Local D.C. Lawmakers Could Help Shelve the Morality Debate About Needle-Exchange Programs

Two days into 2008, Washington, D.C., Mayor Adrian Fenty called a press conference to reintroduce local funding for needle-exchange programs. Freed from a nearly decade-long congressional ban on D.C. financing of needle exchange, Fenty responded with a $650,000 investment.

"We know that [needle exchange] is a best practice," Fenty said during his remarks. "Here in Washington, D.C., with one of the highest HIV/AIDS rates anywhere," funding for needle-exchange programming "goes right where the rubber meets the road on this very serious health crisis."

But D.C. health officials and needle-exchange advocates aren't content to just reintroduce needle exchange. They want to reconceptualize it.

Rather than engaging in the ethical go-round over whether government-funded needle exchange officially, if tacitly, sanctions illegal injection drug use, local advocates are sticking to the scientifically proven bottom line: Needle exchange reduces the transmission of HIV/AIDS without increasing injection-drug use.

They're more interested in talking, instead, about what needle exchange can become. To wit, successful needle exchange sites provide an obvious bridge to a range of holistic treatment and care options for an otherwise isolated population.

The standard conception of needle exchange as a place, either mobile or concrete, to exchange used, potentially infected needles for new, clean syringes is incomplete. A comprehensive needle-exchange site can offer a host of services to historically underserved populations of injection drug users: substance-abuse treatment, primary medical care, rapid HIV counseling and testing, mental health linkages and referrals, and information on safer sex practices.

Needle-exchange programs should be "about the people and not the paraphernalia," said Dr. Shannon Hader, Washington's new director of the HIV/AIDS administration, in a neat summation of the approach. "It's really about how we keep [people] safe, get them to all the services they need."

It's a medically responsible move that has the added benefit of being politically strategic.

When the new Democratic Congress unshackled D.C. from the local-funding ban, the city suddenly found itself with both the opportunity and the political will to implement holistic needle-exchange programming almost immediately. If successful -- both in helping combat a citywide reemergence of HIV/AIDS and providing sustainable care and treatment for injection-drug users -- Washington might just shelve the irresponsible morality debate for good.

Though Hader and other local proponents have largely moved beyond that debate, there still exist politicians willing to disregard scientific evidence in their continued assault on needle exchange. They spin funding bans to an uninformed public as an ethical stand against illegal drug use. Their efforts have cost both time and lives, especially in D.C., which has no autonomy over its own budget. That right is reserved for Congress, which, beginning in 1998, instituted the local-funding ban on needle exchange.

It mirrors a federal funding ban, enacted in 1988, a ban President Bill Clinton refused to lift in 1998, despite the recommendation of his Department of Health and Human Services Secretary Donna Shalala and a host of reputed medical organizations, including the American Medical Association. President George W. Bush has maintained the ban.

While this prohibition has stymied the development of needle exchange nationwide, many cities and counties have been able to call on enlightened local legislatures and councils for funds.

In Washington, only the local organization PreventionWorks!, which is buoyed by private funding, has been able to sustain a stable needle-exchange operation. In 2007, before the ban was lifted, PreventionWorks! distributed 183,803 clean syringes with a more than 95 percent disposal rate for used syringes and served 1,982 clients. But the organization is unable to reach all of the D.C.'s injection-drug users, a population estimated to number at least 10,000.