By Monica S. Ruiz and Del. Eleanor Holmes Norton The outbreak of HIV in Indiana last spring serves as yet another wake-up call to America about injection drug use and the urgent need for needle exchange programs.
Soon after the outbreak erupted, Indiana’s Republican Governor Mike Pence approved a needle exchange program in Scott County in an effort to stop the rapid spread of HIV. Lawmakers on Capitol Hill should follow that courageous lead and lift the ban on federal funding for needle exchange programs, an effort that could prevent similar HIV outbreaks all over the country.
What’s the urgency? Public health officials say there has been a sharp rise in the number of people using heroin and other highly addictive drugs in recent years. In fact, between 2012 and 2013, the number of U.S. drug overdose deaths resulting from heroin spiked from 5,900 to 8,200, according to the White House Office of National Drug Control Policy.
At the United States Conference on AIDS, starting today and running through Sept. 13 here in Washington, D.C., experts are sure to point out that the same crisis that hit Scott County will affect other parts of the country unless action is taken now. Just last April, the Centers for Disease Control and Prevention warned health officials all over the U.S. to look for signs of emerging outbreaks — like the use of injection drugs and an increase in HIV or hepatitis C, which can also be spread through needle sharing.
Lawmakers on both sides of the political aisle must put aside the rhetoric and take a hard look at the abundant data showing that needle exchange programs work. In some cases, legislation must be changed in order to allow needle exchange programs to be put in place. We now know such policy changes can have a big impact on city-wide or regional HIV epidemics. In fact, this week, one of us published a study that found that such a policy change for the District of Columbia resulted in a 70 percent reduction of new HIV cases associated with injection drug use.
Behind that success story of a needle exchange program, there’s a long history of inaction that helped fuel the epidemic of HIV in the nation’s capital.
In 1998, Congress banned the use of federal funds for needle exchange programs but did allow states and cities to use locally generated revenues to establish such programs. However, additional legislation was passed specifically prohibiting the District of Columbia from using its own municipal revenue on a needle exchange program, making it the only jurisdiction in the nation that could not use its own funds for such purposes.
The D.C. ban was lifted in 2007 and the very next year the city launched a multi-site needle exchange network.
The new study, published on Sept. 3 in AIDS and Behavior, found that the lifting of the D.C. ban — and the actions that resulted from the removal of those funding restrictions — prevented 120 new cases of HIV in the first two years alone. Furthermore, the study showed that the costs associated with such prevention — an estimated $44 million in lifetime treatment for 120 people with HIV — are savings that are passed down to D.C. residents, whose taxes support the publicly funded health insurance programs that would have been providing treatment in those cases.
That’s just one reason to keep the deadly rider that banned D.C. from using local funds for needle exchange from being re-imposed by Congress. But we need to go further than that if we are to systematically stop these emerging HIV outbreaks no matter where they occur, whether in a rural county in Indiana, or neighborhoods in D.C. just miles from the White House.
Congress must end the ban on federal funding for needle exchange, a step that would go a long way toward ensuring that states and municipalities have the resources to fight HIV as it presents in their communities. State and local health departments need to have the autonomy to respond to their own public health emergency using the best evidence-based interventions available. Allowing the use of federal resources for needle exchanges will help states and cities to respond to and stop an emerging HIV outbreak before it has time to spread.
Removing the ban on federal funding is a public health investment that is long overdue. We should not have to wait for another outbreak to prove that point.
Monica S. Ruiz is an assistant research professor at Milken Institute School of Public Health at the George Washington University. Eleanor Holmes Norton, a Democrat, is the District of Columbia’s representative in Congress.