Monday, June 25, 2012

Should Needle Exchange be Funded?

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Should Needle Exchange Be Funded By The Federal Government?

The key to slowing the HIV epidemic is HIV prevention. There are several prevention techniques that slow the transmission of HIV from one person to another. One such prevention method is needle exchange.

Needle exchange involves providing clean, sterile needles and syringes to IV drug users in exchange for their used syringes and needles. If IV drug users can't stop injecting recreational drugs, then providing them with sterile needles and syringes should decrease the incidence of sharing needles. As we know, sharing needles is a source of HIV infection. Decrease needle sharing and HIV transmission will decrease. But how should needle exchange programs be funded? Right now, it's illegal to use federal monies to fund needle exchange programs. Because of this, funding is difficult and programs struggle to survive. Should needle exchange programs be funded by the federal government? There are two schools of thought.

Current Status
Globally, sex between men and women is by far the most common way of passing on HIV. But a second transmission route drives the epidemic in many countries outside Africa; transmission among men and women who inject drugs. Injection of any sort is a more efficient way of spreading HIV than sexual intercourse. Since injecting drug users are often linked in tight networks, sharing injection equipment is common. But because the injection equipment is rarely disinfected, HIV infection among this population is common.

Also, people who inject drugs may acquire HIV infection through their sexual partners while having unprotected sex. In the United States, it's estimated that 9 out of 10 cases of heterosexual transmission of HIV occurring in New York City is related to sex with a drug user. In some places, including much of China and parts of India and Myanmar, more women are infected through sex with drug users than any other way. Injecting drug use also contributes to mother-to-child transmission of HIV. In Uruguay, 40 percent of babies with HIV are born to mothers who inject drugs.

So it's clearly obvious that transmission of HIV by way of sharing dirty needles must be addressed. The way to address the issue is through needle exchange. But how do we pay for exchange programs?

What's all the Fuss About?
If needle exchange is the answer, then why all the fuss? Programs should be funded and put in place across the country. If only it were that easy. The fact of the matter is, needle exchange is a politically charged issue that few want to take on. It's because of the controversial nature of needle exchange that programs are not federally funded. In fact, the law states that needle exchange programs can't be paid for with federal monies. And because of the politics involved, few government leaders are willing to risk their careers by fighting for change.

Arguments For
Proponents of needle exchange site several reasons why the federal government should get involved and offer funding for such programs.

• Data shows that upwards of 90 percent of heterosexually transmitted HIV is related to IV drug use and the sharing of dirty needles.
• Data shows that in several communities in the US and around the world, HIV transmission has increased where needle sharing and injecting drug use is common.
• Many studies have proven that needle exchange programs lead to decreased rate of HIV transmission among IV drug users.
• Studies have concluded that needle exchange does not increase the incidence of IV drug use.
• Some studies have shown that entrance into drug treatment programs are increased in the presence of needle exchange programs.

Arguments Against
Opponents of federally funded needle exchange point out several concerns.

• Funding needle exchange programs sends the "wrong message" to children.
• Clean needle exchange will lead to an increase in IV drug use among populations already ravaged by recreational drug use.
• Federal funding of exchange programs would allow tax dollars to be used to increase the amount of drug paraphernalia in areas already overburdened with IV drug use.
• Distributing drug paraphernalia is in stark contrast to the accepted morals of our culture.

Where it Stands
While acceptance and funding of needle exchange programs has continued in the private sector as well as the state and local level, the federal government continues to balk at offering funding of any sort. Yet, studies continue to show that needle exchange programs are successful in decreasing HIV transmission. So the debate continues.

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