to expand to six days a week in three neighborhoods at different times of the day. “Most injectors that are pretty committed to the behavior are homeless and really underground,” Tucker said. “They are the people that you see pushing the shopping carts and collecting bottles. People don’t see them anymore.” Last year, her agency served 12,000 people and exchanged 1.2 million syringes, she said The rate of HIV infection in the IDU community, dropped to 13-14 percent from 19 percent. “Our outreach is working, and more and more people are trusting the syringe exchange program. People that inject care about their health,” she said. “They may miss other appointments, but they don’t miss syringe exchange and most of them don’t have watches.”