New research released this week confirms that needle exchange programs have dramatically reduced the spread of HIV/AIDS in New York City - saving thousands of lives. In less than a decade, increased availability of sterile syringes has reduced the number of New York City residents acquiring HIV through needle sharing from four to five percent of all injection drug users each year to just one percent.
Syringe sharing by injection drug users reached epidemic proportions in New York City during the 1980s and early '90s. During this time, nearly 10 percent of all Americans who became HIV-positive were New York City residents who acquired the virus through needle sharing. By 1990, needle sharing was responsible for the infection of over 100,000 New York City residents - half of the city's HIV-positive population.
Policy-makers responded to the epidemic by making sterile syringes more readily available. In 1992, New York State law was changed to allow the establishment of needle exchange programs, whereby drug users could exchange their used syringes for clean ones, and obtain information on safe-injection practices and available drug treatment programs. In 2000, New York State joined all but six states in legalizing over-the-counter sales of syringes, allowing pharmacies to sell them without prescription.
Such policies have dramatically reduced the spread of HIV in New York City, new research shows. The annual rate of HIV-infection among New York City injection drug users has plummeted to just one percent, and the pool of HIV-infected drug users is down to about 30 percent of the injection drug-using population. The findings, presented at the National HIV Prevention Conference by Dr. Don DesJarlais of Beth Israel Medical Center in Manhattan, are based on six studies, involving 11,000 drug-using participants in the five boroughs of New York City.
"There is still a considerable possibility of doing more," said DesJarlais in a recent interview. "We estimate that we could reduce the new infection rate down to about .05 percent here in New York City if there was broader access to needle exchange. And then the transmission would be down to just sexually acquired infections."
Broader access to sterile syringes, however, may be an uphill battle. Availability of sterile syringes has only been aggressively promoted in three of New York City's five boroughs (Manhattan, Brooklyn and the Bronx), and community resistance has effectively blocked needle-exchange programs in Staten Island and Queens. Additionally, three of New York's five border states bar over-the-counter sales of syringes; and New Jersey, New York City's closets neighbor, actively curtails the availability of sterile syringes.
Nationally, syringe sharing among injection drug users is associated with more than 250,000 HIV infections among American injection drug users, their sex partners, and their children - including the majority of all cases among children and women. Conservative estimates hold that nationwide implementation of syringe exchange in the late 1980s would have saved 20,000 lives and $1.1 billion in health care costs.
Overwhelming evidence shows that increasing the availability of sterile syringes reduces unsafe injection practices such as needle sharing, curtails transmission of HIV/AIDS and hepatitis, increases the safe disposal of used syringes, and helps injecting drug users obtain drug information, treatment, social services, and primary health care. Every established medical, scientific and legal body to study the issue concurs in the efficacy of improved access to sterile syringes to reduce the spread of infectious diseases, including the National Academy of Sciences, the American Medical Association, the American Bar Association, the U.S. Conference of Mayors, the American Public Health Association, the Center for Disease Control and Prevention, former President Bush's and President Clinton's AIDS Advisory Commissions, and others.
In a report last year by the U.S. Department of Health and Human Services (HHS), U.S. Surgeon General David Satcher concluded that, "[t]he senior scientists of the Department and I have unanimously agreed that there is conclusive scientific evidence that syringe exchange programs, as part of a comprehensive HIV prevention strategy, are an effective public health intervention that reduces transmission of HIV and does not encourage the illegal use of drugs." Despite the study, and dozens of others, the federal government still prohibits the use of its funds on needle exchange programs - even barring states from using any part of their share of federal anti-AIDS money on such programs. See Evidence-Based Findings on the Efficacy of Syringe Exchange Programs: An Analysis from the Assistant Secretary for Health and Surgeon General of the Scientific Research Completed Since April 1998.