Expanding Access to Evidence-Based Services for Injection Drug Users
Co-authored by Jeffrey S. Crowley
We have known from the very beginning of the HIV epidemic that sharing needles and other drug-related paraphernalia is associated with transmission of HIV and other infectious diseases including hepatitis B and C. The Centers for Disease Control and Prevention (CDC) recently reported that injection drug use accounts for 12% of new HIV infections each year in the United States. Globally, it is estimated that 5-10% of new infections result from injection drug use.
On December 16, 2009, President Obama signed into law an end to the longstanding ban on most Federal funding for needle exchange programs. The removal of this ban will aid local communities in their efforts to fund needle exchange programs. As a result, the Departments of State and Health and Human Services (HHS) have recently issued policy guidance for U.S. programs and global partners in the President’s Emergency Plan for AIDS Relief (PEPFAR) program interested in implementing syringe services programs (SSPs).
The Office of National Drug Control Policy has recently released its National Drug Control Strategy and the Office of National AIDS Policy released its National HIV/AIDS Strategy this past Tuesday. Both strategies are aligned on the important role of syringe services programs (SSPs) as part of more comprehensive approaches to preventing transmission of infectious disease and linking people to needed services. The policy guidance issued by HHS and State requires that SSPs be implemented as part of a comprehensive program for injection drug users that includes linkage and referral to substance abuse prevention and treatment services, mental health services, and other support services. HHS Guidelines stipulate that programs must comply with local laws and regulations and cannot operate in locations where the programs are opposed by public health and law enforcement officials.
Over the years, many trusted experts and scientific institutions have endorsed the effectiveness of SSPs in contributing to the reduction of HIV transmission, including the CDC, the National Institutes of Health, and the American Medical Association. SSPs are also cost-effective: It is estimated that lifetime costs for treating HIV infection is in excess of $350,000 compared to less than $2 cost of providing a sterile needle.
Despite their success, only about 7% of injection drug users in the U.S. have access to SSPs and HIV epidemics in some PEPFAR partner countries are largely driven by injection drug use. These guidelines are an important step forward in preventing HIV infection and expanding access to needed HIV services for injection drug users. ONDCP and ONAP look forward to continuing to collaborate on ensuring the widespread dissemination and application of these guidelines and to improving public health.
R. Gil Kerlikowske is the Director of the Office of National Drug Control Policy (ONDCP) and Jeffrey S. Crowley is the Director of the Office of National AIDS Policy (ONAP).