Of the 40,000 new HIV infections per year in the United States, 25 percent involve intravenous drug users. The traditional focus of HIV prevention programs is sexual health and safety; however, these programs struggle to be effective and face stagnating results. In contrast, needle exchange is an option often ignored but proven effective in reducing rates of infection among injection drug users. True dedication to confronting the public health crisis of HIV/AIDS requires the consideration of all available options. Sound science and cost-effectiveness, not "moral values," should be the terms of the debate. Under those terms, implementing needle exchange programs nationwide is clearly responsible public health policy.
Can heroin addiction reduce the value of a human's life so that he no longer merits the most basic care, even when that care effectively advances HIV/AIDS prevention, addressing one of the greatest public health crises in the United States today? Should we ignore a measure that could prevent up to 10,000 HIV infections a year just because the recipients are drug addicts?
A common concern is that needle exchange programs facilitate drug use and encourage its spread, corrupting neighborhoods in the process. However, just as colleges provide condoms to encourage safety, not sex, needle exchange programs provide sterile syringes to promote safety, not drug use. Both acknowledge public health realities and focus on responsible and effective solutions.
Needle exchange is certainly not about facilitating or enabling addiction or merely reducing infection rates among intravenous drug users. In addition to providing sterile syringes, a needle exchange center is a nexus from which to introduce treatment and counseling to an otherwise overlooked and difficult to reach population. Services include HIV/AIDS education and counseling, condom distribution to encourage safe sex, referrals to treatment programs, on-site HIV testing, screening for tuberculosis and Hepatitis B and C and provisions of basic medical services. Needle exchange programs are not a "necessary evil," promoting addiction out of a sense of helplessness, but rather a means to help addicts recover or at least be safer and healthier.
Even from a purely pragmatic viewpoint, needle exchange programs are not only justifiable but also overwhelmingly cost-effective. The cost to distribute a single clean syringe is $0.97. The cost per HIV infection prevented by needle exchange programs is between $4,000 and $12,000 depending on the size of the program and the nature of the drug-using population. In contrast, the medical cost of providing lifetime health care for a person infected with HIV is $190,000. Moral objections to needle exchange prevent the implementation of programs that would cost only 2.1-6.3 percent of what would otherwise be spent on health care.
Statistics indicate that in minority and low-income communities, the risk of contracting HIV is much greater. In nearby Springfield, the Massachusetts Department of Public Health estimates that 56 percent of HIV cases are related to the sharing of dirty needles. Despite this serious public health problem, Springfield does not have a needle exchange program because the city council refuses to act. In response to this crisis, Arise for Social Justice, a non-profit focused on low-income rights, ran an illegal needle exchange program. Last September, the city narcotics agency raided the program, shut it down, and arrested its operators. Today, representatives from Arise for Social Justice and the communities that benefited from the needle exchange program will come to Amherst College to discuss the importance of such programs and the current situation in Springfield.
All information was taken from the Massachusetts Department of Public Health and the Center for Disease Control.
Jones can be reached at mrjones@amherst.edu
Norton can be reached at dmnorton@amherst.edu