Obama's HIV Fix: Syringe Exchange Is a Major Component

What if we had a mechanism that stopped the spread of HIV that experts had speculated would work even before the cause of AIDS had been identified and that subsequent scientific enquiry confirmed was effective? We do, that mechanism is syringe exchange.

What if we had national governments dating back to President Ronald Reagan that knew what worked and yet fought against it, lied to the public, bullied local governments and generally saw the spread of HIV as justified, purely because the population that was affected was drug users, and drug use is addressed in the United States by making it as dangerous as possible?

What if men, women and children had been needlessly infected with HIV purely to teach them the "evil of their ways?" And what if we knew that the majority of these people were African American or Latino? Sadly, this is an exact description of the political response to syringe exchange and to the HIV epidemic among injection-drug users in the United States.

A ban on syringe exchange has existed in the United States since 1988, when Congress prohibited funding to support syringe exchange. In order to overturn the ban, it had been incumbent on the surgeon general to determine that syringe exchange prevents the spread of HIV and does not increase drug use. Evidence to support these conditions has been met repeatedly.

In 1998, under President Bill Clinton, Secretary of Health and Human Services Donna Shalala certified scientific evidence in support of syringe exchange as a valid public-health intervention, however Clinton did not act to have the ban lifted. The irony is that because of the ban, syringe-exchange research exists in abundance, and it is irrefutable that it is an effective means to stop the spread of HIV.

Not only is syringe exchange effective in halting the transmission of HIV, evidence from New York demonstrates that hepatitis C (HCV) transmission rates among injection-drug users can also be significantly lowered. The incidence of HCV infection among drug injectors has begun to drop from 80 percent to below 40 percent among newer injectors.

Harm-reduction services, such as syringe exchange, promote the prevention of HCV, as well as make medical treatment and social services more readily available to people who are living with HCV. The maintenance of the ban on syringe exchange callously excludes drug users from receiving essential prevention-and-intervention services and carries a symbolic dimension that delegitimizes syringe exchange and undermines public health advocacy efforts.

Regardless of how one might feel about drug users, syringe exchange is effective, is essential and there is momentum for change.

During the recent presidential campaign, each of the Democratic candidates endorsed removing the federal ban during their term in office. One of the candidates was elected president, and another was appointed secretary of state. President-elect Barack Obama's HIV platform says he will "support legislation that would lift the ban on federal funding for syringe exchange as a strategy to reduce HIV transmission among injection-drug users and their partners and children." On Jan. 6, 2009, Bronx Democratic Congressman Jose Serrano, along with 28 sponsors, introduced into Congress a bill -- HR 179, the Community AIDS and Hepatitis Prevention Act of 2009 -- to lift the ban.

The time to act is now. We need to call and to write our congressional members. We need to insist that the United States joins the rank of syringe-exchange-enlightened countries such as Australia, Holland, Canada, the U.K., Iran (yes, Iran), Moldova, and others. The damage that has been wreaked over the last 20 years cannot be undone, but a new direction can be forged. It is imperative that we participate in cultivating a new course of action and participate in the righting of wrongs.