Alessandra Tomasi received her B.A. from Cornell University and is now a first year medical student.
Human Immunodeficiency Virus (HIV) and Hepatitis C Virus (HCV) affect 1.1 million and 3.2 million individuals, respectively, in the United States alone. 54% percent of new HCV infections are attributed to injection drug use, and approximately 10% of HIV infections fall under this same exposure category. It follows that co-infection with HIV and HCV is common (between 50%–90%) among HIV-infected IDUs. As a result, each year, thousands of individuals are diagnosed with preventable infectious diseases due to the practice of sharing needles. As injection equipment is communal among groups of users, residual blood remaining in syringes is passed on from each individual to the next. However, spreading of the virus is not restricted solely to those physically sharing the contaminated needle— it extends to their partners and children through sexual and perinatal transmissions as well. The proportion of affected individuals therefore remains extensive.
In an attempt to combat these statistics, needle exchange programs have been implemented in several cities around the United States. However, these local efforts continue to be unendorsed on a federal level as accepted forms of intervention, and the allocation of federal funds to such programs remains prohibited by Congress. As a result, NEPs are limited by local or private resources, and their efficacy remains extremely restricted.
The ban on federal support of NEPs by Congress was enacted in the 1980s, and will remain as such until “the Surgeon General of the United States determines that such programs are effective in preventing the spread of HIV and do not encourage the use of illegal drugs.” Numerous countries, however—among which Canada, France, Great Britain, and Australia— have implemented successful, federally funded NEPs. Furthermore, studies across the United States as well as abroad have continued to support the efficacy of such programs. Nevertheless the ban here remains, as policymakers believe that these studies have actually been inadequate in proving the effectiveness of the programs, and that providing clean injection equipment will ultimately promote an increase in drug use in the American public.
If NEPs were instead to be embraced on a federal level, accessibility to sterile needles and syringes would provide a safe means of limiting HCV and HIV transmission among drug users nationwide. Especially for individuals who are unable or unwilling to quit injection drug habits, this remains an extremely promising approach to lessening the burden of infectious disease. On a societal level, too, many of the financial and medical resources currently being used to treat a large proportion of HCV and HIV patients can be reallocated to other cases. In order to lift the ban on federal support and thus allow NEPs to be unrestricted, adequate studies detailing the efficacy of extant programs need to be conducted and presented to policymakers. Alternatively, the supposed limitations of previous individuals studies should be scrutinized in order to determine whether they necessarily disqualify proper conclusions from being drawn.
All in all, federal support of NEPs would allow communities in which such programs are desired to implement them, without the present limitations of minimal resources and funding. Distributing a small amount of money's worth in needles/syringes to prevent diseases that would otherwise cost hundreds of thousands of dollars over a lifetime to treat appears to be a cost-effective and logical approach to reduce the transmission of HIV and HCV among IDUs. However, with a lack of federal support, current and future programs face limitations not only in financial terms, but also in methods of public outreach.