Sin, stigma and syringes: The struggle for harm reduction

The contents of a needle exchange kit.
Torniquet, cotton balls, a "cooker," condom, sterile water, alcohol swabs and needles It is hard to believe that there is so much resistance against the distribution of this inexpensive collection of items'the contents of "kits" distributed by Needle or Syringe Exchange Programs (NEPs and SEPs). Public health officials, AIDS researchers and activists involved in harm reduction are all in accord'NEPs save lives, reduce the transmission of HIV and Hepatitis C, and save millions of dollars in health care costs.

Needle exchange programmes are one of the main harm reduction measures that aim to curb the spread of blood-borne viruses such as HIV and Hepatitis C among injecting drug users (IDUs). With an estimated 1 in 5 injecting drug users worldwide infected with HIV and 30 percent of HIV infections outside sub-Saharan Africa resulting from injecting drug use, such programmes are key to bringing the global epidemic under control.

Harm reduction programmes aim to reduce the negative consequences of drug use, by reducing the harm self-inflicted by the user through unsafe practices and the harm inflicted upon society. The provision of needle exchanges and other harm reduction measures, however, is generally poor, and opposition to them is impairing the fight against HIV.

I have lived in communities with high injection drug use, have lost close friends and former partners to AIDS which they contracted via unsterile syringe and paraphernalia sharing.

Those deaths were preventable.

I've done needle exchange, observed needle exchange and published research about needle exchange.

I worked at a research agency with Don Des Jarlais who is cited in this NPR report:

A study at the Washington AIDS conference shows HIV incidence among injection drug users in Amsterdam has fallen to almost zero. "We conclude that drug users no longer play a role in the HIV epidemic in Amsterdam," researcher Bart Francis Xavier Grady told an audience at the AIDS conference. Another study, presented by Trang Nguyen of Johns Hopkins, calculated the costs and benefits of expanding needle exchange programs in the United States. She says a 10 percent expansion ' at a cost of $64 million a year ' would prevent 500 HIV infections among U.S. drug users. The savings, from not having to provide HIV treatment for that relatively small number of people, would be $193 million.

Des Jarlais, who is a coauthor of that report, says needle exchange programs in New York City have reduced HIV infections to about 150 a year out of 150,000 injection drug users. "That is very, very close to zero," DesJarlais says, pointing out that most of the remaining infections may be due to sexual transmission, not needle drug use. At the peak of its drug-related HIV epidemic, New York City had about 13,000 new infections a year among injection drug users. There are about 200 needle exchange programs in the United States, he says. Congress has barred federal support of needle exchange, largely in the belief (never proved) that providing clean needles increases illicit drug use. This spring there was an attempt by some in Congress to prevent the District of Columbia from using nonfederal funds for needle exchanges. Washington has the worst HIV epidemic in the nation, and much of it is driven by injection drug use.

In order to understand the challenges faced in confronting this resistance, we need to explore recent legislative reversals as well as public attitudes about drug use, and the specific stigma attached to IDUs. So follow me below the fold.