Needle ban could halt some indirect research
Agencies unsure how to proceed now
A new congressional ban on using federal funds for needle-exchange programs has government agencies concerned that even research indirectly related to injection drug use and AIDS will dry up.
The concerns arise in the wake of a double blow. The first blow came when the Clinton administration refused to lift the federal ban on funding for the programs despite testimony from federal agencies, including the Department of Health and Human Services, stating that the programs decrease HIV infection without increasing drug use. Several weeks later, the Senate voted 52 to 46 on an amendment to the tobacco bill that included a provision codifying the ban on federal funds. In April, the House had passed a bill that banned federal funds for needle-exchange programs.
The Senate bill, which is likely to pass the House, states that "no federal funds shall be made available or used to carry out or support directly or indirectly any program of distributing sterile hypodermic needles or syringes to individuals for injection of any illegal drugs."
The administration's lack of support for the needle-exchange program was a disappointment to officials at the Centers for Disease Control and Prevention, many of whom believed that with the Secretary of Health and Human Services' backing, the ban would be lifted. The CDC would have administered federal funding for the programs through its cooperative agreements, said Helene Gayle, MD, MPH, director of the CDC's Center for HIV, STD, and TB Prevention.
"There were many in the department who really thought this was going to move forward and are completely demoralized," she told the CDC's Advisory Committee for HIV and STD Prevention.
What exactly does 'indirect' mean?
The term "indirect" is of particular concern to health officials, as it calls into question whether research tied to needle-exchange programs or support for staff training and evaluation of programs that offer needle exchanges can continue.
"It is a very chilling effect on research, and we are going to have to figure out what `indirect' really means," Gayle said.
On a more local level, Edwin Sanders, minister of the Metropolitan Interdenominational Church in Nashville, TN, and a CDC advisor, said the law would spell the end of the needle-exchange program that has taken months to put together in his community.
There is an upside to the ban, however. Stephen Jones, MD, a CDC epidemiologist who studies HIV infection in injection drug users, pointed out that "the potential value is perhaps that the incredible overfocus on syringe exchange as the only piece of intervention for IDU-related HIV transmission may be reduced a little and we are able to look at what you need to do in a broader perspective."
Gayle agreed, adding that there needs to be a greater focus on substance abuse treatment and possible reform in paraphernalia laws so sterile needles can become more accessible to IDUs without depending on taxpayer dollars.
In a special supplement devoted to HIV prevention for IDUs published in the July issue of the Journal of AIDS and Human Retrovirology, Jones and colleagues cite the high rate of syringe reuse and sharing in Rhode Island, which has one of the most punitive criminal laws for drug paraphernalia possession.1 Yet even the repeal of paraphernalia laws may not be adequate. The authors note that Maine repealed state laws requiring a prescription to purchase syringes from pharmacies in 1993, and yet a 1995 survey of pharmacists found that only half were willing to sell syringes to IDUs.
"Pharmacists are the gatekeepers for the sale of sterile syringes to IDUs and as such they are key to sterile syringe access for IDUs," they write. "More pharmacists must recognize that the use of sterile syringes is a legitimate medical purpose because of its importance in the prevention of blood-borne infections, including HIV and HCV."
Reference
1. Jones S, Vlahov D, eds. HIV prevention for injection drug users. J AIDS 1998; 18:S1.
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