Add needle exchanges to the list of HIV and AIDS programs that have fallen on hard times in the 21st Century. According to a U.S. Centers for Disease Control and Prevention study published last week, both the total number of syringe exchange programs nationally and public funding for them has dropped for the first time in almost a decade.
According to the new CDC study, published July 15 in the agency’s weekly report on disease in America, in 2002 researchers identified 148 syringe exchange programs, down from 154 in a 2000 survey – a nearly 4% decrease. In every previous survey, dating back to 1994, the number of operating exchange programs had steadily increased.
The number of states and territories with needle exchanges also fell, down to 32 in 2002 from 35 in 2000.
Forty percent of all Black AIDS cases diagnosed through 2003 were attributable to dirty needles. And the nation’s exploding Hepatitis C epidemic – an estimated 2.7 million people and counting with chronic infections – is primarily driven by needle sharing.
The CDC found that public funding for needle exchanges dropped by a whopping 18% between 2000 and 2002, down to $7.3 million from $8.9 million.
Overall budgets, however, increased as a result of private funding. The vast majority of exchanges still in operation reported larger budgets, and their total funding went up to $13 million, from $12.1 million in 2000.
But needle exchanges have always operated on shoe-string budgets, and last week’s survey showed a handful of large programs fairing well while the majority struggled. The median budget for the programs surveyed in 2002 was just over $53,000. More than a quarter ran on less than $25,000.
All public funding for needle exchange comes from state and local governments, as federal law continues to ban federal dollars for such campaigns. That ban stems from a long-standing concern that pumping clean needles into neighborhoods with high rates of drug use will only make the problem worse.
At least eight government-funded studies, dating as far back as 1991, have however concluded the opposite — that exchange programs effectively reduce the spread of HIV without increasing drug use, and that they in fact can be excellent tools for getting users into addiction treatment.
“There is conclusive scientific evidence,” wrote Surgeon General David Satcher in 2000, “that syringe exchange programs, as part of a comprehensive HIV prevention strategy, are an effective public health intervention.”
The CDC’s July 15 study did offer some bright spots for the state of the nation’s needle exchange network. While it is shrinking in overall number, those programs that are still running are larger than ever. Fueled by private cash, the existing programs exchanged nearly 25 million syringes in 2002, an increase of more than 10% over 2000.
But as with many things in the AIDS epidemic, reaping the benefit of those gains depended on living in the right place. Just 11 programs accounted for half of all syringes exchanged in 2002, and more than two-thirds of the existing syringe exchange programs were in just seven states.
Where the needles are. Seven states accounted for more than two-thirds of the existing syringe exchange programs in 2002: California (25), Washington (15), New Mexico (14), New York (12), Wisconsin (eight), Massachusetts (six), and Oregon (six). Overall, 102 cities in 31 states and the District of Columbia had exchanges of some sort.
The money divide. Syringe exchange programs reported annual budgets ranging from $0 (nine programs) to just over one million dollars. Almost two-thirds of the programs ran on less than $100,000 a year, and more than a quarter had less than $25,000 a year.
In a year’s work. The programs offered more than just clean needles. Seventy-seven percent made referrals to addiction treatment programs, 72% did HIV testing and counseling and 23% provided medical care on-site.