Lawmakers in the Republican-controlled House are quietly moving to partially lift the longstanding ban on federal funding to support syringe exchange programs, months after an HIV outbreak devastated a rural community in Indiana.
Language inserted into the omnibus budget bill currently before Congress would allow public health departments and nonprofit organizations to spend federal dollars on syringe exchange programs in areas deemed by the Centers for Disease Control and Prevention (CDC) to be hard-hit by injection drug use, as long as the money doesn't pay for the syringes themselves.
Harm reduction specialists and public health activists are breathing a sigh of relief at this move toward a common-sense syringe exchange policy, after years of political fearmongering.
"Our response needs to be informed by science, compassion and the three decades of experience that demonstrate that syringe exchange programs do not lead to an increase in crime or drug use," said Mary Beth Levin, an associate professor at the Georgetown University School of Medicine who has advocated against the ban on Capitol Hill. "Instead they are a cost-effective means of preventing HIV and viral hepatitis, serving as an essential bridge to care for substance use disorder and making neighborhoods safer for everyone."
Syringe exchange programs allow injection drug users to turn in used syringes for clean ones, and serve as a point of access to treatment and other services. In the 30 years since radical activists founded the harm reduction movement and organized the first exchanges in urban areas like New York City, researchers have gathered a mountain of evidence showing that exchanges are one of the most effective tools for preventing new infections of HIV and hepatitis C.
The new budget language's exception for syringes doesn't bother harm reduction and public health advocates too much; they point out that syringes are actually quite cheap. It's staffing clinics and programs, and disposing of the needles that costs the most, according to Levin.
Rural HIV Outbreak Rattles Republicans
Conservative politicians in all levels of government have consistently opposed funding exchanges due to bogus concerns that they encourage drug use with taxpayer dollars. (In fact, some studies have found that exchanges can reduce rates of drug use because they connect users to treatment.)
Opposition to syringe exchanges began to crumble this past spring when 150 people in Scott County, a small, predominantly white community in the heart of red state Indiana, tested positive for HIV during a public health investigation. Many had also contracted hepatitis C.
"Unfortunately, it took the tragedy in Scott County, Indiana, to get state and national lawmakers to realize that no one is immune and we have a collective responsibility to address HIV, viral hepatitis and substance use disorder," Levin said.
HIV/AIDS is commonly seen as a problem that impacts urban communities, queer and trans circles and communities of color. Untold thousands of AIDS-related deaths in these communities over the years certainly did not move conservative politicians to action like the outbreak in Scott County did. Politicians did not ignore rising rates of injection drug use or the spread of HIV, but they approached these realities with fear, ridicule and stigma, making funding for syringe exchange politically untenable.
The outbreak made international headlines, and alarmed politicians declared a state of emergency in Indiana and surrounding states. Medical experts, however, were not surprised by a cluster of infections in a state where public health budgets had been slashed as the federal government tightened control over prescription painkillers, forcing people living with addiction to turn to injection drug use and street drugs like heroin.
"If you've got the rise of prescription drugs, then the rise of injection drug use, then a drop in [health-care] services over time - you drop a little HIV in there, and you can have an explosion," said Eric Wright, the chair of the Indiana State Epidemiology and Outcomes Workgroup, in a June interview with Truthout. "In some ways, it was predictable I guess."
The crisis had a political domino effect. Indiana Gov. Mike Pence, a Republican who originally opposed syringe exchange programs, was forced to approve a temporary program in Scott County, and later signed a bill making it easier for other counties in the state to start their own. Legislative efforts to legalize syringe exchange programs in neighboring Kentucky had stalled out in the past, but lawmakers were able to pass a legalization law despite conservative opposition shortly after the outbreak.
Levin said this sent a clear signal to Kentucky's representatives in Congress, especially Rep. Hal Rogers, a Republican and chair of the powerful House Appropriations Committee, which inserted language in the current budget bill to lift the federal funding ban. Like other Republicans, Rogers supported the ban until this year.
Opposition to Syringe Exchange Crumbles in Congress
Republicans had originally banned the use of federal funds for syringe exchange programs during the AIDS hysteria of the late 1980s. In 2009, with backing from the Obama administration and a majority in the House, Democrats were able to lift the ban, but Republicans reinstated it after taking control of the House in 2011.
Levin and other advocates have been fighting to lift the ban ever since. Members of Congress on both sides of the aisle have looked at the facts and told advocates that they support syringe exchange programs, but with partisan bickering over hot-button issues like the Affordable Care Act dominating debates over the budget bill in recent years, lifting the ban was not their political priority.
"This is the best opportunity we have had to lift the ban since it was reinstated in 2011," Levin said.
The language in the current bill provides lawmakers facing challengers in more conservative districts with some political cover. Because federal funds would be available to support any element of a syringe exchange program besides the actual syringes, their opponents would not be able to accuse them of using taxpayer dollars to pay for drug paraphernalia.
The updated language also requires that the CDC determine that an "area or jurisdiction" is experiencing or at risk of experiencing a blood-borne disease outbreak due to injection drug use before federal funds can be spent there. Levin said public health advocates would have to work with the CDC to craft protocols for that process.
"CDC approval is a hurdle, rather than an obstacle," she said.
If approved, the new language would not allocate any new money for syringe exchange programs, but it could help public health providers start new ones with federal funding they already have. It could also encourage states that restrict access to clean syringes to update their laws.
Levin said the new language would be a big deal for states like Indiana, where three syringe exchanges are already operating and 19 other counties are working to establish their own.
"They definitively qualify as having a crisis by CDC standards," Levin said.