A needle exchange program in Washington, D.C., is preventing dozens of HIV infections a year and is saving tens of millions of dollars in healthcare costs, according to a new study released today.
Supporters of needle exchanges say the research is significant because it shows these types of programs are both good health policy and prudent fiscal policy.
They hope the results will spur the current move in Congress to allow federal funding for needle exchange programs across the country.
“I’m hopeful for the future of needle exchange programs,” said Greg Millett, vice president and director of public policy for the Foundation for AIDS Research (amfAR).
What the D.C. Needle Exchange Program Has Done
The results of the Washington needle exchange study were published today in the journal AIDS and Behavior.
Researchers said the D.C. program prevented 120 new cases of HIV infection over a two-year period.
They estimated that prevention also would save $44 million that would have been spent treating those 120 individuals over the course of their lives.
"Our study adds to the evidence that needle exchange programs not only work but are cost-effective investments in the battle against HIV," study co-author Monica S. Ruiz, PhD, MPH, an assistant research professor in the Department of Prevention and Community Health at George Washington University’s Milken Institute School of Public Health, said in a press release.
In 2007, Congress lifted a ban that had prevented Washington, D.C., from receiving federal funds for needle exchange programs.
Researchers kept track of the number of new HIV infections associated with injection drug use. In a two-year period after the ban was lifted, they tallied 176 new cases. The District of Columbia allocated $650,000 per year for the needle exchange programs over those two years.
The researchers then estimated how many new HIV cases would have occurred without the newly implemented needle exchange programs. They came up with a figure of 296, meaning 120 new cases were prevented.
Ruiz added that the programs also lower new infections of other diseases spread by dirty needles, such as hepatitis.
Changing Public Attitudes
Millett told Healthline he thought the methodology used by the D.C. researchers and their conclusions were well-grounded.
“It’s a solid study that advances the evidence that needle exchange programs reduce HIV prevalence,” he said.
Critics have said needle exchanges encourage drug use and therefore can lead to increases in diseases such as HIV and hepatitis.
However, Millett said study after study has shown that assertion to be false: Addicts will inject their drug of choice whether there are clean needles or not.
“New infections definitely go down with needle exchange programs,” he said.
As an example, Millett cited an HIV outbreak earlier this year in Scott County, Indiana. Health officials said the spread of the disease was fueled by the lack of needle exchange programs in that rural region of the state.
Millett said that pocket of Indiana, with 22,000 people, usually has fewer than 10 new HIV cases a year. This year’s outbreak produced more than 160 new cases.
Compare that to New York City, a metropolis with an abundance of needle exchange programs. With 8 million people, New York City sees fewer than 100 new HIV cases among injection drug users a year.
“That shows the power of needle exchange programs,” Millett said.
Millett added the D.C. research is one of the first studies to estimate the cost savings of needle exchange programs.
“It shows this is not only good public health policy, it’s also good fiscal policy,” he said.
Changing Politicians’ Minds
The D.C. study and the Indiana outbreak are also helping to change the opinions of elected officials.
Indiana’s Republican governor, Mike Pence, had been opposed to needle exchange programs — until the outbreak hit his state.
In April, Pence approved a temporary needle exchange project. In May, he signed legislation that makes it easier for counties in Indiana to set up needle exchange programs.
This political conversion is also wafting through the halls of Congress.
In 1998, Congress banned the use of federal funds for needle exchange programs. Cities and counties were free to use municipal funds for those programs, something Washington, D.C., couldn’t do.
Congress lifted that ban in 2009 while striking a budget deal with the White House. However, it reinstated the ban in 2012.
Now, this year Republican congressional leaders have proposed legislation in the budget that would allow federal money to be used to set up and operate needle exchange programs.
The funds, however, could not be used to purchase sterile needles or syringes.
Millett sees this as progress.
“It’s welcoming to see Congress recognize this program backed by scientific evidence,” he said.