Needle Exchanges

The cost of putting politics before public health now stands at 130 HIV infections in less than a two-month period in one small area of southern Indiana.

That’s how activists, doctors, and scientists are describing the epidemic and what they say are the bad politics behind it in this corner of the U.S. Midwest.

Indiana has no needle exchange program, and officials there have repeatedly scoffed at the idea. The reason lawmakers are opposed to such legislation? They say they’re not going to aid and abet an addict.

Drug rehabilitation experts say such points of view display a serious misunderstanding of what it means to be an addict. There are simple explanations for how needle exchanges work while not destroying communities, they say.


The Foundation for AIDS Research (amfAR) released a report last week underscoring the importance of needle exchange programs. Nationwide, at least 8 percent of all HIV infections come from sharing needles.

Meanwhile, a temporary needle exchange program in Scott County set up by Indiana’s governor has been extended through May.

“The new cases of HIV and hepatitis C among injecting drug users in Indiana and Kentucky could have been prevented if syringe service programs were in place,” said amfAR CEO Kevin Robert Frost. “For too long, government officials have refused to acknowledge the proven public health benefits of syringe service programs in spite of the scientific evidence.”

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Needle Exchanges ‘Biggest Success Stories’ in HIV Prevention

In an interview with Healthline, Kali Lindsey, amfAR deputy director of public policy, explained why and how needle exchange programs work, beginning with the scientific evidence.

“The truth is the HIV prevention response to HIV transmission through needle sharing is one of the biggest success stories in the HIV domestic response,” Lindsey said. “As a result of many jurisdictions expanding access to syringe exchange services supported by state and private resources, in the absence of the ability to use federal HIV prevention resources for this intervention, HIV transmissions due to sharing needles have fallen dramatically.”

But infections have continued to occur in areas where such scientific evidence is disregarded. In some places, infections have remained low because injection drug use also has remained relatively low, he said.

But now injection drug use is spiking among communities and demographic groups not previously exposed to it.

As states have successfully restricted and reduced the availability of prescription painkillers, addicts have turned to injecting heroin instead to get the opiate fix.

“This includes many young adults who became dependent on the substance through exposure to their parents’ prescriptions and are not part of the target audience for HIV prevention outreach that has traditionally been targeted to drug users,” Lindsey said.

Therein lies how needle exchanges work. Once they become established, addicts stop sharing needles for convenience, thereby stopping the spread of bloodborne killer diseases that are costly to manage.

Addicts also stop disposing of hazardous needles in places like city parks and playgrounds.

Finally, when addicts go to needle exchanges, they get prevention information about HIV and hepatitis C testing, as well as referrals to treatment if they get infected.

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Free Needles and the HIV Prevention Connection

The latest research showing the effectiveness of syringe exchange programs comes out of New York City’s Mount Sinai Beth Israel Medical Center. It showed that providing public funding for such programs and permitting over-the-counter sale of syringes were associated with reduced HIV incidence and maintenance of already low levels of infection.

The researchers concluded that all 15 states with public funding for syringe exchanges reduced incidence or kept incidence low.

Lindsey said New York City itself is a success story. Between 1990 and 2002, a period in which annual syringe exchange program distribution increased from 250,000 to 3 million syringes, HIV incidence declined from 3.55 percent to 0.77 percent.

Lindsey said there is no evidence upholding the claim that needle exchange programs make a community’s drug problem worse.

“In fact,” he said, “all of the available evidence points to the contrary. Evaluation of existing syringe exchange programs continues to demonstrate that their existence reduces HIV transmission and [that they] do not contribute to increased drug use or violence in the communities where they operate. In those communities, more drug users are able to access treatment for their drug use and be connected to treatment if they are diagnosed with an infectious disease, such as HIV or hepatitis C.”

Evaluation of existing syringe exchange programs continues to demonstrate that their existence reduces HIV transmission and [that they] do not contribute to increased drug use or violence in the communities where they operate.
Kali Lindsey, Foundation for AIDS Research

Only 17 states in the U.S. do not have a needle exchange program. The federal government has had a ban against using federal money for needle exchange programs since 1989. It is re-established each year by Congress, Lindsey said.

According to the amfAR brief, expanding the availability of syringe programs to cover just 10 percent of injections would avert 500 new HIV infections per year — a $64 million investment with a triple payoff of $193 million in treatment savings.

“The number of new HIV diagnoses in Scott County, Indiana, in the first three months of 2015 alone (population 24,000) is nearly double the number of new HIV diagnoses among the estimated 100,000 people who inject drugs in New York City of the last calendar year of available data from the NYC Department of Health,” amfAR reported in a news release.

Meanwhile, the Indiana Department of Public Health reports on its website that as of Thursday there have been 130 confirmed positive HIV tests since the outbreak was first discovered two months ago.

In a news release, the health department stated that, as of April 9, 437 syringes had been turned in and 1,151 syringes had been given out. A measure in the Indiana Senate would allow high-risk counties to establish permanent needle exchanges, but the Senate leader told the Associated Press last week he’s leery of legislation that helps addicts inject their drugs.

Meanwhile, Lindsey said he would like to see larger numbers of people using the exchange. “There is likely more that needs to be done with sensitizing the community and law enforcement so more in need will access this effective intervention, and more outreach is likely needed as well to stave off further infections. In reality, those who have received the 1,500 syringes may share their clean needles with other IDUs [intravenous drug users], which can be helpful as long as it does not result in sharing down the line. It is encouraging that some individuals are being served, and it would be more encouraging to learn about efforts to expand the intervention where needed to reduce the risk of further infection at some point in the future.”

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