Federal funding for needle-exchange programs -- a controversial concept that public health advocates have long argued prevents the spread of HIV and other diseases -- is about to be prohibited once more, just two years after Congress lifted a 21-year ban.
Congress reinstated the policy as part of a broad spending bill it passed last week to fund the federal government through fiscal year 2012, which ends Sept. 30. During the contentious negotiations that led up to its passage, Democrats successfully removed a number of Republican policy riders and restrictions. But, the exchange ban on syringes and needles backed by Republicans remained in the final deal. House Republican leaders did not respond to requests for comment about the issue.
The exchange programs provide sterile syringes to injection-drug users in an effort to reduce the spread of blood-borne diseases and often include other services such as HIV counseling and testing or referrals for substance abuse treatment. A number of federally funded studies have shown that comprehensive syringe-exchange programs help prevent the spread of disease and do not increase illegal drug use.
Program advocates say the ban -- first imposed in the late 1980s -- is irresponsible because it runs contrary to scientific evidence and would undermine efforts to halt the spread of HIV and other diseases, such as hepatitis C.
“Not basing policy on the evidence of what works risks wasting tax dollars and undermining public health,” said Chris Collins, vice president and director of public policy at amfAR, the Foundation for AIDS Research.
But critics of the exchanges argue that such programs send the wrong message. They say the programs could condone or encourage drug use.
Georges Benjamin, the executive director of the American Public Health Association, said that these fears are unfounded and that people should not be denied the best public health interventions because they are using drugs. Furthermore, preventing disease now costs less than disease treatment in the long term, he said.
The president is expected to sign the legislation, although the Obama administration disagrees with the reinstatement of the federal funding ban on syringe exchanges.
“The omnibus spending bill was the product of a tough negotiation, and the bill provides increased funding to implement health reform and Wall Street reform. But to reach a compromise, we had to accept certain provisions that we oppose, and this is one of them,” an administration official said.
There are at least 221 sterile syringe exchange programs total in 33 states and the District of Columbia, through it is not known how many receive federal funding, according to the North American Syringe Exchange Network.
The spending bill does allow the District of Columbia to use its own local funds for syringes, a practice that Congress banned from 1998 until 2007. Other jurisdictions were able to use private or local funds for these purposes.
The bill, however, extends the ban on syringe exchanges to federal funding for certain global health programs.
Ronald Johnson, vice president of policy and advocacy at AIDS United, said that even though cities and states can use their own funds for syringe exchange programs, the administrative hassle of keeping federal and other funds separate could encourage them to drop their programs.
“It is a really serious setback for public health and HIV prevention specifically,” he said.