A Simple, If Unpopular, Method To Fight A Deadly Scourge

November 23, 2009

The following feature by writer Tina Rosenberg appeared in the Sunday New York Times magazine (about AIDS, and good luck finding many stories on that vitally important topic, by the way)…

We know that abstinence, sexual fidelity and consistent condom use all prevent the spread of H.I.V. But we do not yet know how to persuade people to act accordingly.

Then there is another way that H.I.V. infects: by injection with a hypodermic needle previously used by an infected person. Outside Africa, a huge part of the AIDS epidemic involves people who were infected this way. In Russia, 83 percent of infections in which the origin is known come from needle sharing. In Ukraine, the figure is 64 percent; Kazakhstan, 74 percent; Malaysia, 72 percent; Vietnam, 52 percent; China, 44 percent. Shared needles are also the primary transmission route for H.I.V. in parts of Asia. In the United States, needle-sharing directly accounts for more than 25 percent of AIDS cases.

Drug injectors don’t pass infection only among themselves. Through their sex partners, H.I.V. is spread into the general population. In many countries, the H.I.V. epidemic began among drug injectors. In Russia in 2000, for example, needle-sharing was directly responsible for more than 95 percent of all cases of H.I.V. infection. So virtually all those with H.I.V. in Russia can trace their infection to a shared needle not many generations back. Though it has been scorned as special treatment for a despised population, AIDS prevention for drug users is in fact crucial to preventing a wider epidemic.

Unlike with sexual transmission, there is a proven solution here: needle-exchange programs, which provide drug injectors with clean needles, usually in return for their used ones. Needle exchange is the cornerstone of an approach known as harm reduction: making drug use less deadly. Clean needles are both tool and lure, a way to introduce drug users to counseling, H.I.V. tests, AIDS treatment and rehabilitation, including access to opioid-substitution therapies like methadone.

As Rosenberg tells us, “needle exchange is AIDS prevention that works.”

However, as the Times also tells us here…

A bill working its way through Congress would lift a ban of more than 20 years on using federal money for needle exchange programs. But the bill would also ban federally financed exchanges from being within 1,000 feet of a school, park, library, college, video arcade or any place children might gather — a provision that would apply to a majority of the country’s approximately 200 exchanges.

“This 1,000-foot rule is simply instituting the ban in a different form,” said Rebecca Haag, executive director of the AIDS Action Council, an advocacy group based in Washington. “Clearly the intent of this rule is to nullify the lifting of the ban.”

Under a separate bill, all exchanges in Washington within the 1,000-foot perimeter would be barred from receiving city money as well as federal money.

And guess which utterly clueless Republican is behind this idea…

“Let’s protect these kids,” said Representative Jack Kingston, Republican of Georgia, who introduced the Washington bill. “They don’t need to be playing kickball in the playground and seeing people lined up for needle exchange.”


And of course, in Kingston’s Ward and June Cleaver World, the girls wear hoop skirts, the guys are all rebuilding the engine blocks on their ’57 Chevys, and they both surreptitiously rendezvous at Lookout Point at midnight to watch the submarine races.

Ugh (somehow I think that, if individuals were to come to a needle-exchange center, not necessarily each one would be highlighted by, say, ground-up glass on the blacktop of basketball courts surrounded by chain-link fences in typically urban settings, on a route traveled by school kids of course).

As noted here, President Obama proposed an increase in spending to combat AIDS (as has just about every other president in my memory, including Dubya, believe it or not, though with at least one “string” you’ll read about shortly), and Obama has also lifted the idiotic ban his predecessor placed on people with AIDS traveling to this country. However (as noted here), his FY2010 budget proposal retained the decades-old ban on federal funding for syringe exchange (though Congress passed legislation to lift the ban shortly after Obama’s budget was announced, as noted here – that body instituted the original ban in 1988, hence Kingston’s antics in trying to get it passed once more).

And as the Times Sunday article tells us…

The administration of George W. Bush made the policy more aggressive, pressuring United Nations agencies to retract their support for needle exchange and excise statements about its efficacy from their literature. (Today, U.N. agencies again recommend that needle exchange be part of H.I.V.-prevention services for drug users.)


Rosenberg’s article also highlights the effectiveness of needle-exchange programs in Western Europe, Australia and New Zealand, among other regions. The biggest enemy to such programs, though, is the stigmatizing of needle users so manifestly on display in Kingston’s grotesquely stupid measure (as Rosenberg states, internationally financed groups can implement effective programs, but only governments can protect the rights of those populations who would stand to benefit, which, ultimately, includes all of us).

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